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A Rabies Case in Utah

Unlike most other vaccine-preventable diseases, we have gotten rabies under good control by vaccinating and protecting our pets and some wild animals.

Never touch a bat that you find on the ground during the day, as it might have rabies.
Never touch a bat that you find on the ground during the day, as it might have rabies. Photo by Radu Privantu (CC BY 2.0)

Add in post-exposure prophylaxis with the rabies vaccine and human rabies immune globulin and you understand why human rabies cases are so rare.

A Rabies Case in Utah

For all of this to work though, folks need to vaccinate and protect their pets and they need to know to get post-exposure prophylaxis when they encounter an animal that might have rabies.

Unfortunately, this doesn’t always work, which is why human rabies cases are rare, but not unheard of.

Did you hear about the case of rabies in Utah in 2018?

A 55 year old man died, getting exposed to bats, one which must have been rabid, that were roosting in his home.

“The patient’s family reported that, beginning in August, a large number of bats had occupied their attic and frequently were found in the living area of the home, particularly in the master bedroom. On multiple occasions, the patient had removed bats from the home with his bare hands, and on one occasion, the patient awoke to find a bat near his head. In September, a dead bat was found on the floor of the bedroom. Despite the substantial bat contact, no bites were noted.”

Morbidity and Mortality Weekly Report, Volume 69, Issue Number 5 Human Rabies — Utah, 2018

Don’t you have to be bitten to get rabies?

“On October 17 and 18, 2018, a man aged 55 years who lived in Utah sought chiropractic treatment in Idaho for neck and arm pain thought to be caused by a recent work-related injury. On October 19, he was evaluated in the emergency department of hospital A for continued neck pain, nuchal muscle spasms, burning sensation in his right arm, and numbness in the palm of his right hand.”

Morbidity and Mortality Weekly Report, Volume 69, Issue Number 5 Human Rabies — Utah, 2018

A bite from a rabid animal is the typical way that you get exposed to rabies.

People usually get rabies from the bite of a rabid animal. It is also possible, but rare, for people to get rabies from non-bite exposures, which can include scratches, abrasions, or open wounds that are exposed to saliva or other potentially infectious material from a rabid animal.

How is rabies transmitted?

Surprisingly, bites from bats can go unrecognized, especially if the person was sleeping at the time.

“In instances in which a bat is found indoors and there is no history of bat-human contact, the likely effectiveness of postexposure prophylaxis must be balanced against the low risk such exposures appear to present. Postexposure prophylaxis can be considered for persons who were in the same room as a bat and who might be unaware that a bite or direct contact had occurred (e.g., a sleeping person awakens to find a bat in the room or an adult witnesses a bat in the room with a previously unattended child, mentally disabled person, or intoxicated person) and rabies cannot be ruled out by testing the bat. “

Rabies in Bats

In this case, even though the man had extensive exposure to bats, he didn’t know that he was at risk for rabies, so didn’t mentioned the bats or rabies when he first got sick.

“When specifically questioned about the patient’s exposure to wild animals, family members reported extensive contact with bats that had occupied the patient’s home in the weeks before illness onset.”

Morbidity and Mortality Weekly Report, Volume 69, Issue Number 5 Human Rabies — Utah, 2018

Tragically, he had been in the hospital for 14 days and in a coma for 9 days before they recognized that he likely had rabies.

“CDC confirmed the presence of rabies virus antigen and RNA in postmortem brain stem tissue and cerebellum specimens by DFA and real-time RT-PCR, respectively. Antigenic typing with monoclonal antibodies to the rabies virus nucleo- protein, and phylogenetic sequence analysis indicated that the virus identified in the patient’s specimens was consistent with that of a rabies virus variant associated with Mexican free-tailed bats (Tadarida brasiliensis). “

Morbidity and Mortality Weekly Report, Volume 69, Issue Number 5 Human Rabies — Utah, 2018

He died the next day.

“The delayed diagnosis of rabies in the patient in this report prevented him from receiving any early treatment for rabies and also resulted in potential rabies exposures for 279 persons in multiple settings during the patient’s infectious period.”

Morbidity and Mortality Weekly Report, Volume 69, Issue Number 5 Human Rabies — Utah, 2018

Hopefully his death will be publicized so that everyone knows to avoid contact with bats and to consider post-exposure prophylaxis (rabies vaccine and human rabies immune globulin) if they do have direct contact with a bat, keeping in mind that other wild animals that can have rabies include raccoons, skunks, and foxes.

Health care providers should also consider rabies early in their differential diagnosis when faced with an unexplained illness, although rabies is typically fatal once symptoms begin.

“The first symptoms of rabies may be very similar to those of the flu including general weakness or discomfort, fever, or headache. These symptoms may last for days. There may be also discomfort or a prickling or itching sensation at the site of the bite, progressing within days to acute symptoms of cerebral dysfunction, anxiety, confusion, and agitation. As the disease progresses, the person may experience delirium, abnormal behavior, hallucinations, hydrophobia (fear of water), and insomnia.”

What are the signs and symptoms of rabies?

If nothing else, this should demonstrates how important it is to learn how to remove (exclusion) and keep bats out of your home.

More on Rabies

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