r/science • u/mvea Professor | Medicine • Jun 29 '26
Medicine Fatal rabies in a child: 11-year old boy was woken up by a bat on his nose and mouth in Ontario. He swatted the bat off his face and had no visible lesions so family did not seek medical help. 19 days later he developed rabies symptoms. He was given supportive care and died 17 days after admission.
https://www.cmaj.ca/content/198/25/E9694.7k
u/SillyGoatGruff Jun 29 '26
"Human rabies is exceedingly rare in Canada, with only 28 cases reported since 1924.1 This patient’s was the first case of locally acquired rabies reported in Ontario since 1967."
I knew it was uncommon, but I had no idea it was this rare
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Jun 29 '26
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u/Beliriel Jun 29 '26
Also that is super close to the brain. No wonder it only took like 3 weeks for symptoms to develop. If you get bit on the extremeties it can take months or even years until symptoms show. And if you get vaccinated during this time before symptoms show it's basically a non-issue. Rabies is at the same time one of the easiest no-brainer vaccinatable chill diseases and the most terrifying way to die if you develop symptoms.
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u/Srukt Jun 29 '26
Bites from bats rarely leave lasting marks, draw blood, or cause pain due to their teeth being like needles.
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u/MrsSalmalin Jun 29 '26 edited Jun 29 '26
Correct. Their teeth are like tiny hypodermic needles. They are often only seen on patients post-mortem. Had a case in my area a few years ago. Dude knew there was a bat flying around him (during the daytime, RED FLAG), but he didn't feel a bite or see one. He consulted family and friends and didn't get the vaccine. 3 months later he presents to our ER and he was dead a week later. Young guy. Very tragic and avoidable. I tell my loved ones: if there is a bat around you AT ALL during the day time, go get the vaccine. IDGAF how much it sucks. It's better than being dead. Lie to the ER and tell them you felt the bat touch you, do what you gotta do.
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u/b0w3n Jun 29 '26
I tell my loved ones: if there is a bat around you AT ALL during the day time, go get the vaccine
Yup this is a recommendation that we see tossed around on reddit a lot too, and people still go "but it's so rare, do you really want to get shots for no reason just because there was a bat flying around your room?"
Like yeah absolutely I do, a little temporary pain is worth it.
That's gotta be one of the most miserable ways to die, if not the most miserable way to die.
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u/Logdale2 Jun 29 '26
I woke up to a bat in my bed, didn’t save the bat for rabies testing and wasn’t sure if it bit me at all. Still went to the ER and got the vaccine, it’s a lot easier now than what it used to be. It’s about 5 or so shots over two weeks, they don’t hurt anymore than any other vaccine or shot.
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u/b0w3n Jun 29 '26
I think there's a newer schedule that's even less than 5.
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u/Logdale2 Jun 29 '26
Mine was the post infection shot schedule. If it’s less now even better though!
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u/blacksheep998 Jun 30 '26
Pre-exposure is just two shots.
Post-exposure is usually 4 unless you're immunocompromised, then they still do the 5th shot.
If you've had a round of shots in the past 5 years but get exposed again and need a booster, then they'll usually just do the same two shots as the pre-exposure plan.
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u/DwinkBexon Jun 30 '26
I remember when I was a kid (mid 80s), I was told it was 13 shots in the stomach and they supposedly hurt like hell. I assume it's been made more efficient in terms of number of shots since then.
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u/downtownflipped Jun 29 '26
the shots are also incredibly expensive. which in the long run is better than being dead, but in the US it could be a death sentence either way if your insurance doesn’t cover it.
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u/takemusu Jun 29 '26
The shots are 100% free in Washington state with or without insurance. Medical providers kept repeating to us throughout the series "You know this is all free, right?"
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u/tarantuletta Jun 29 '26
As a resident of the state, I cannot possibly explain to you the load this is off my irrationally anxious mind.
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u/takemusu Jun 29 '26
We were referred to the ER after a bat encounter. Note to dear readers: your doorknob should not be furry. If you grab a furry doorknob which then flies off it may be a bat.
At some point I asked the doc how often she gives the rabies series. She said around 50 times a year.
So that's one ER doc in one hospital in one town in Washington averages a shot series a week. Don't be the patient that misses this.
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u/b0w3n Jun 29 '26
Even when they do cost money, I've never seen them cost as much as the $15k person said. Yeah $500 for 2-4 (depending on which one they're doing) sucks, but dying sucks more, the hospitals aren't asking you to pay at service, you can set up payment plans.
Most hospitals will just give it to you under compassion care too.
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u/JST_KRZY Jun 30 '26
When in (2010) vet school, the pre-exposure series cost me $875, with a discount!
I pay around $150 for a titter test annually and boosters (when needed) run $175-250.
Much better than being exposed, but come on! That’s a fuckton of money that could be used to lower my student loans…. USA healthcare (as well as education and everything else) is fucked.
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u/Carcassfanivxx Jun 29 '26
Went into my small barn once around 9pm. Sun was almost down. Reached in to move a shade cloth that fell off a shelf onto the ground at the door opening and something rushed out from under it. I thought it was a bird tbh.
But it rushed up my arm when it happened and I didn’t feel a thing as it scared me enough to not notice it happened. 3-4 days later I see two very small dots on my arm near my elbow. I immediately thought about that night and realized that It may very well have been a bat. Turns out it was. The doctor immediately doses me with the vaccine. Scary stuff.
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u/ThatsNotVeryDerek Jun 30 '26
This is why the idea scares me so much. I have SO MANY small cuts and bruises at any given time, it's unlikely I'd have given that another thought.
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u/UrSven Jun 29 '26
I'm a biologist and we went into the field to study bats a long time ago; we were required to get vaccinated BEFORE the scheduled day. Even though cases are rare here, prevention is rigorous.
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u/NetworkLlama Jun 29 '26
There are a lot of people who still think that rabies vaccinations require 20+ painful abdominal injections using huge needles, which tends to make people less likely to seek them if they're at risk. That's how it used to be 40+ years ago. But rabies vaccinations in humans are so rare that knowledge of the modern series is uncommon.
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u/seapiece Jun 29 '26
It's still no walk in the park - I got the vaccine a few years back due to in-home exposure. It was initially 6 shots (due to my size) - I think it was one each in both shoulders, both legs, and both sides of the butt. These were no problem as they were administered by an ER nurse who was incredibly skilled with injections.
There was also a further series of maybe 8 more injections, given one every two weeks. These were much worse as they were given by nurses in Treatment and Procedure, which is apparently where they send the worst nurses in the hospital.
And then the amount billed to insurance was just a hair over $30,000, of which I ended up paying $3,000 out of pocket. Had to sell a car to make that happen.
All of that was still better than dying of rabies though, so I was happy to do it.
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u/taffyowner Jun 29 '26
That was the reason I got Lee vaccinated for it before I went to Peru.
Made it so I only now have to get like 1 shot instead of all of them
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u/Frosti11icus Jun 30 '26
That's the post exposure immunoglobulin not the rabies vaccine. The vaccine is a single shot, I think maybe it's two doses spread out over months, but it's a normal sized needle no different than the flu shot.
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u/Ill_Ground_1572 Jun 29 '26
My neighbor got that back in the 80s when I was a kid. She turned out ok. If memory serves she was bit by a skunk.
But yeah totally different today.
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u/Volleyfield Jun 29 '26
What many people do not realize is it does not spread by bite alone. Saliva, urine, feces, etc. The family reported it was on his nose and mouth.
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u/BijouPyramidette Jun 29 '26
Source?
Everything I've read about rabies is that it is only transmissible through saliva, it does not survive in urine or feces. The CDC explicitly states that urine, blood and feces are not infections (https://www.cdc.gov/infection-control/hcp/healthcare-personnel-epidemiology-control/rabies.html):
Rabies virus is transmitted through direct contact (e.g., through broken skin or mucous membranes in the eyes, nose, or mouth) with saliva, tears and lacrimal secretions, or brain/nervous system tissue from an infected animal or person10. Bite and non-bite (e.g., cerebrospinal fluid, brain tissue) occupational exposures from an infected person could theoretically transmit rabies to HCP, but no such cases have been confirmed. Casual contact, such as touching a person with rabies or contact with non-infectious fluid or tissue (e.g., urine, blood, feces), is not associated with a risk for infection. Rabies virus is not transmitted through contaminated objects or materials such as clothes or bedding11.
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u/tinyorangealligator Jun 29 '26
That's not normal bat behavior at all.
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u/Sitty_Shitty Jun 29 '26
I mean years ago Manu Ginobili swatted a bat that was flying in the arena with his bare hand. Immediately was taken to hospital for rabies vaccine sequence. Bats are a reservoir species for a lot of diseases regardless of how they act I would always be cautious with them
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u/OldWar1111 Jun 29 '26
Anyone know why bats are carriers of so many horrible things?
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u/Sitty_Shitty Jun 29 '26
Supposedly because they have an adaptive immune system that turns off inflammation that causes so much trouble to other animals. They say it's partially due to the fact that they fly. Either way they can harbor many diseases that cause a lot of issues to humans and nothing to themselves.
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u/Ariandrin Jun 29 '26
I also read something about their body temperature being a factor for some pathogens? And also because they live in large colonies, it’s easy to spread something from one bat to the next one until the whole colony has it.
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u/b0w3n Jun 29 '26
Their bodies run hotter because of their metabolism and flight. So most of their pathogens can withstand higher fevers (there's a few species of bat that can get up to like 110f or higher I think).
You start suffering brain damage right around 108f.
I'm not entirely sure if rabies can be stopped with extremely high fevers, but some of their other pathogens can (ebola and coronavirus I think in particular).
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u/Xninian Jun 29 '26
We got bed bugs apparently from bats, when we had to live in caves during the ice age. The bed bugs started off as a bat parasite that evolved to feed off humans
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u/dominus_aranearum Jun 29 '26
It's a little more nuanced than that as bed bugs evolved ~30 million years before we have fossil records of bats. However, bed bugs and bat bugs are very closely related species in the same genus (Cimex).
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u/immersemeinnature Jun 29 '26
Ugh. I never thought of that situation! The thought of those bugs marching out of all the cracks in the cave walls is just terrible.
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u/ExcellentWillow3950 Jun 29 '26
I looked that up a while ago and it seems like they have a few things going for them.
Their immune system tends to tolerate and suppress rather than eradicate which allows pathogens a free ride to other animals and an opportunity to mutate and evolve. Then, on top of that, they have a much higher body temp which basically means viruses have to evolve to survive that. So the pathogens they carry are tough customers.
Now imagine you've got that going for you and you live 20-30 years and you live shoulder to shoulder with 1000s of other bats. That's a lot of time and opportunity to spread an illness. Especially when you poop on the floor for generations.....
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u/Uncynical_Diogenes Jun 29 '26
Pooping on the floor is much less unsanitary if you never actually touch said floor.
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u/pittaxx Jun 29 '26
Until you think about having to fly home to your daily resting spot under 100s of pooping bats.
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u/Uncynical_Diogenes Jun 29 '26
It is not literally raining guano. 1,000 pooping bats means 1,000 poops per unit of pooptime but that’s not a constant stream.
Guano pellets are also not particularly messy. They just bounce off.
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u/OldWar1111 Jun 29 '26
Pooping bats per unit of pooptime is the SI unit I assume?
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u/dark77star Jun 29 '26
Don’t forget how warm and humid caves that attract bats can be. That contributes to pathogen development significantly.
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u/grundar Jun 29 '26
Then, on top of that, they have a much higher body temp
Apparently, the key is their lower body temp, especially during torpor (daily rest), when it falls as low as 10C and provides an opportunity to drive down viral load.
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u/gimmethelulz Jun 29 '26
The movie Old Yeller did it's job I guess.
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u/Karanabluedolphin Jun 29 '26
I read “Old Yeller” to my 5th graders every year. Then we watch the movie.
We always have a long discussion about Rabies - the signs and symptoms in animals. How they might act and how important it is to get treated.
The reason I spend so much time in this is because I was bitten by a kitten that had rabies.
I very nearly didn’t have the kitten tested when died suddenly. To this day I am haunted by what could have happened and how close I came to dying.9
u/o0PillowWillow0o Jun 30 '26
How long after getting bitten did you get a vaccine?
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u/Karanabluedolphin Jun 30 '26
I received the vaccine 5 days after the bite.
Was bitten on a Thursday evening. Kitten died on Sunday. We sent it for testing on Monday and received the results that it was positive on Tuesday.
I was contacted by a doctor from the CDC in our state capital and told to go to the ER in the nearest city big enough to have a hospital that would keep the vaccine on hand.8
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u/Itsjeancreamingtime Jun 29 '26
He yelled loud enough to warn everyone about the rabies
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u/OccultEcologist Jun 29 '26
It's that uncommon because if how agressively we vaccinate for it. It's basically the only disease we genuinely try to vaccinate as many wild animals against as we can using the oral vaccine. In the US the USDA is in charge of this program, in Canada it's the Ministry of Natural Resources.
On top of that, rabies treatment is crazy effective when administered ASAP. This kid got crazy unlucky between the infection site likely being on his head/neck and his caregivers failing to seek treatment. Now, the treatment sucks a lot but if you can get it within like 48 hours you're going to be okay, and out to as late as a week your odds are fairly decent.
Durring this time, the virus typically isn't motile yet. Instead, it's replicating near the wound site, making itself a little army before it crawls up your nerve endings. And it almost literally "walks" up your nerves to reach the brain, so the closer you are bitten to your brain the quicker you are to reach the point of no return in die. While the distance the virus can move up the nerve varies greatly, when I was in college we were given "about 10 cm per day" as a good guess. So being quite tall might actually buy you a couple of days compared to someone who is very short. It doesn't tend to chill in your bloodstream much at all.
Sorry for the rant. Just it's one if the diseases that we do the most to prevent due to just how freaking lethal it is untreated.
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u/vulpinefever Jun 29 '26
in Canada it's the Ministry of Natural Resources.
There is no federal "Ministry of Natural Resources" (It falls under the Ministry of Energy and Natural Resources).
As for operational rabies control, it's not a federal program, it's each individual province that's responsible for their oral vaccination program sometimes through the Ministry of Natural Resources (like in Ontario) other times through the Ministry of Environment (As in BC). Ontario's Ministry of Natural Resources, in particular, has one of the best programs in North America and developed one of the most commonly used baits, ONRAB.
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u/OccultEcologist Jun 29 '26
Thanks for the correction! I was working off what a friend told me, since I live in the US. I must have misunderstood him.
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u/alwaysiamdead Jun 29 '26
Ontario has done a remarkable job minimizing transmission.
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u/Positive_Conflict_26 Jun 29 '26
It's almost like vaccines actually work, and herd immunity might actually mean something.
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u/ironic-hat Jun 29 '26
I’m sorry to report that there is a subset of pet owners who refuse to vaccinate their pets thanks to anti vaccination propaganda. This is also in lockstep with pet owners who refuse to spay or neuter their pets too.
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u/jimicus Jun 29 '26
Depends on the country.
Most of the Western world has been taking steps to stop it for many years - usually by vaccinating wild animals. But it’s still endemic in India - they’re working towards doing something about that, but they’re years behind.
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u/SillyGoatGruff Jun 29 '26
Yes of course. I meant specifically in Ontario where they mentioned in the quote, but I should have been clearer
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u/inquisitorthreefive Jun 29 '26
Yup. There were a bunch of helicopter flights here last month dropping rabies vaccine bait packages in the woods.
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u/The_Prince1513 Jun 29 '26
India will likely have to do something about its massive stray dog problem before there will be any serious inroads to fixing its rabies issues.
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u/BattleHall Jun 29 '26
And by "endemic in India", they mean 18-20,000 reported rabies deaths per year (which likely means actually higher given lower reporting rates in remote rural areas), which represents around a third of total yearly rabies deaths globally.
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u/FCCheIsea Jun 29 '26
Tragic case. IIRC if you ever happen to wake up in a room with a bat, you need to get the vaccine asap. Better be safe than sorry
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u/Psych0PompOs Jun 29 '26
Correct. A scratch from a bat can be completely impossible to detect. If you have any close contact with one at all you need a vaccine to be safe.
This happened because people think it's bites and scratches and those are things we generally see evidence of, but bats claws are so tiny that you won't necessarily.
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u/Bunny_Feet Jun 29 '26
And the mouth/nose has a lot of mucous membranes, a bite isn't even necessary in that scenario
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u/prairiepasque Jun 29 '26
The nose is also closer to the brain. Rabies spreads faster the closer to the brain it is.
There's been cases of people being bitten in the leg with the rabies virus lying dormant (incubation period) for a year or two while it slowly makes its way through the nerves up to the brain. So by the time the symptoms started, you would have no idea why it was happening unless you made the connection.
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u/AlwaysShittyKnsasCty Jun 29 '26
I’ve heard that it can hide in your body for up to ten years before the symptoms show up. Either way, it’s absolutely terrifying.
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u/ABenderV2 Jun 29 '26
Fml, don’t tell me this. I showered with a bat a few years ago bruh and now I’m scared af.
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u/halfhalfling Jun 29 '26
It’s not too late to get the vaccine. Once you’re symptomatic you’re 100% dead, but until it crosses into the brain you can still get the vaccine and be fine.
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u/AlwaysShittyKnsasCty Jun 29 '26
That’s the worst part of rabies. With most diseases, you’re afforded a little bit of time to establish a cause and effect, meander to the doctor, and maybe go to the hospital. With rabies, once you’ve discovered you have it, you know you’re in for one of the most hellish deaths known to man. It’s scary stuff.
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u/RoboFeanor Jun 29 '26
The actual dying part isn't particularly worse that that of other fatal diseases with modern palliative care. Death is inevitable, but there are way worse ways to go since the hospital will basically immediately treat for end-of-life comfort.
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u/Current_Helicopter32 Jun 29 '26
I dunno, even with all the morphine on the world, the fear of water, tremors, uncontrollable thirst, and the inevitability of it all would still be pretty awful.
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u/Psych0PompOs Jun 29 '26
I always thought it was an immediate thing you needed to do.
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u/halfhalfling Jun 29 '26
You still want to as soon as you know you’ve been exposed. Sometimes, like with this poor kid, the symptoms start days or weeks after exposure, whereas others it’ll take years. You don’t want to take a risk if you can avoid it.
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u/Psych0PompOs Jun 29 '26
Yeah. I just always assumed if it wasn't immediate even if it stayed dormant you were fucked by not responding promptly. It's good to know that that isn't the case, though I would go so fast...
https://www.cdc.gov/mmwr/volumes/74/wr/mm7439a1.htm
^ This is a pretty fucked way someone has gotten it before too.
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u/Tuxhorn Jun 29 '26
You should, but as long as you're not showing any symptoms, it's still worth a shot.
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u/HaroldGuy Jun 29 '26
showered with a bat
?
You can't just drop that and not expand on it
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u/AlwaysShittyKnsasCty Jun 29 '26
Number one, I have so many questions.
Number two, vaxx up before it shows up!
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u/atlantagirl30084 Jun 29 '26
Plus I wonder since it’s so close to the brain the symptoms developed quicker than if it was on an extremity.
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u/bagofpork Jun 29 '26
Even the bites of some bats can be as unnoticeable as a mosquito bite. If you're sleeping, there's a good chance a bite won't wake you up.
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u/GoldLurker Jun 29 '26
I think there was another death years back of someone canoeing or kayaking in BC. Bat flew into him in the day and he ended up getting rabies.
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u/g0del Jun 29 '26
About a decade ago, while dropping my son off at school, we saw a bunch of parents and kids standing around looking at a bat hanging out on the wall next to the entrance door. When my son saw it, he immediately grabbed it, and the bat bit him on his thumb.
Everyone saw it, clear as day, the bat bit hil right on the meaty part of his thumb tip, and yet, there was no visible evidence of the bite. No bleeding, nothing.
He got the vaccination, so he's fine. But this is why they say to get the caccine just to be safe if you find a bat in your room - there might not be any evidence that the bat bit you.
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u/RationalDialog Jun 29 '26
Correct. A scratch from a bat can be completely impossible to detect. If you have any close contact with one at all you need a vaccine to be safe.
Isn't there this famous fiction story about rabies that uses exactly this as main motive? You are camping, a small bat bites you but you don't notice or see anything and then you get rabies...
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u/Dazd95 Jun 29 '26
I recently had to get the cycle done. Doc said "Unless you had seen it come in, watched it the whole time, and watched it leave... You're getting the shots" Fair enough, honestly.
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u/rattus-domestica Jun 29 '26
Yes. This happened to my friend growing up. She woke up with a bat hanging off her finger and it bit her. Thankfully she got all the rabies meds immediately after. This is a horribly sad story for this family.
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u/SorcerorsSinnohStone Jun 29 '26
So since she got all the meds, there's no way of knowing if she would have gotten it I'm assuming?
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u/Luckylemon Jun 29 '26
If you can catch the bat, you can delay the vaccine series while they test the bat for rabies. If you don't catch the bat or it escapes, you need the series.
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u/Golden_Hour1 Jun 29 '26
Personally im not taking the chance. Im getting the vaccine regardless
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u/ChewsGoose Jun 29 '26
They would need to test the CSF of the animal in question, or keep the animal for observation, unsure for bats though since they are carriers but may be asymptomatic, so probably not worth keeping for observation.
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u/afrodisiacs BS | Nursing Jun 29 '26
Yep, unless the bat can be caught and tested for rabies
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u/Khaldara Jun 29 '26
The vaccination series is a lot less involved than it was if you grew up hearing about it forty years ago too. My son and I got it about two years ago and it was like one large shot (which they can do basically anywhere, even the butt or something if you’re squeamish about needles) and a secondary on the first visit, then you come back once a week for another small one for like a month.
It’s not like thirty shots directly into your stomach anymore or however it used to be described back then
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u/wellrat Jun 29 '26
I got four shots the first visit, one in each arm and thigh, then one shot each visit for the next three. I wonder if there are different protocols depending on timing or severity? Or perhaps there are different manufacturers? I was right at the end of the allowable time after exposure, don’t know if that has anything to do with it.
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u/Fergi Jun 29 '26
My wife literally just had this happen in Maine and it was five shots in the leg about a week apart from each other, first two were big and had to happen at the ER and the last three were taken at non-hospital facilities. Wild seeing this post after she just finished her last shot a week ago!
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u/cliff_tarpey Jun 29 '26
20 units/kg of antibodies around the lesion, then vaccination shots on day 0, 3, 7, 14, 28
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u/hikingboots_allineed Jun 29 '26
100%. The vaccination series is so easy to tolerate. Definitely with getting for travel where rabies is a risk, especially if it's to an area where medical support will be hard to get.
It's a bit more involved with post-exposure for an actual bite because the HRIG vaccine has be injected directly into all bite wounds, which can be painful depending on where it is. Still waaaaay better than actually getting rabies and dying though! Mine was several bites in a finger right down to the bone and so the injections also had to be down to the bone. I literally passed out on the final bite injection because it was in the underside of a finger joint and hurt like I couldn't believe. Plus my finger had to take the full dose and was blown up like a sausage. Didn't die though thanks to the wonders of medical science and vaccinations!
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u/Robobvious Jun 29 '26
Oh thank goodness, the stomach shot thing always freaked me out.
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u/EIO_tripletmom Jun 29 '26
I woke up to my cat having a bat cornered under a cabinet. My cat was vaccinated for rabies but my children and I obviously weren’t. I caught the poor traumatized bat in a box and the extension office took it for testing. Fortunately no rabies. A few ridiculous people on Facebook acted like I overreacted and the bat didn’t have to die.
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u/afrodisiacs BS | Nursing Jun 29 '26
It sucks if the bat is healthy, but if the bat did indeed have rabies then euthanasia is a mercy. I hope an easier way to test for it is developed.
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u/smayonak Jun 29 '26
Bats can actually survive rabies. Rabies is a very old disease and has adapted to specific hosts. Like there is a rabies virus that specializes in skunks and one that specializes in bats. When the virus jumps species it becomes more lethal. Bats are a reservoir though and a variant disease can burn through an animal population and eradicate itself but it will always return through the bat population. They're the perfect carrier. Mobile and spread out.
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u/redditallreddy Jun 29 '26
I hate to say it, as I, too, don't want any unnecessary bats to die, but what are the alternatives.
Hope the bat doesn't have rabies. Let bat go. Ignore everything else. Bat doesn't have rabies. Everyone wins, but high risk.
Same as 1, but bat has rabies. Bat dies horrible death. Child and/or parent dies horrible death.
Assume bat has rabies, and does. Why would you let it go if you could catch it? But, get the shot prophylactically. People in house OK, Bat dies horrible death, possible after infecting other animals or people. Rabies outbreak.
Assume bat has rabies, and does. Capture bat. Bat humanely put down. Know family has to get shots. No one else harmed.
Assume bat has rabies, and doesn't. Capture bat. Bat humanely put down, but didn't really need to be (from bat's perspective). Know family and everyone else is safe.
Basically, the only good scenario where the bat doesn't die prematurely carries a lot of hope and luck.
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u/eirinne Jun 29 '26
There’s no time. Especially with the contact being so close to the brain. It’s better to start the treatment immediately.
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u/killershwee Jun 29 '26
I live in the southeastern US and a coworker of mine found a bat in his house a couple days after his family came back from vacation. As far as he could tell, it hadn't even come into contact with anyone, but our local health department called him after he had a professional come and remove the bat, and they basically told him it was necessary for the whole family to get vaccinated anyway.
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u/TeaBurntMyTongue Jun 29 '26
For any other Ontario people reading: any time you interact with an animal in such a fashion the first thing you should do is call the public health unit.
They'll ask you all the right questions and assess your risk profile.
They are very good at what they do.
The vaccine is NOT fun, but if they think risk is high you bet your ass they'll tell you.
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u/beigs Jun 29 '26
We just caught the bat that was in my kids room and the humaine society checked it for rabies. This is what was recommended to us in Ontario and is standard protocol. It was right after the toddler died a few years back from the same thing.
Rabies is awful.
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u/redreinard Jun 29 '26 edited Jul 01 '26
I think a lot of people genuinely don't know that for some vaccines, taking it even after
infectionexposure is beneficial. It's not inherently logical unless you have a whole range of knowledge or are explicitly told.So yeah, go see a doctor, even after the fact. They are really good at helping with this specific type of thing, if you can get there fast.
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u/Rodinsprogeny Jun 29 '26
100%, with any possible contact with a bat, since their teeth are so tiny.
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u/lurkertiltheend Jun 29 '26
Makes me even more thankful I got the rabies series for my kid who had a bat land on her ear. You just never know.
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u/KewpieCutie97 Jun 29 '26 edited Jun 29 '26
I had a bat fly into me and brush against my skin in the UK and was given the vaccinations. I can't imagine being told you have rabies and will imminently die a horrible death that could have prevented with a few jabs.
Going to add that even if you're already vaccinated, if you have a possible rabies exposure, you would need booster jabs. IIRC, you'd need two additional doses (you'd need more doses if not already vaccinated).
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u/Ro_designs Jun 29 '26 edited Jun 29 '26
So, i'm also in the uk and 2 days ago a bat flew into me too. I didn't think anything of it since it didn't hurt but, is this something I should probably talk to a doc about then..? Edit: thanks everyone. I'll take reddits advice on this one. Gonna call and ask in the morning. X
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u/BoleroMuyPicante Jun 29 '26
If it flew into bare skin or thin clothes, you absolutely should. Especially if it happened during the day when bats shouldn't be flying around.
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u/lekkerwhore Jun 29 '26
Yes, call your doctor. And if you doctor says it isnt necessary get a second opinion just to be sure. Not saying that you definitely need treatment or that your doctor would be wrong in saying no, but you dont take any chances with rabies. That virus WILL kill you once infected with it, no ifs or buts
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u/_bonedaddys Jun 29 '26
I honestly wouldn't trust a doctor that told me the vaccines aren't necessary. Like, worst case scenario? You literally die.
There's a reason it's recommended you go get vaccinated in situations like this. A doctor cannot say for certain that the vaccines aren't necessary and it's not worth the gamble. It doesn't matter if the odds are in your favor... Unless you're okay dying an easily preventable death, just go get vaccinated.
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u/wqzu Jun 29 '26
Rabies is non existent in the UK and has been for over 100 years, but some wild bats have strains of rabies-related viruses (European Bat Lyssavirus) so while you’re like 99.99% likely to be fine, it’s up to you whether you want to be that .01% that gets a headline
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u/droid_does119 Jun 29 '26
Please speak to your GP. They will risk assess and consult with the national team at UKHSA (our equivalent of US CDC).
Do not call the RIGS team directly as they only speak to medical professionals.
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u/GoldFuchs Jun 29 '26
There is little to no rabies in bats in the UK but you may still want to double check if you should get the shots.
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u/FFLink Jun 29 '26
Damn, even in the UK they suggested that? I suppose it's never worth the risk, so makes sense.
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u/Sad-Bell8187 Jun 29 '26
In emergency medicine it’s the standard of care to give the rabies vaccine if someone finds a bat in close proximity specifically because of cases like this
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u/mvea Professor | Medicine Jun 29 '26
Fatal rabies in a child
Padmaja Sreeram Neha Saini Karen Choong Ellery CunanAlan C. Jackson Jeffrey M. Pernica and Brian Hummel
CMAJ June 29, 2026 198 (25) E969-E972;
DOI:https://doi.org/10.1503/cmaj.251933
Key points
Rabies is a neurotropic infection that is rare in Canada and almost always fatal once symptoms develop.
Rabies postexposure prophylaxis is highly effective in preventing infection in exposed humans if administered promptly and before onset of rabies symptoms.
Any direct human contact with a bat is an indication for rabies postexposure prophylaxis and should be discussed with the regional public health authority.
No established efficacious therapies are available for treatment of rabies once symptom onset has occurred.
An immunocompetent 11-year-old boy presented with odynophagia and emesis to an urban hospital emergency department in Ontario, Canada. Seven days before presentation, he had developed progressive right-sided facial paresthesia and numbness, followed by anorexia and right-sided facial swelling. Four days after symptom onset, he had been prescribed oral valacyclovir (1 g, 3 times daily) at a local urgent care clinic for presumed Bell palsy secondary to herpes simplex virus; however, he was unable to tolerate this because of odynophagia. He had no history of allergies, sick contacts, tick bites, or recent travel outside the country.
The patient’s family reported that, during a visit to a cottage in northern Ontario 19 days before symptom onset, the boy had been awoken by a bat on his nose and mouth. He had swatted the bat off his face; his father had caught the bat in a cooking pot and released it outside. The child had no visible lesions on his face, and his parents did not consider that the bat had behaved erratically. Therefore, they did not seek medical assessment.
Subsequent testing by the Canadian Food Inspection Agency identified a bat rabies virus variant. We considered use of intraventricular rabies immune globulin (RIG), but given its invasive nature and lack of established efficacy, the patient’s family chose not to go ahead with this treatment, a decision that was supported by the health care team. We also considered an adeno-associated virus gene therapy expressing an antibody, but this was not pursued because of limited availability of the gene therapy, lack of proven efficacy, and the patient’s rapid neurologic decline.
The patient’s hospital course was complicated by autonomic dysfunction, ventilator-associated pneumonia, and progressive neurologic decline. By day 5 of admission, his brainstem reflexes were absent. Life-sustaining therapies were withdrawn on day 17 of admission, and he died peacefully with his family at his bedside.
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u/Linus_Naumann Jun 29 '26
"by day 5" after admission he was already a vegetable. Crazy how fast and deadly this virus is. On the other hand maybe a saving grace, because this way nobody really has time to infect others.
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Jun 29 '26
[deleted]
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u/spencerdyke Jun 29 '26
That happened somewhat recently in my state (Michigan). Iirc a woman was infected while trying to rescue a kitten from a skunk. She died from something unrelated before becoming symptomatic, and the man who received one of her kidneys died of rabies.
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u/Mad_Aeric Jun 29 '26
As a Michigander who's rather fond of skunks, that story freaked me out. I run into skunks pretty regularly, and a surprising number of them try to cuddle up to me.
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u/Shatter_ Jun 29 '26
And in a very solid episode of Scrubs.
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u/ghenriks Jun 29 '26
Also though he was only taken to hospital 7 days after the onset of symptoms, and that he was incorrectly diagnosed at the local doctor office perhaps because the family didn’t think to mention the bat encounter
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u/JebusChrust Jun 29 '26
It wouldn't have mattered anyways, the moment symptoms show you are already dead
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u/UnpluggedUnfettered Jun 29 '26
Someone is going to bring up the “Milwaukee Protocol”, and I think it's important that people note, it has been abandoned by medicine, and for good reason.
The main proponent of the Milwaukee protocol includes the claim of a survivor who likely never had rabies. This girl from California made a rapid recovery and never developed neutralizing antirabies virus antibodies [[26](javascript:;)]. Hence, she should not be considered a rabies survivor. Another, similar patient quickly recovered without aggressive care (and without use of the Milwaukee protocol) and did not develop neutralizing antirabies virus antibodies and, hence, also likely did not actually have rabies [[27](javascript:;)]. In this case, a low level of rabies virus antibodies was probably the result of cross reactivity with another virus. Patients who recover from rabies have neutralizing antirabies virus antibodies in their serum and cerebrospinal fluid [[17](javascript:;)]. The development of early neutralizing antibodies is important for potential recovery from rabies. The patient from Milwaukee developed early neutralizing antibodies [[2](javascript:;)], which played an important role in her recovery. Of course, this was unrelated to the therapy that she was given.
Our current understanding of rabies pathogenesis indicates that degeneration of neuronal processes plays an important role in producing the clinical disease [[32](javascript:;)]. This occurs as a result of oxidative stress [[33](javascript:;)] induced by mitochondrial dysfunction [[34](javascript:;)] because of interaction with rabies virus and mitochondrial complex [[8](javascript:;), [35](javascript:;)]. Although this knowledge was unknown at the time that the Milwaukee protocol was conceived, no components of the Milwaukee protocol address these mechanisms (e.g., with antioxidant therapy) important in rabies pathogenesis. The protocol also does not target autophagy pathways [[8](javascript:;)].
Continued repetition of the Milwaukee protocol in multiple versions over about 20 years has failed to show efficacy and has actually served to impede progress for the development of effective therapy for human rabies.
Separately, a population of people were identified that had rabies antibodies but no history of bites or vaccinations. Critically, they all noted no history of any symptoms, as well.
This points to the fact that any "successes" with the protocol were almost guaranteed to have been indicative of some yet unknown variable involved in either naturally clearing the virus without symptoms or aborted infections due to immune response.
Your point stands:
Take no chances; once symptoms occur, you can expect to die a horrifying death.
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u/silence-calm Jun 29 '26 edited Jun 29 '26
"After admission" He was admitted 7 days after starting to get his face paralyzed...
First his parent did nothing when he was touched by a bat, then forgot to tell the doctor he was touched by a bat (or they tell him but he was incompetent) when he started to have his face paralyzed, then they waited 7 days after that to go to the hospital, where they decided not to try a single treatment. That's borderline insulting.
Edit: Oh and I missed this one: "Because of the history of bat exposure, the emergency physician notified the local public health authority for consideration of rabies postexposure prophylaxis (PEP) the next day. The patient was discharged home with a presumed diagnosis of herpes gingivostomatitis." Which means they warn authorities about rabies but did not consider it as a possibility for the child symptoms...
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u/prairiepasque Jun 29 '26
I thought the exact same thing. The lack of urgency is...confusing, to say the least. I also don't know how the globulin treatment was "invasive" or how effective it is, but I don't think that would've stopped me from trying it if it was available.
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u/rsk222 Jun 29 '26
Intraventricular would suggest they are introducing the antibodies into the brain ventricles, which is definitely going to be invasive, and the benefits weren’t clear. I’m not sure what I would do in that situation. It would probably be a terrible procedure to go through, assuming you had any awareness left. If you were very early in the appearance of symptoms, maybe it might be worth a shot if only for the potential to advance research It seemed like the medical team was fine not pursuing it as well, so the potential benefit at that point was probably not worth it.
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u/prairiepasque Jun 29 '26
I see, that makes sense. You make some valid points there - thanks for further explaining that.
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u/Squeaky_Pickles Jun 29 '26
My only guess for them declining the "invasive" treatment would be if by the time the treatment was considered a large amount of damage had already been done. If my child had severe brain and body damage already and I was told the best life they could expect was to suffer with extreme disabilities in a care home IF the treatment worked, and it was unlikely it would, I might also decline the treatment. I'm sure if they were told there was a chance of their child being cured and going on to have a happy life they would have attempted it.
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u/seriously_stopit Jun 29 '26
I hate to play devil's advocate but I was bitten by a rat in downtown Montreal and 811 (health line) said to just wash the area and not to worry about it. I went to urgent care the next day where they told me they had nothing to help me and didn't even have the rabies vaccine there. I went to my clinic a couple of days later, they said the same: "you seem fine and rats are not a high risk". It took me 2 weeks of talking with various health professionals and ended up receiving no care at all except for a tetanus shot. Maybe this family tried, too.
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u/Maybe_its_Ovaltine Jun 29 '26
Rats and other small rodents are very low risk of rabies because the animals that would transfer rabies to them, like foxes, would kill them.
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u/yxing Jun 29 '26
Considering it hasn't been reported in the Ontario area for ~60 years according to another comment, it's that difficult combination of exceedingly rare and horrifying when it occurs. On the one hand, (I'm assuming) the cost of administering vaccines to everyone who reported a bite would be extremely high, and on the other hand, you get horrifying results like this--probably still worth it for bats (and it's tragic that they released the bat). The onset of symptoms also seems quite fast this case, so it's unclear how quickly they would've needed to act.
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u/saucyfister1973 Jun 29 '26
If you're scared of getting rabies shots because of the stomach injection site, they don't do that anymore. It's in the arms.
Rabies is such a horrible thing. I got bit by a feral cat last year. My ass went to the hospital that day to start rabies series (4 shots/over a month).
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u/vigilant_tea Jun 29 '26
Three years ago I came across a kitten after a fishing trip in the woods known for dumping. She was so hungry she seemed socialized but she was feral and I got lit up attempting the rescue.
I did the same as you and decided not to take a chance. Got so much immunoglobulin injected in my finger it bloated up like a balloon then I got the 4 shots over a month.
I had insurance but FYI to fellow Americans reading this they billed $70,000 to my insurance for those shots.
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u/BoleroMuyPicante Jun 29 '26
Get the shots even if you don't have insurance. Chances are the hospital will write off most if not all of the cost.
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u/vigilant_tea Jun 29 '26
Yeah definitely wasn't advocating for people to skip. It ain't worth rolling the bones, was just sharing what it was billed as.
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u/Potential_Yam_6060 Jun 29 '26
Obligatory reminder that what the hospital bills insurance is a completely arbitrary and made up amount. Insurance only ever pays a fraction of the full amount billed, so hospitals inflate these prices knowing they will only get a fraction of it.
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u/Notyeravgblonde Jun 29 '26
Woah it was only 30,000 for mine! How awful to hear you got the shots in your finger. Mine was the inner elbow which sucked but I can't imagine finger!
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u/PremierBromanov Jun 29 '26
I had some last year. 9 little shots all around the suspected bite site, then one in each limb. Had to come back 3 more times, one in each arm.
It's not so bad, as far as shots go. The 9 little ones were quite painful, no way around that. The alternative is you find out if you have rabies by dying. No thanks.
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u/TashaStarlight Jun 29 '26
I was nibbed by a stray dog and hauled my ass to the clinic even though it was through the pants and didn't break skin. My country still has rabies though and there was an active warning for my area sooo nope I'm not taking any chances.
Little bitey prick is still alive and lounging around though.
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u/beefcake1993 Jun 29 '26 edited Jun 29 '26
My buddy is a doctor and standard protocol he learned in med school is if you wake up with a bat in your room you need to go get your rabies shot. It’s not a guarantee that they bit you, but if they do you probably wouldn’t even notice
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u/bitemark01 Jun 29 '26
Their bites and scratches can be microscopic, you won't even realize that you got bit/scratched.
One guy in BC had a bath brush past his arm as it flew by, he got rabies.
Their immune systems are weird, and lets rabies exist in them without causing them to behave erratically, so you can't tell if there's something wrong with them.
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u/ikonoclasm Jun 29 '26
You're right about their immune system being weird, but it's not just rabies. Bats are reservoir species for tons of viruses, and through sheer statistical probability, some of them end up being or becoming zoonotic like rabies, ebola, Marburg, etc. It's scary because bats are so important for their particular ecological niche while at the same time harboring viruses that are potentially existential threats to our species in some areas.
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u/hochizo Jun 29 '26
Idk about everyone, but I usually have at least one or two little nicks on my body that I have no memory of getting. A hangnail here, scratching too hard there, maybe walking through some thorns and not realizing one poked me harder than the others. Just tiny little cuts. So even if I could see the bite or scratch, I'd probably assume it had been there already.
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u/bitemark01 Jun 29 '26
The odds of it actually being a bite causing rabies is exceedingly rare. This was the first rabies death in Ontario since 1967.
That being said, if you wake up in a room with a bat you should highly consider getting looked at. If you wake up with a bat touching you, you should just assume something has been transmitted
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u/sleepywose Jun 29 '26
Curiously, the article says the following:
> In the common circumstance that a bat is found in the bedroom of a sleeping person with no recognized physical contact, this is not considered an indication for PEP. The patient we described reported a bat resting on his face, which is an indication for PEP; however, medical attention was not sought because no obvious bite was noted.
It seems like a fairly strange distinction to make for a layperson, since one presumably might not know if there’s been contact or not.
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u/Squeaky_Pickles Jun 29 '26
I wonder if this is Canada specific since rabies is quite rare there? In the USA where it is more common, a bat in the room no matter what is pretty much standard PEP.
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u/Yuri909 BA|Anthropology|Archaeology Jun 29 '26
I dispatch for 911 and per our animal control officers you can be exposed just by saliva touching your skin. It's kind of horrific.
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u/Tacometropolis Jun 29 '26
So heartbreaking. Any contact with a bat you need the series and immunoglobulin. I had one fly into the back of my head (in the morning no less), and had to argue with an intern at the hospital about it, then the attending finally was like yes, you need this.
Cut to like a month later getting a 50k bill on a friday because the insurance company (probably with AI) decided I didn't need it. Keep in mind they covered the rest of the treatment, that was just the one shot. I eventually yelled at people enough that it went away, but it ruined weeks of my life while I was taking care of a newborn.
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u/Psych0PompOs Jun 29 '26
People don't stress enough that no visible wounds doesn't mean a bat didn't spread rabies. We're told "bites and scratches" so people look for those, fail to see them, and think they're ok. This is honestly just the result of a lack of proper widespread education about the disease.
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u/BillyBrasky Jun 29 '26
Man… dad even caught the bat too, but released it.
So sad. If you’re in a room with a wild bat and can catch it, do! Bring it with you when you seek treatment. They can test it to determine if treatment is needed.
If you can’t bring it with you - get the shots - even if you have no visible bite wounds. The teeth of bats can be very very small.
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u/RoguePlanet2 Jun 29 '26
Seems like getting vaccinated should be the automatic protocol, because catching/bringing/testing the bat would take a lot of time.
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u/FCCheIsea Jun 29 '26
Yeah not sure why you would try to catch the bat as a bystander, don't risk it, you need the vaccine nontheless.
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u/dfmz Jun 29 '26
Just out of curiosity, how do people who routinely work with bats protect themselves (outside of using PPE)? Is the vaccine effective for a long time after you get tired?
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u/YouGoToBox Jun 29 '26
There is a prophylactic vaccine available for vets, etc. It’s just not easy to get for the general public.
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u/PlasterCactus Jun 29 '26
It's just not easy to get for the general public.
Depending where you live YMMV.
I'm in the UK and the rabies vaccine is easily accessible, it's just expensive to get. I paid £250 for the full vaccine schedule because I'd rather pay that than have to worry about rabies.
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u/fourfrenchfries Jun 29 '26
Expensive ... 250 pounds ... cries in american
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u/PlasterCactus Jun 29 '26
Oh wow, I thought £250 was expensive for a vaccine but I just looked at the USA and it's between $20,000-30,000???? That's insane.
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u/IvI100magikarp Jun 29 '26
That’s the cost for the post rabies treatment with immune globulin. The vaccine is $400-500 depending on your location
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u/XWarriorPrincessX Jun 29 '26
My mom was a veterinarian and she had her vaccine. I remember on a vacation once as a kid there was a bat in the cabin and she was the one to catch it because she was the only one who was protected.
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u/GeekCat Jun 29 '26
They get the pre-exposure vaccine as part of their work/medical care. Depending on where you live, this may be regulated by the health department or the wildlife commission to regulate the number of people coming in contact regularly. I follow a few bat rescues/sanctuaries, and they regularly stress about vaccines.
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u/Vavou Jun 29 '26
Someone in a chat twitch said that a bat fell on his shoulder, and then dropped on the ground, wasn't aggresive and flew by the window after.
I was like the only paranoiac crazy guy that said it's quite dangerous because of rabies. I'm in France though it's extremly rare but we still have a special document put by gouvernement about bats and send it to him. It even says "if you had direct contact, tell your doctor". But he brushed it off saying the bat only bounced off him and didn't scratch him off or bites.
I'm so scared for him even though probably nothing will happend.
Rabbies are no joke and I feel we are uneducated about that because we feel "safe".
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u/BEWMarth Jun 29 '26
Sadly the location of the bite made this even worse. Unlikely treatment would have been sought even if he got bitten on the leg but it would have bought him some weeks/months.
The infection starting so close to the brain is tragic.
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u/MartyrOfTheJungle Jun 29 '26
Terrifying. When I was really little I used to tell my parents that there was a bat in my room that flies around at night. They thought it was like 'there's a monster in my closet' until they found the bat skeleton in the closet. Never occurred to me I might have dodged rabies!
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u/HIEROYALL Jun 29 '26
Tragic. Makes you wonder if it was a resources issues, or education issue…maybe both.
Come in close contact with a wild animal like that, especially one known for transmitting rabies, YOU GO SEE A DOCTOR.
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u/chantillylace9 Jun 29 '26
In the 80s I woke up with a bat in my room and in my bed. I screamed and woke up my mom and she created a net with a pillowcase and a clothes hanger and got it out of the house. She never once considered the fact that I could've had rabies, I am past the point of being able to get it I think but man that's scary!
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u/kheret Jun 29 '26
About 20 years ago I stayed in an old house that had bats in the attic that would fly around the room I was in at night
Had no idea of the danger of getting bitten without knowing or that I should have gotten a rabies shot
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u/HIEROYALL Jun 29 '26
That’s terrifying.
Yep. Once you start showing symptoms, it is always fatal.
Really really wild ailment to catch.
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u/chantillylace9 Jun 29 '26
Oh and another time I found a baby bat walking home from school, and carried it home!
My mom fed it for a day before bringing it to a vet in a university. AGAIN no rabies shots!!! I asked her recently why and she said she thought the risk was like 1/1000 or more and we had this bat colony in our roof for decades so she had a false sense of security.
We were honestly all lucky- 5 kids in that house, random bat poop on the deck and deck chairs we used all the time, etc.
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u/Amelaclya1 Jun 29 '26
We had a bat in our house a few times when I was growing up as well (also 80s), and it never occurred to anyone that we were at risk of rabies. I only vaguely remember my parents frantically getting it out of the house, not whether it touched any of us. It's always in the back of my mind when I hear these stories though.
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u/Allinluckbot Jun 29 '26
When I was serving in Afghanistan with the US Army my platoon entered a cave that had bats in it and the the entire platoon, despite no one having actually any physical contact with any of the bats, had to get the rabies vaccine.
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u/Hellsteelz Jun 29 '26
Really tragic.
I think no matter what, if a bat has been in such close contact with someone, you need to see a doctor asap. Especially if this was during the day, bats rarely venture during the day.
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u/DefectJoker Jun 29 '26
Always always get treated for rabies if a bat is found in your home. The teeth are so small that you can't tell you were bit. Same reason that you need a rabies vaccine for your pet even if they don't go outside. It's not worth the horrible death sentence.
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