Algorithm continued for bats
Bat exposure defined
to Rabies prevention flowchart introduction
What constitutes an exposure?
The vast majority of human rabies cases in the USA have resulted from
virus types that are carried by bats. Significantly, most of these
case-patients did not report having been bitten by a bat. This
suggests that some bites or scratches from bats may be so minor as to go
unnoticed, disregarded, or forgotten, yet can still result in
transmission of the rabies virus. Accordingly, criteria for considering
whether a person has sustained a potential rabies exposure are different
when bats are involved.
Clearly, a bite, scratch, or mucous membrane contact with a bat
should be considered a potential rabies exposure. However, postexposure
prophylaxis should also be considered whenever direct contact between a
human and a bat has occurred, unless the person can explicitly rule out
the possibility of a bite, scratch, or mucosal exposure.
Furthermore, prophylaxis can be considered for persons who were in the
same room as a bat, but who might be unaware that a bite or direct
contact had occurred (e.g., a sleeping person awakens to find a bat in
the room, or an adult witnesses a bat in the room with a previously
unattended child, mentally disabled person, or intoxicated person).
In all instances of potential bat exposures, the bat in question
should be safely collected, if possible, and submitted for rabies
diagnosis. This will eliminate the need to consider prophylaxis in most
It is important to note that these recommendations regarding
postexposure prophylaxis for bat contact exist because of the possibility
that a bite or scratch from a bat may go unnoticed due to the patient's
age or level of consciousness. They should NOT be construed to mean that
simply being in the same area as a bat constitutes an exposure for a
competent conscious adult or older child.
to the algorithm
June 08, 2012