Medical Journal Warns of Rabies Risk From Bat Contact After Ontario Boy’s Death

A medical journal article is urging the public to seek immediate medical assessment after any direct contact with a bat, after an Ontario boy died of rabies in 2024 despite having no visible marks.

The boy’s death highlights “an important gap in public awareness,” where individuals may decide not to seek medical care after an encounter simply because no obvious bite or scratch is visible, the article in the Canadian Medical Association Journal (CMAJ) says.

While bats infected with rabies may demonstrate erratic behaviour such as difficulty flying or appearing in the daytime, the absence of such behaviour does not indicate that rabies is not present, the article says.

It adds that any direct contact with a bat, even when there is no visible bite or scratch, should prompt consideration of rabies post-exposure prophylaxis (PEP), and that possibility should be discussed with a medical professional.

“In the circumstance that the bat is available for rabies testing, and results can be obtained within 48 hours, PEP could be held pending the results,” the CMAJ article says.

However, if a bat is found in the bedroom of a sleeping person with no recognized physical contact—which is a more common situation—there is no indication for PEP.

Rabies is a disease in animals caused by virus and can spread to humans. According to Health Canada, the disease is very serious and almost aways leads to death in animals and humans once symptoms develop.

However, rabies is a rare disease in humans and “exceedingly rare in Canada.” Only 28 cases have been reported in Canada since 1924, the CMAJ article says, adding that the Ontario boy’s case was the first case of locally acquired rabies reported in Ontario since 1967.

In Canada, the disease is primarily carried by bats, skunks, raccoons, and foxes, but bats pose a particular risk due to the nature of the marks from their bites or scratches being small and easily overlooked.

The article also warns that testing cannot detect early infection.

It says doctors tested the boy roughly 21 days after exposure, and while they initially suspected rabies given the “typical neurologic features,” findings from magnetic resonance imaging and testing of serum, cerebrospinal fluid, saliva, and nuchal skin biopsy samples were “nonspecific but compatible with rabies.”

Symptoms, Prevention, Treatment

Health Canada says the incubation period for rabies can range from one to three months after exposure, although it can be as short as a few days or as long as several years, before the virus spreads to the brain, disseminates through the central nervous system, and spreads along nerves to various organs, causing symptoms.

Early symptoms, which may last for up to 10 days, may resemble the flu and include fever, tiredness, and headaches. The patient may also feel pain, tingling, numbness, or itching around the area where the animal has bitten, scratched, or licked.

Symptoms worsen quickly as the virus attacks the central nervous system, causing neurologic symptoms, as the disease takes on one of two forms: encephalitic rabies, which occurs in 80 percent of patients, or paralytic rabies, which occurs in the other 20 percent.

Symptoms of encephalitic rabies can include anxiety, seizures, confusion, hyperactivity, hallucinations, strange behaviour and general agitation, fear of water, and fear of fresh air or drafts. Symptoms of paralytic rabies include weakness and gradual paralysis, often beginning near the wound site and progressing slowly.

According to Health Canada, after exposure to a potentially rabid animal, efforts should focus on prevention before symptoms appear and on therapy after symptom onset.

Prevention includes proper wound care as soon as possible, by cleaning and flushing the wound with soap and water for 15 minutes to its full depth. Following wound care, a health-care provider may administer rabies post-exposure prophylaxis (RPEP), to neutralize any rabies virus that had been introduced.

For people who have not previously been vaccinated against rabies, RPEP involves administering rabies immune globulin (RabIg) treatment and rabies vaccine.

“Once clinical symptoms develop, rabies is almost always fatal. Death typically occurs within 7 to 14 days of symptom onset although critical care measures (supportive therapy) may delay the timing of death,” Health Canada says.

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