Q: We just heard a story on the news about a man who got bitten by a bat and then died of rabies a few weeks later. We see bats in our area a lot, so we're worried. Why didn't the rabies treatment work? What is rabies, anyway?
A: You're referring to a case that occurred last August in a community just north of Chicago (Spring Grove). An 87-year-old man woke up to find a bat on his neck. The bat, which was captured, tested positive for rabies. Despite urgent warnings that he needed immediate preventive care, the man refused.
Treatment for rabies consists of an initial injection of a medication known as rabies immunoglobulin, which is made up of antibodies against the rabies virus. It is given in the vicinity of the bite to stave off infection. This is followed by a series of four shots given in the arm over the course of two weeks. The medication in these shots teaches the immune system to recognize and fight off rabies infection.
Unfortunately, the man developed symptoms consistent with rabies a month later. These include headache; neck pain; difficulty controlling the motor function of the arms, hands and fingers; difficulty with speech; exhaustion; and numbness.
Rabies is almost always fatal, and the man passed away. However, with the medical care that the man declined, the disease is 100% preventable. Once the virus begins to cause symptoms, though, it's too late for the treatment to be effective. That's why, whenever exposure to rabies is suspected, treatment must begin immediately.
Rabies is caused by a virus that attacks the nervous system. It is spread via the saliva of an infected animal, most often through a bite. In other parts of the world, where up to 60,000 people die of rabies each year, dog bites are the most common cause of infection. Here in the United States, thanks to robust veterinary vaccination programs, the disease is most often found in wild animals. This includes raccoons, skunks, foxes and, yes, bats.
Cases of rabies in humans are quite rare in the U.S., with fewer than three reported each year. The death in Illinois was the first in 67 years in the state. This speaks to the efficacy of the treatment, which is received by 30,000 to 60,000 people each year. However, it's still important to practice prevention. At this time, physical contact with saliva from an infected bat is the leading cause of rabies exposure in the U.S. Wildlife experts caution that you should never touch a bat with your bare hands.
If you know or suspect that you've been bitten by a bat, seek immediate medical care. Whenever possible, the bat should be captured and sent to a laboratory for rabies testing. But just because you have bats in your area doesn't mean you're in danger. Wildlife experts say that just a fraction of 1% of bats carry rabies. Stay safe by keeping your pets' rabies vaccinations up to date, and when it comes to bats and other wildlife, keep your distance.
• Dr. Eve Glazier is an internist and associate professor of medicine at UCLA Health. Dr. Elizabeth Ko is an internist and assistant professor of medicine at UCLA Health. Send your questions to askthedoctors@mednet.ucla.edu.
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