The case of a young boy in Ontario, Canada, who died weeks after contracting rabies from a bat that sat on his face while he was asleep, highlights a critical gap in public awareness about the disease.
Rabies is "exceedingly rare in Canada, with only 28 cases since 1924," according to a recent report by the Canadian Medical Association. The patient in question was the first case of locally acquired rabies in Ontario since 1967. If not treated early after an incident, rabies has a fatality rate of almost 100%, although 34 survivors have been documented, with most experiencing severe neurologic sequelae.
Neurologic sequelae refer to the long-term after-effects or complications that affect the nervous system (brain, spinal cord, and nerves) as a consequence of a previous disease, injury, or medical treatment. In North America, bats, skunks, raccoons, and foxes are the primary carriers, with bat exposures accounting for most human cases.
Bats pose a higher risk of possible exposure because bites or scratches may be small and easily overlooked. Patients may not recollect or recognize exposure. "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," the doctors write in the report.
PEP is short for post-exposure prophylaxis and refers to a combination of antibodies and a vaccine given to the patient. The report notes that if the bat or other animal is available for rabies testing, results can be obtained within 48 hours. This particular incident occurred in northern Ontario in 2024, where an 11-year-old boy was woken by a bat on his nose and mouth.
After he swatted the bat off his face, his father caught the bat and released it outside. The parents did not seek immediate medical attention because there were no visible signs of bites in the facial area. However, more than two weeks after the incident, the boy developed a tingling sensation, numbness, and swelling on the right side of his face, leading to a diagnosis of rabies.
The boy's condition continued to decline, with symptoms including facial weakness, slurred speech, fever, trouble swallowing, confusion, and visual hallucinations. By the fifth day in hospital, he had no reflexes in his brain stem, and by day 17, he died "peacefully with his family at his bedside."
The case illustrates several critical points about rabies, including its almost always fatal nature, the importance of prevention through prompt PEP administration after any direct human contact with a bat, and the need to ask patients with progressive neurologic symptoms about exposure to potentially rabid animals.
There are eight species of bats in Ontario, including the hoary bat, the eastern red bat, the silver-haired bat, the big brown bat, the tricolored bat, the little brown myotis bat, the northern long-eared myotis, and the eastern small-footed myotis. Health Canada provides various information online about rabies and its treatments.
