Child Dies of Rabies After Bat Exposure in Northern Ontario
In Monday’s issue of the Canadian Medical Association Journal, infectious disease experts described the case of an 11-year-old boy who died of rabies nearly two years ago. The case serves as a sobering reminder of the dangers posed by bat encounters and the critical importance of seeking medical attention after any contact with these animals.
“It was important for us and the family to take the opportunity to gain learning experiences and draw lessons from his case to increase awareness and understanding of rabies infections and risks,” said Dr. Brian Hummel, senior author of the case report and a pediatric infectious disease physician at McMaster Children’s Hospital in Hamilton.
How the Exposure Occurred
The boy was staying at a cottage in northern Ontario in the summer of 2024 when he was awakened by a bat lying on his nose and mouth. He hit the bat away, and his father caught it in a pot and released it outside.
Because the parents didn’t see any scratches or bites on their son’s face and the bat hadn’t appeared to be acting strangely, they didn’t suspect rabies at the time and didn’t seek medical care for the boy.
Symptoms and Rapid Deterioration
Nearly three weeks after the encounter, the boy developed tingling, numbness, and swelling on the right side of his face. A doctor at an emergency room initially suspected Bell’s palsy — a temporary paralysis on one side of the face that can be caused by viral infections — and prescribed antiviral medication.
Within a few days, his condition worsened. He returned to the emergency room at McMaster Children’s Hospital suffering from vomiting and pain when swallowing. He subsequently developed more severe facial weakness on the right side and slurred speech.
He was admitted to the pediatric intensive care unit, where his neurological condition continued to deteriorate. On his fifth day in the hospital, he had no reflexes in his brainstem — the part of the brain that regulates breathing, heart rate, and other essential body functions. He was eventually taken off life support and died peacefully, surrounded by his family.
Why Rabies Is Almost Always Fatal Once Symptoms Appear
Once rabies symptoms appear, there is no treatment or cure. “If you get a symptomatic rabies infection, it’s almost universally fatal. But if you get prevention before symptoms appear, it’s almost universally successful,” Dr. Hummel said.
The rabies virus infects the nerves around the site where it entered the body, then travels to the spinal cord and brain, ultimately causing death. However, the virus has a relatively long incubation period — usually several weeks — before symptoms develop, which provides a critical window for preventive treatment.
During that window, a series of vaccines and a dose of antibodies can stop the infection. The first rabies vaccination is given immediately, followed by additional vaccinations on days three, seven, and 14. The vaccination helps the body build an immune response against the virus. Because this reaction takes some time to develop, patients also receive an injection of immunoglobulin — a ready-to-use antibody that immediately begins fighting the virus.
Bats Pose the Greatest Rabies Risk in Canada
Rabies is an extraordinarily rare infection in humans in Canada, with only 28 reported cases since 1924. The most recent case before this one involved a man who died in British Columbia in 2019 after contact with a bat. There had not been a reported rabies case in Ontario since 1967.
While rabies can also be transmitted by skunks, raccoons, and foxes, bats are the biggest concern. Any physical contact with a bat is considered high risk. Bats have tiny teeth, so people can be bitten without realizing it. Even without a visible bite or scratch, a bat’s saliva can make contact with skin and enter through cuts or mucous membranes such as the eyes, nose, or mouth.
“Any time a bat has touched human skin, that would be reason to see your doctor immediately,” Dr. Hummel advised. Primary care providers often work with public health officials to determine whether post-exposure prophylaxis — a series of vaccinations and an antibody injection — is warranted.
Treatment Benefits Far Outweigh Risks
Vaccine side effects are generally mild and temporary, including fever, chills, sweats, and malaise. As with any vaccine, there is a very rare risk of anaphylaxis, which is why patients are monitored briefly after receiving the injection.
Older versions of the rabies vaccine carried a very low risk of Guillain-Barré syndrome, a rare condition in which the body’s immune system attacks its own nerves. However, there is no known causal relationship between the syndrome and modern rabies vaccines.
“Given the near-certain death from rabies infection, the benefits almost always outweigh the risks,” Dr. Hummel said.
