Bat Bite Rabies Post-Exposure Prophylaxis

Rationale for Bat Bite PEP

Bats are documented rabies reservoirs in all 49 continental United States, making them a significant wildlife reservoir for rabies virus variants transmitted to humans 3
Bat bites often cause minimal injury compared to larger carnivores, making them difficult to detect but still dangerous 4
Of the population exposed to bats, 34 bat-associated human rabies cases were reported in the US from 1990-2007, with only 6 having documented bites, while 15 had physical contact but no detected bite, highlighting the risk of unrecognized exposures 5
Bat-related rabies viruses may be more likely to cause infection even when inoculated into superficial epidermal layers in individuals exposed to bats 5

All persons with bite, scratch, or mucous membrane exposure to a bat should receive rabies PEP unless the bat is available for testing and is negative for rabies, as recommended by the Centers for Disease Control and Prevention (CDC) 2, 3
PEP may be appropriate even when a bite or scratch is not apparent if there is reasonable probability that exposure occurred in individuals who have been in the same room as a bat 4
Consider PEP when a bat is found in the same room as a sleeping person, an unattended child, a mentally disabled person, or an intoxicated person, as advised by the CDC 2, 4, 5

The bat should be safely captured if possible and submitted for rabies testing - this can prevent unnecessary PEP if the bat tests negative, according to the CDC 4
Do not delay PEP while waiting for bat testing results; treatment can be discontinued if the bat tests negative, as recommended by the CDC 5, 7
Failing to recognize that bat bites may be minor and easily overlooked can lead to delayed PEP, as noted by the CDC 3
Not considering PEP for situations where a bat is found in a room with someone who cannot reliably report a bite (sleeping person, child, etc.) can increase the risk of rabies transmission, as cautioned by the CDC 4