First reported failure of rabies shot reported after man woke to find bat biting his hand

Male silver-haired bat. Larisa Bishop-Boros, CC BY-SA 3.0, via Wikimedia Commons.

In January 2021, an 84-year-old male in Duluth, Minnesota died from rabies six months after being bitten by a rabid bat despite receiving timely rabies post-exposure prophylaxis (PEP). This is the first reported failure of rabies PEP in the Western Hemisphere using a cell culture vaccine. 

Rabies is a viral disease that affects mammals, including humans. It is caused by the Rabies virus, which is usually transmitted to humans through the bite of an infected animal, primarily dogs, bats, and wild animals such as foxes, raccoons, and skunks. In rare cases, the virus can also be transmitted through saliva, usually through a scratch or open wound, or by inhaling the virus in bat caves.

Once the virus enters the body, it travels to the central nervous system, where it begins to replicate and spread rapidly. The virus can take anywhere from several weeks to several months to incubate before symptoms begin to appear.

The early symptoms of rabies can be similar to those of the flu and can include fever, headache, and general malaise. As the disease progresses, more severe symptoms begin to appear, such as anxiety, confusion, hallucinations, and agitation. The disease can also cause muscle spasms, convulsions, and paralysis.

Without prompt medical treatment, rabies is almost always fatal. Once the disease has progressed to the point where symptoms are present, there is no cure. However, a vaccine is available that can be given before symptoms appear, which is highly effective in preventing the disease from progressing.

Preventing rabies in humans involves avoiding contact with infected animals and getting prompt medical treatment if bitten or scratched by an animal. If a person has been bitten by an animal, they should clean the wound immediately with soap and water and seek medical attention as soon as possible. The healthcare provider will administer a vaccine and possibly immunoglobulin, which are antibodies to neutralize the virus, to prevent the virus from replicating and spreading.

As this is what both the victim and medics did, doctors have now been advised to consider measuring rabies neutralizing antibody titers after completion of PEP if there is any suspicion for immunocompromise.

Five rabies deaths occurred in 2021. This is the largest number in 10 years – and health officials said three refused a series of shots that could have saved their lives. 

The Centers for Disease Control and Prevention (CDC) report details the deaths, four of which stemmed from contact with bats, and the last from a rabid dog.