Doctors urge caution after rare rabies death in Canadian boy

By Stephen Beech

An 11-year-old boy died from rabies 19 days after waking up with a bat lying on his mouth and nose.

The child passed away as a result of the deadly virus despite having suffered no apparent bite or scratch marks, reveals a new report.

The tragedy was the first fatal case of rabies in the the Canadian province of Ontario for over 50 years.

Experts hope that the report on the boy's death, published in the Canadian Medical Association Journal (CMAJ), will provide critical guidance to help prevent future rabies deaths.

Rabies is humans 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.

Bats, raccoons, skunks, and foxes are the prime carriers of rabies in North America.

Bur bats are the most common cause of rabies and pose heightened risk as scratches or bites may be small and hard to see.

In the 2024 Ontario case, the boy had no apparent bite or scratch marks.

He visited an emergency department, 19 days after waking up with the bat on his face, with a range of symptoms.

These included vomiting, facial "pins and needles" and numbness.

Once diagnosed with rabies, medics provided supportive care, as there is no cure once the symptoms of the virus develop.

The parents of the boy, who has not been named, agreed to share their son's case to help raise awareness of rabies.

Report co-author Brian Hummel said: "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.

"This is especially important to consider as we approach the summer months, when human–bat encounters are at their peak."

He says people who may have been in contact with a wild animal that could potentially have rabies should seek medical attention promptly.

In the case of possible rabies virus exposure, public health authorities should be notified and PEP started in consultation.

Hummel, a pediatric infectious disease specialist at the McMaster Children's Hospital and McMaster University, Ontario, said: "Rabies is almost always fatal, with no established efficacious therapies, making prevention crucial."

He added: "Rabies PEP is highly effective if administered promptly, in consultation with public health authorities, after any direct human contact with a bat, even in the absence of visible lesions.

"Bats may or may not show classic signs of rabies; hence, any direct human contact with a bat is considered high risk.

"In people with neurological symptoms that may be compatible with rabies, clinicians should ask about exposure to potentially rabid animals."

There have been 27 confirmed cases of human rabies in the UK since 1924.

All bar one were contracted abroad, primarily from dog bites in South Asia or Africa before the patient returned to Britain.

The only recent case where rabis was contracted in the UK was in 2002 when a licensed bat handler in Scotland died from a rabies-like virus.

The UK has been completely free of terrestrial rabies - the kind spread between dogs and foxes - since 1922.