Ontario's first fatal rabies case since 1967 provides critical guidance to help prevent deaths from rabies in future cases. The article was published in the Canadian Medical Association Journal.
Human rabies is caused by a virus and is almost always fatal, but post-exposure prophylaxis (PEP), with a series of rabies vaccines and human rabies immune globulin injections, can prevent death if given promptly and before symptoms develop. In North America, bats, raccoons, skunks and foxes are the main carriers of rabies. Bats are the most common cause of rabies and pose a heightened risk because scratches or bites may be small and hard to see.
This fatal rabies case occurred in an 11-year-old boy who awoke with a bat lying on his mouth and nose and had no apparent bite or scratch marks. Nineteen days after exposure, he went to an emergency department with a range of symptoms, including vomiting, facial "pins and needles" and numbness, and was later diagnosed with rabies. The health care team provided supportive care, as there is no cure once rabies symptoms develop.
The parents agreed to share their son's case to help raise awareness of rabies.
"Any direct human contact with a bat, even in the absence of a visible bite or scratch, is an indication for PEP and should be discussed with public health authorities," writes Dr. Brian Hummel, a pediatric infectious disease specialist at McMaster Children's Hospital and assistant professor at McMaster University, Hamilton, Ontario, with co-authors.
