Ontario boy died two years ago after a bat sat on his face. There were no visible bites

Human rabies is very rare but is almost always fatal if left untreated. Photo by Peter Scott /Pexels

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An 11-year-old Ontario boy who died of rabies after an encounter with a bat should offer a wakeup call for people to be more cautious of such experiences, doctors say.

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The warning comes in a newly released report in the Canadian Medical Association Journal titled “Fatal Rabies in a Chid.”

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“Any direct human contact with a bat, even in the absence of a visible bite or scratch, is an indication for PEP and should be discussed with public health authorities,” the doctors write in the report. PEP is short for post-exposure prophylaxis, and refers to a combination of antibodies and a vaccine given to the patient.

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The boy’s family reported that, during a visit to a cottage in northern Ontario in 2024, he had been awoken by a bat on his nose and mouth. He swatted the bat off his face, and his father caught it in a cooking pot and released it outside. Since the boy had no visible bites and the bat had not been behaving erratically, the parents did not seek medical attention.

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However, more than two weeks later the boy developed paresthesia (a tingling sensation), numbness and swelling on the right side of his face. A local urgent care clinic prescribed an antiviral drug.

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A few days after that the boy was admitted to hospital. His condition continued to worsen, with symptoms including facial weakness, slurred speech, fever, trouble swallowing, confusion and visual hallucinations

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“He was admitted to the paediatric intensive care unit and his neurological condition continued to deteriorate,” the report says. “By his fifth day in hospital, he had no reflexes in his brain stem — the part of the brain that regulates breathing, heart rate and other essential bodily functions.”

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By this time, doctors had confirmed the diagnosis of rabies. “Subsequent testing by the Canadian Food Inspection Agency identified a bat rabies virus variant,” they write. However, despite the effectiveness of early use of PEP, and despite decades of research, “no proven effective therapy exists after symptom onset.”

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They add in the report: “Life-sustaining therapies were withdrawn on day 17 of admission, and he died peacefully with his family at his bedside.”

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The report notes that if the bat or other animal is available for rabies testing, results can be obtained within 48 hours, with PEP held pending those results.

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“In the common circumstance that a bat is found in the bedroom of a sleeping person with no recognized physical contact, this is not considered an indication for PEP,” it notes. “The patient we described reported a bat resting on his face, which is an indication for PEP; however, medical attention was not sought because no obvious bite was noted.”

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It adds: “This highlights an important gap in public awareness. Although rabid bats may show unusual behaviour — such as appearing during the daytime, resting on the ground or someone’s face, having difficulty flying, or being easily approached — the absence of these behaviours does not exclude rabies.”

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It says PEP can be started in consultation with local public health authorities, who can help guide risk assessment, management decisions and procurement. “Adverse effects associated with PEP are generally mild and include reactions at injection sites and transient systemic symptoms,” it adds.