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August 29th, 2011
07:59 AM ET

Rabies shots needed for bat exposure?

Every weekday, a CNNHealth expert doctor answers a viewer question. On Mondays, it's pediatrician Dr. Jennifer Shu.

Question asked by Dan from South Carolina:

During a recent family trip to the mountains, our kids, who were sleeping in the attic, were awakened by a bat flying around the room. We called our doctor, who told us to go to the emergency room, where the kids got the rabies vaccine and immune globulin. Was that really necessary?

Expert answer:

Thanks for your question. In hindsight (such as following a negative rabies test on the animal in question) it often does seem that rabies prevention shots are unnecessary.

However, doing the injections as a precaution is a very reasonable recommendation. That's because rabies infection is almost always fatal without the treatment.

Fortunately, most animals are not infected with rabies, so transmission to humans is rare, affecting just a handful of people every year. Bats are one of the most common animals that transmit rabies in the United States, along with raccoons, skunks, foxes and coyotes.

The rabies virus can be found in all parts of the country except for Hawaii.

If there is concern about an exposure to rabies, prophylaxis consisting of rabies immune globulin (an injection that contains human antibodies against the rabies virus) and rabies vaccine (four injections over the course of two weeks) is recommended.

This treatment should be started as soon as possible after the exposure, ideally within 24 hours.

Bat bites reportedly feel like sharp jabs and may leave tiny marks that look like scratches. Most adults who were awake during the time of a bat bite will know they have been bitten.

However, if a person is uncertain whether a bite or scratch from a bat occurred (such as if a bat was found in the room of a sleeping person, a child, a person with mental disabilities or someone who is impaired by the influence of alcohol or drugs - basically anyone who is unable to give an accurate report about a bite), the rabies prophylaxis regimen is recommended.

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soundoff (34 Responses)
  1. DrDoIT

    What about ball exposure? ha ha

    August 29, 2011 at 10:46 | Report abuse | Reply
    • Elizabeth

      Obviously, it is too late for you to get the vaccine, because rabies has affected the brain.

      August 29, 2011 at 14:05 | Report abuse |
  2. mervel

    The other option is to capture/kill the suspect bat and have it tested first.

    August 29, 2011 at 11:13 | Report abuse | Reply
    • Displeased

      That is the preferred option, and it was mentioned in the first paragraph of the answer.

      August 29, 2011 at 12:06 | Report abuse |
  3. careful

    Testing usually takes time. Also, if the bat was making enough noise to wake someone up, it's usually a sign that it is ill. Taking precautions by getting vaccinated is the safest option.

    August 29, 2011 at 11:34 | Report abuse | Reply
    • Aaron

      Bat's make audible and inaudible sounds all the time. :)

      August 29, 2011 at 15:32 | Report abuse |
  4. Pediatric doctor

    Did the bat BITE anyone?

    August 29, 2011 at 11:46 | Report abuse | Reply
    • Veterinarian

      That's the issue. The question is regarding children who were sleeping in the room. There is a possibility they were bitten and did not realize it. There was recently a case of a prisoner who was bitten in the process of roadside cleanup and was not aware. While some people overreact and jump the gun in cases of possible exposure, treatment is warranted in cases of uncertainty. It's rabies – better safe than dead.

      August 29, 2011 at 12:16 | Report abuse |
    • Elizabeth

      The same thing happened years ago in my family, but for some reason we did not think of getting vaccinated for rabies. People could wait over 24 hours for an immediate life-threatening trauma at the NYC hospitals then. The long wait in emergency rooms is enough to deter people from getting treatment for important reasons. Nobody was scratched or bitten though. We were on the top floor of an apartment near woods, and a guest opened a window without sliding the screen into place.

      August 29, 2011 at 14:13 | Report abuse |
  5. charls

    Dan, giving the vaccine taken was the wise decision. Rabies is almost 100% fatal. I would not risk the life of my child. I was bitten by a dog when I was a child. Since no rabies had been reported in the county in 25 years, I was not given the vaccine. Luckily the dog did not have rabies.

    August 29, 2011 at 13:30 | Report abuse | Reply
  6. seattleite09

    My wife and I went through a similar incident when my daughter was ~2 years old. I woke up with a bat flying around in our home, while all inside doors were wide open. I caught the bat and called the doctor, who recommended rabies shots for all three of us. We never even questioned the recommendation - why endanger the lives of my loved ones? Except for 2 recorded cases, rabies is always fatal. There's simply too much risk in not having the shots. My wife was 3-months pregnant at the time with our second child. She got the shots anyway.

    August 29, 2011 at 14:42 | Report abuse | Reply
  7. AliCat

    Also, we had a similar incident. The professionals that we contacted (Fire Department, Poison Control, Family Doctor) urged us to do the same due to the following: not only can a person be infected by a bite or scratch; if a sleeping person has his/her mouth open, and the bat drops a bit of saliva (not too far-fetched if it is infected with rabies)...that makes its way to the person's mouth...well, then you can get rabies. We were lucky to be able to capture the bat for testing, which took a day, and the results were negative. As some have said, "it is rabies; why take chances?"

    August 29, 2011 at 15:15 | Report abuse | Reply
  8. Tom

    Be aware, there are places in other parts of the world where rabies is much more common, India for example. I forget the statistics the travel medicine clinic told me a year or two ago, but it was something like over half of all human rabies infections occur in India annually. Because there are so many animals wandering loose in some cities and there tends not to be the laws in place to require innoculations, cats or dogs just running the streets may be infected.

    August 29, 2011 at 15:15 | Report abuse | Reply
  9. Aaron

    I understand the concern, however was it necessary? Unless the children were actually bitten by a bat, the answer is a resounding no. As a caver, several years ago we would have come into close contact with bats on a regular basis and there was no need for concern as statistically only one bat in a million here on the east coast would test positive for rabies. Now that number has likely changed to 1 in several million since many bat colonies from the southeast to the northeast have been wiped out by White Nose Syndrome. The desire for precaution is understood, but articles like this also easily cast misunderstood animals such as bats in bad light...unless actually bitten or scratched, you would have little to worry about from a bat.

    August 29, 2011 at 15:31 | Report abuse | Reply
    • Bruce

      You're absolutely correct, Aaron. Cavers like us are around bats routinely for decades of our lives and don't get rabies shots and don't become infected. Unless the person was actually bitten, there's no danger. And the effect of another article like this is the continued paranoia and vilification of bats in the public which ultimately hurts their WNS decimated numbers.

      August 29, 2011 at 16:12 | Report abuse |
    • Christine

      The issue here is that the bat was found in a room where the children were SLEEPING. Therefore, they didn't know whether or not they'd been bitten. That's why the vaccinations were necessary.

      October 20, 2012 at 05:56 | Report abuse |
  10. Marshall S Williams

    I was given the rabies vaccine series after being bitten by a rabid dog in the the early 1950's. Would the current vaccine have unwanted side effects if I were to have to take it now?

    August 29, 2011 at 16:24 | Report abuse | Reply
    • nimrod

      No. The old vaccine was either horse or cow serum based (I can't remember which) but in the mid seventies a human serum based vaccine was developed. The injection series went down from something like 15 shots to around 5 with much less discomfort and less risk of complications.

      August 30, 2011 at 00:17 | Report abuse |
  11. Lori

    My son was recently bit by a bat (at least he had bite marks), and there was a bat in the basement where he was. He underwent rabies shots for sure as any doctor will say better safe than sorry. Apparently in our region, there had not been a bat bite since 2004 so they took it very seriously. We have since had our house bat proofed....my son is sixteen and has slept with his light on since the incident...poor kid!

    August 29, 2011 at 16:33 | Report abuse | Reply
  12. Eileen

    Some of you may remember this. A couple of years ago, a young man from the Texarkana area entered the hospital with an "unknown neurological illness." The apartment complex in which he lived had a problem with bats, although he had not reported being bitten. I remember reading at that time that sometimes you can be bitten by a bat and not even know it. The illness was never officially diagnosed, and when the man was ruled brain dead, his family gave consent to transplant his organs and tissues. As of the time I last heard anything about this story, five more people (recipents), in addition to the young man (donor), had died of rabies, which was, of course, finally diagnosed. There's just too much risk not to get the shots if you think there is any chance that you have been exposed.

    August 29, 2011 at 17:09 | Report abuse | Reply
    • charls

      Sad but true.

      August 29, 2011 at 19:22 | Report abuse |
  13. Chris MD

    The first paragraph gives, I believe, false information. If you have captured the animal and testing can be done quickly (1-2 days) then there is no need to initiate vaccination. Local health departments and Animal Control work hand-in-hand to see that this public heath threat is dealt with responsibly. It is true that current CDC recommendations are to vaccinate if awakened by a bat in the room ........ but only if the bat gets away !! Also my understanding is that most serious cavers, and veternarians and others around wild animals get vaccinated for their own protection.

    August 29, 2011 at 17:46 | Report abuse | Reply
  14. JULIE

    bats can carry histoplasmosis, rare ocasions yes rabies, there are a lot of myths like they will fly into your hair. when they swoop they are hunting insects on the wing. poor bats are dying from white nose disease.

    August 29, 2011 at 18:59 | Report abuse | Reply
    • Samar

      Weve been taking our dabermon Ailsa on short breaks here in the UK for over 8 years and generally stay in Travelodges: they are cheap, cheerful and pet friendly. You can take up to 2 pets and pay just a320 per pet per stay which is not bad when the accomodation or us humans is as little as a319 per night per room! Weve been all over the uk from Brighton to Edinburgh; Pembrokeshire to Norfolk; Devon; Dorset; Cornwall and Northumbeland. This year we will be heading for Sussex and the Kent Coast and yet again, weve bagged a bargain; a319 per night for 4 nights plus a320 for Ailsa. Cant wait and she will love every minute of it too

      April 7, 2012 at 21:18 | Report abuse |
  15. mervel

    Yes better to be safe. In our situations (we have had a bat problem but it is solved now), the preferred solution we were given was to capture and kill the bat and have the bat tested. Which we did twice, both times negative. If we could not have captured the bat we would have gotten the shot.

    August 29, 2011 at 20:30 | Report abuse | Reply
  16. Mark

    Ahhhh, I know this scenario well. My wife, a graduate in zoology, saw our cats chewing on a bat. She knew instantly that something must be wrong with the bat for the cats to have caught it AND for it to be around in the daytime. With gloves we sent it off for testing. It turns out four of our five kids and my wife had handled the cats after they had a field day chewing on the bat's head. We asked our pediatrician, an infectious disease specialist and several physician friends of ours if it would be necessary to get rabies vax considering. All said "yes" to err on the side of caution. 100% fatality at the first sign of symptoms was compelling. So we did it. The bat came back positive for rabies. I don't regret it but I will tell you something that isn't mentioned: It costs $10,000.00 per person. So it cost $50,000.000!! One of these kids isn't going to college. But at least they're alive. ;)

    August 29, 2011 at 22:09 | Report abuse | Reply
  17. Eric

    Bats do not carry histoplasmosis. Histo is a fungal disease that grows in guano or bird droppings, especially a problem where there are dry and dusty droppings.

    August 29, 2011 at 22:49 | Report abuse | Reply
  18. Dave

    I would not be worried about a bat in your home (or anywhere else) unless it seems to be having trouble flying – which means it is sick or injured. If a bat is flying around inside your home, usually you can just open the windows and it will fly out. Although young bats are fairly curious and are still mastering their flying skills so they might not fly out right away. Here is some good info on what to do if there is a bat in your house: http://www.batcon.org/index.php/bats-a-people/bats-in-buildings.html

    The only time I would be worried about an "undetected" bite is if the bat is found in or on your bed. If you roll over on it during your sleep, it will bite in self-defense. But if it is on your bed or the floor, there is a good chance it is sick or injured. A healthy bat in a room will either be flying or roosting at some high place in the room, usually on curtains or some other textured surface.

    More info on Bats & Rabies from Bat Conservation International: http://www.batcon.org/index.php/bats-a-people/bats-and-rabies.html

    August 30, 2011 at 01:49 | Report abuse | Reply
  19. Margaret

    Another thing the doctors won't tell you is how you will react to the vaccinations! I was bit by a rabid cat, while trying to rescue it. tested positive for rabies, 24 shots in the behind for two weeks. Sent my body into a shock as it worked it's way through. Many health problems worked it's way out finally leaving me with no thyroid. Three years of intense pain and medical problems....at least I didn't have to pay for them. Are there no alternatives?

    August 30, 2011 at 14:19 | Report abuse | Reply
  20. James

    Strains of Rabies?

    I've read before that its preferred to bring the animal in for testing, not simply to confirm rabies infection, but to determine the strain of rabies it carries. Is there any truth to this, or is there a universal vaccine?

    August 30, 2011 at 21:11 | Report abuse | Reply
    • annyomous

      Most tests don't test for different strains of rabies. That can take too long to help the person. You look for the presence of something called Negri bodies in the brain. Negri bodies are small black areas in brain. They only occur in rabies. Doctors may test for strains after finding Negri bodies, but by then the person exposed to rabies would have already started post-exposure treatment.

      Even if the testing is inconclusive, it's still recommended to get treated anyways.

      The vaccine and treatment are the same no matter what strain of rabies you are infected with. So yes, there's a universal vaccine. Unfortunately only those in high-risk jobs, like those who work in veterinary medicine, are given the vaccination as a precaution. The rest of us just aren't as likely to get bitten or scratched by unfamiliar animals, so we don't need it. Even if they have been vaccinated before being bitten, people still need to undergo treatment– they just skip some of the steps (like the number of post-vaccinations).

      January 18, 2012 at 17:39 | Report abuse |
  21. annyomous

    Yes, it's necessary. Bats are notorious for being asymptomatic carriers of rabies. It's just best to err on the side of caution if you're around any wild bat.

    It can be helpful to get confirmation that the animal had rabies, but that's not always possible... esp. if you can't even catch the animal or the results were inclusive. Plus testing can take a day in some cases, and there's a better prognosis when you start vaccine and immune-goblin as soon as possible.

    Most tests don't test for different strains of rabies anyways, as that will definitely take too long to help the person; you look for the presence of something called Negri bodies in the brain. Negri bodies only occur in rabies.

    January 18, 2012 at 17:14 | Report abuse | Reply
  22. inquirer

    If I remember correctly, rabies infected patients had to take 24 shots in their stomach, is this correct? This was like 50 years or so ago.

    March 19, 2012 at 22:55 | Report abuse | Reply
  23. Mary

    We were exposed to a bat flying in our house about 10 days ago. No one has any bite marks or scratches, but I wonder if we should still get the post-exposure vaccine?

    March 30, 2014 at 01:41 | Report abuse | Reply

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