An 11-year-old boy in Canada has tragically died from rabies, two years after a bat was found on his face while he slept. The “exceedingly rare” case, detailed in the Canadian Medical Association Journal this week, has prompted infectious disease physicians to call for greater public awareness regarding rabies transmission and prevention.
The incident occurred in northern Ontario in 2024 when the child awoke to discover a bat resting on his nose and mouth. His father quickly removed the bat, which was then released outside. As no visible scratches or bites were observed, and the bat did not appear to be behaving unusually, the parents did not initially seek medical advice for their son.
However, 19 days after the encounter, the boy began to experience symptoms including tingling, numbness, and swelling on the right side of his face. He was initially discharged from hospital with a presumed diagnosis of herpes gingivostomatitis, but the detail of the bat exposure prompted a doctor to contact the local public health authority regarding anti-rabies medication. The boy's condition rapidly worsened the following morning, leading to his admission to intensive care with a strong suspicion of rabies. Subsequent MRI scans revealed brain stem lesions, and tests confirmed the rabies diagnosis.
Despite considerations for administering rabies antibodies directly into the boy's brain, the medical team and family ultimately decided against further invasive treatment due to its unproven efficacy and the advanced stage of the disease. Once rabies symptoms manifest, the virus is almost always fatal, as there is currently no cure or effective treatment. This highlights the critical importance of early intervention.
Experts emphasised that while rabid bats can exhibit unusual behaviours such as appearing during the day or having difficulty flying, the absence of these signs does not rule out infection. Bites and scratches can be incredibly small and easily overlooked, and the virus can also be transmitted if bat saliva comes into contact with cuts, the eyes, nose, or mouth. In North America, bats are the primary carriers of rabies, although other animals like skunks, raccoons, and foxes can also be infected.
The report underscores that immediate administration of rabies post-exposure prophylaxis (PEP) – a series of treatments given after potential exposure – is nearly always effective if given quickly. With overwhelming success documented in 29 million cases globally, early recognition of exposure and timely PEP remain the only effective means of rabies prevention. The last confirmed human rabies case in Ontario prior to this incident was in 1967, and only 28 cases have been documented in Canada since 1924, making this a truly exceptional and tragic event.