Medical Advisory: Bat Exposure Criteria Reminder for Rabies Post Exposure Prophylaxis (PEP)

As per the Management of Rabies Exposures Guideline, 2020 the following is the criteria for determining a bat exposure. 

Bat exposures: Post-exposure rabies prophylaxis following bat contact is recommended when both the following conditions apply: 

• There has been direct contact with a bat; AND 
• A bite, scratch, or saliva exposure into a wound or mucous membrane cannot be ruled out. 

Direct contact with a bat is defined as the bat touching or landing on a person. When there is no direct contact with a bat, the risk of rabies is extremely rare and rabies PEP is not recommended. 

Finding a bat in the room, even if the person was asleep generally does NOT merit administration of PEP UNLESS direct contact is known to have occurred, or there is evidence of direct contact with the bat.

When a bat is found in the room with a child or adult who is unable to give a reliable history, assessment of direct contact can be difficult. Factors indicating that direct contact may have occurred in these situations include the individual waking up crying or upset while the bat was in the room, or observation of an obvious bite or scratch mark. 

If the exposure criteria are met and the bat is available, arrangements will be made to test it for rabies. Unless exposure from the bat is in the person’s head or neck region, PEP can be delayed for up to 48 hours until the rabies test result on the bat is obtained. If PEP is initiated, it can be discontinued if the bat tests negative for rabies. 

Post-exposure prophylaxis must be coordinated in consultation with Hamilton Public Health (ie, do not commit to prophylaxis without Hamilton Public Health’s agreement). Rabies vaccination is not a universal vaccination (ie, unlike vaccinations for infections such as measles and tetanus). As such, it should only be administered after careful assessment in conjunction with Public Health of the affected person’s risk of having been infected.

• During Regular Business Hours - To report an incident during business hours, please fax to 905-546-2787. To request vaccine during business hours please call 905-546-2424 ext 3327. 
• After Hours and Weekends – To report a rabies incident outside of business hours please fax 905-546-2787. To request vaccine after hours/weekends please call the City of Hamilton Environmental Public Health Inspector on-call at 905-546-2489 (CITY).