February 2nd, 2010

Bats in the Bedroom: Canadians Make a Policy Change

cat-batID doctors know all too well the panicky call — usually from a terrified friend, family member, or colleague, or possibly the emergency room or primary care doc — about finding a bat in the house.

Usually in the bedroom.

(In one memorable case, it was the house cat’s leaping in the air to try and catch the bat that woke up the sleeping couple.  Each missed pounce led to a loud “thud” as the cat fell to the ground.)

The concern, of course, is bat-related rabies, which I’ve written about before, mostly at the prompting of a fine pair of papers (summarized here and here) published over the past few years by a Canadian group.  They have painstakingly documented just how rare human rabies arises from “stealth” bat exposure in the house — 1 case per 2.7 billion person-years

And number of such situations that would need rabies vaccination to prevent one case?  From a low of 314,000 to whopping 2.7 million persons.

Well Canada’s National Advisory Committee on Immunization (NACI) has read these papers too, and has decided to stop recommending rabies immunization for bats-in-house-but-no-exposure cases:

Researchers have since reviewed this approach and determined that when there is no obvious contact with a bat, the risk of rabies is extremely rare. Furthermore, there are considerable resource implications to implementing this strategy. Based on the review, which is outlined below, NACI is now recommending intervention only when both of the following conditions apply:  1) There has been direct contact with a bat;  and 2) A bite, scratch, or saliva exposure into a wound or mucous membrane cannot be ruled out

According to this nice summary — and hat tip to the author for notifying me of policy  change in Canada — it doesn’t sound like the US Advisory Committee on Immunization Practices is ready to make the change quite yet.

But maybe in the next revision of these guidelines?

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HIV Information: Author Paul Sax, M.D.

Paul E. Sax, MD

Contributing Editor

NEJM Journal Watch
Infectious Diseases

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