As the weather warms and people engage in more outdoor activities, patients may present to physicians with concerns about rabies risk following bat or other animal exposure.
In British Columbia, bats are the only natural reservoir of rabies. While a human case of rabies did occur in 2019, this was the second case in B.C. in over 95 years. The prevalence of rabies among bats has not changed. About one per cent, and likely less, of bats carry the infection.
Who to contact:
- The Fraser Health Public Health Communicable Disease Environmental Health Officer (CDEHO) is available during daytime hours for rabies exposure consultations at 1-866-990-9941 and Select option 2. The Medical Health Officer (MHO) is available after hours (evenings, weekends and stat holidays) for rabies exposure consultations at 604-527-4806.
Scenarios you may encounter and recommended actions:
- Direct contact with a bat
If a patient reports direct contact (e.g., bite, scratch, unprotected handling/touching) with a bat in B.C. please call Fraser Health Public Health. Public Health will conduct a risk assessment to determine whether rabies post-exposure prophylaxis (RPEP) is indicated. RPEP is not indicated for every case of possible direct contact with a bat and will be provided at the discretion of the MHO.
- Bat in a room
RPEP is generally not indicated if there is no history of direct contact. BCCDC guidelines indicate that if a bat was found in the house or if someone woke up with a bat in the room without any evidence it touched someone then RPEP is not indicated (BCCDC, 2021). A clear patient history of direct contact with a bat is important to elucidate. When a bat is found in the room of a child or someone whose history may be less reliable, assessment of direct contact can be difficult and contacting Fraser Health Public Health/the MHO is appropriate.
- Contact with other animals (not a bat)
In British Columbia, terrestrial mammals are not known to be reservoirs of rabies. Therefore, rabies is extremely rare in pets and domestic animals or wildlife in B.C. Rabies risk is higher in animals recently imported from outside B.C. (in the last six months) or if the exposure occurred while travelling. Please call Fraser Health Public Health for an assessment in these cases.
After Hours Response:
Most cases of possible rabies exposure can be managed during daytime hours. Therefore, if a patient presents after hours (i.e. overnight), it is generally appropriate to call Fraser Health Public Health/the MHO the following morning. If you have discharged the patient, please provide the patient’s contact information (i.e. name, phone number, alternate phone number, PHN, name of community of residence) so that someone from our team can follow up. If the patient presents to your care shortly following the exposure, manage the exposed site similar to other wounds. It is very important to wash the contact site with mild soap and copious amounts of water for at least 15 minutes. Also consider updating tetanus-diphtheria vaccine as required.