There are many times in public health when we make health-care decisions and recommendations for people with diseases or conditions while we scratch our heads wondering how the exposure could have happened.
I recently found out how some of these seemingly random situations can occur — and just how important getting treatment can be.
On a recent beautiful Sunday evening in Boise, I was reaching around a closed patio umbrella to untie it and open it for shade. As I began to unfold the umbrella, a sleeping bat fell from the folds on to my bare upper arm. I could lightly feel its claws/feet as it was trying to gain a hold on me in its startled state.
I first thought it was a mouse. Then, I wondered if it was a clump of yellow jackets about to sting me. I tried to figure out what was happening. A bat was the furthest thing from my mind.
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I swatted it away only to have it land on my bare thigh just below my shorts. I felt it cling to my leg, and I swatted it again, this time knocking it to the ground. At that point, I ran into the house screaming!
I looked out through the sliding door to see the bat on the deck with its wings spread. It was slowly regaining its composure. By the time my family could get something to capture it, it flew off the deck toward the ground.
My husband and I searched the ground and the underside of the deck. We also went through all of the potted plants and planters as well as the trees in the yard, but we couldn’t find it.
After I got over my initial fright, I started processing the situation. I know that you’re supposed to report any exposure to a bat to your doctor, and then seek treatment, but it just didn’t seem possible that this seemingly harmless bat could have posed any risk because it wasn’t acting strangely.
I also didn’t want to have rabies shots, and I didn’t want to kill an innocent bat to have it tested for rabies. But mostly, I don’t want rabies!
Time is critical
Bats are known carriers of rabies in Idaho, and rabid bats are reported every year in the Treasure Valley and throughout the state. Without timely medical intervention, rabies infection is 100 percent fatal in people and most animals.
In my role as the administrator of public health and the state health official, it is my division’s responsibility to provide the public with information about what to do in these situations and even to test animals for rabies. Having firsthand knowledge of bats and rabies in Idaho, I want to share with you what to do if you or someone you know has an exposure — even if it seems like no big deal at the time.
First, what is an exposure? I didn’t get a definite bite. Was I really exposed if I felt only its claws and had no visible scratch?
The Centers for Disease Control and Prevention (CDC) has this to say: “Nonbite exposures from terrestrial animals rarely cause rabies. However, occasional reports of rabies transmission by nonbite exposures suggest that such exposures should be evaluated for possible post-exposure prophylaxis administration.”
This somewhat vague information is based on the fact that there have been some cases of rabies in humans after fairly minor scratches or contact with bats.
Talk to your doctor
Unless you can find the exact bat and have it tested, you do not know whether your risk of contracting rabies is zero. It is important to talk with your doctor immediately about the need for medical therapy, which is called post-exposure prophylaxis.
Most physicians do not routinely stock rabies vaccine or the required human rabies immune globulin that gives you an extra boost of antibodies. The immune globulin is typically found in hospital pharmacies that must be accessed through the emergency department.
The next day, I called my doctor. She referred me to the emergency department, where I received my first set of shots.
Post-exposure prophylaxis soon after a possible rabies exposure is extremely effective in preventing rabies. The immune globulin is administered at the exposure site (the bite or scratch), coupled with the rabies vaccine.
The rabies vaccines are not given in the stomach, as you may have heard, and they are given on day zero, 3, 7 and 14.
So in my case, I had both my immune globulin shots and my first rabies vaccination on day zero, which occurred two days after my “batty” encounter. I had two immune globulin shots in my thigh and one in my arm where the bat clung to it.
My rabies vaccine was given in my arm just like a flu shot. My subsequent rabies vaccinations were provided in a clinic setting rather than going back to the emergency department and arranged for by the doctor I saw in the emergency department. I was told that if the timing of my vaccinations fell on a weekend, the emergency department would need to be used to keep the schedule, which is very important.
Insurance typically covers the vaccinations. CDC has a link on its rabies page (cdc.gov/rabies) for programs for uninsured and underinsured patients. I was not thrilled about having that many shots and was concerned about the cost, but it was certainly worth avoiding the risk of a life-threatening disease. I have had no side effects from the shots other than a sore shoulder … well that, and peace of mind.
Don’t take a chance
Idaho has not had a case of human rabies in decades, but it is still prudent to be cautious around bats. A case of rabies in Montana in 2015 occurred when a woman found a bat on her neck when she woke up. She did not seek medical care, and the exposure proved to be fatal in less than a month.
Other human cases have included an infant and an adult man. A bat was found flying around the infant’s bedroom, but the baby had no visible bite or scratch. The man had a bat bump into his chest and fly off. The exposures seemed insignificant, but the man and the baby both died because rabies treatment was not sought in time.
Exposure poses a risk — every time. You should contact your health care provider immediately to seek treatment if you are put at risk.
Taking the chance of getting a disease that is 100 percent fatal in humans is not worth it. I am certainly glad I can rest assured I will be around to tell this story for years to come.
Elke Shaw-Tulloch, master of health sciences, is the state health officer and Division of Public Health administrator with the Idaho Department of Health and Welfare. Find out more at healthandwelfare.idaho.gov.
Rabies in Idaho
• The only way to know for sure that a bat has rabies is to have it tested.
• Rabid bats have been reported from almost all parts of Idaho and have been detected from March to November. No area of Idaho is deemed rabies-free.
• Only bats that have been in contact with humans, livestock or pets are tested for rabies, and these are often bats that have been acting strangely. Approximately 10 percent of the bats tested at the State Public Health Laboratory annually test positive for rabies.
• A handful of other species of mammals in Idaho have tested positive for rabies, but rabies does not appear to circulate in these terrestrial species. Nonetheless, all mammals can potentially contract and spread the disease.
• Learn more about rabies in Idaho at healthandwelfare.idaho.gov/Health/DiseasesConditions/RabiesInformation/tabid/176/Default.aspx.
How to protect yourself
• Do not ever touch a bat with bare hands. Wear leather gloves if you have to touch it.
• Bat-proof homes and cabins by plugging all the holes in the siding. Maintain tight-fitting screens on windows.
• Be sure your pets’ rabies vaccinations are up to date, even if the animals are strictly indoor pets. This includes dogs, cats and horses.
• Teach your children to avoid bats and to tell an adult if they find one. Just because a bat does not appear to be ill or acting erratically does not mean that it is free of rabies.
• Learn more at cdc.gov/rabies.