Bats: A Rising Rabies Threat in the U.S.



About seven in 10 rabies deaths among people in the U.S. were attributed to bats, which make up one-third of rabid animals in this country, CDC researchers said.

Of the 5,000 rabid animals tested in 2017, 32% were bats, and since 2015, bats have surpassed raccoons as the largest source of rabies infections from animals in the U.S., with the gap continuing to widen, reported Emily Pieracci, DVM, of the CDC in Atlanta, and colleagues, in a CDC Vital Signs report.

"People may not realize that bats carry rabies, so they may not see their medical provider after touching or handling a bat," said CDC Principal Deputy Director Anne Schuchat, MD, on a call with reporters. "A healthcare provider can help determine if someone needs post-exposure prophylaxis (PEP)."

But because a bat bite is "smaller than a pencil eraser," she added, many people may not know if they have been bitten. Therefore, she encouraged patients to inform their healthcare provider if they have had any animal bites or scratches or contact with bats.

If a patient has been exposed, Schuchat said the provider should assess whether or not the patient needs PEP, and can contact their state and local health departments to provide them with the necessary tools.

In addition to bat contact, healthcare providers should also talk to patients about upcoming international travel, as Schuchat warned that dogs in many other countries can carry rabies. Providers may recommend the rabies vaccine, depending on where the traveler is going.

When asked by reporters about the timing of this report, Pieracci noted the number of "mass bat exposures" -- or cases where ≥10 people have been exposed to potentially rabid bats -- has risen since 2015. These exposures have occurred in camp grounds, sorority houses, and even in homes.

"As the urban landscape changes and more wildlife cohabitate with people, there are increased instances of people having contact with bats ... and no one is concerned about rabies," Pieracci said. "If people don't know the risk, they may not go to their doctor to see if they need PEP."

Although she noted that researchers believe <1% of bats in the wild have rabies, there are large numbers of bats living in urban environments, such as "under bridges and in people's homes," so awareness is critical.

Pieracci and colleagues examined data going back 80 years (1938 to 2018) using rabies surveillance data, and Healthcare Cost and Utilization Project data from 2006-2014 to estimate the number of PEP visits per 100,000 in 2017-2018.

Overall, 125 human rabies cases were reported in the U.S. from 1960-2018, and a little under 30% were from dog bites during international travel. But 62 of the 89 infections in the U.S. were attributed to bats. The authors also estimated that in 2018, about 55,000 people received PEP after coming into contact with an animal that potentially had rabies. Data from the Center for Medicare & Medicaid Services estimated this resulted in annual costs of $209 million, the authors said.

Since 2003, there have been approximately two human rabies deaths and 175 mass bat exposure events, as well as one rabid dog importation every year, with the authors estimating that costs associated with rabies emergency response activities total $7.6 million per year.

"Any direct contact with a bat, even if [the person was] not bitten, should be discussed with a healthcare provider," Pieracci said. "If a person is exposed to rabies and they do not get PEP, they will die. It's too risky to take that chance."

Pieracci and co-authors disclosed no relevant relationships with industry.

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