What is the protocol for treating a bat bite?

Bat Bite Protocol: Immediate Rabies Post-Exposure Prophylaxis

Any person with a bat bite should immediately receive rabies post-exposure prophylaxis (PEP) unless the bat is available for testing and confirmed negative for rabies. 1, 2

Immediate Management Algorithm

1. Wound Care

• Thoroughly wash and flush the bite wound with soap and copious amounts of water for approximately 15 minutes 2, 3
• Apply an iodine-containing or similarly viricidal topical preparation to the wound where available 2
• Evaluate need for tetanus prophylaxis and measures to control bacterial infection 2

2. Rabies Post-Exposure Prophylaxis

• For previously unvaccinated individuals:
  • Administer both rabies immune globulin (RIG) AND rabies vaccine 2
  • RIG should be infiltrated around the wound site(s) with any remaining volume administered intramuscularly at a site distant from vaccine administration 2
  • Vaccine should be administered as a series of doses on days 0,3,7, and 14 3
• For previously vaccinated individuals:
  • Administer only the rabies vaccine (no RIG needed) 2

3. Bat Testing

• If possible, safely capture the bat for rabies testing 1
• Do not delay PEP while waiting for bat testing results 1
• PEP can be discontinued if the bat tests negative for rabies 2, 3

Special Considerations

Bat Exposure Without Obvious Bite

• Consider PEP even when no bite is apparent if:
  • A bat is found in the same room as a sleeping person 4, 1
  • A bat is found with an unattended child 4, 1
  • A bat is found with a mentally disabled or intoxicated person 4, 1
• Bat bites often cause minimal injury compared to larger carnivores, making them difficult to detect but still dangerous 1

Public Health Notification

• Report the bat bite immediately to local health department 4
• Health authorities should be consulted for coordination of bat testing and PEP recommendations 4

Rationale for Aggressive Management

• Bats are documented rabies reservoirs in all 49 continental United States 1
• Of 34 bat-associated human rabies cases reported in the US from 1990-2007, only 6 had documented bites, while 15 had physical contact but no detected bite 4, 1
• Bat-related rabies viruses may be more likely to cause infection even with superficial exposure 1
• Rabies is nearly always fatal once symptoms develop, with mortality close to 100% 5, 6
• A 2021 case in Texas highlights the fatal consequences of not seeking PEP after a bat bite due to lack of visible bite marks 5

Common Pitfalls to Avoid

• Delaying PEP while waiting for bat testing results - treatment should begin immediately and can be discontinued if the bat tests negative 1, 2
• Failing to recognize that bat bites may be minor and easily overlooked 1
• Not considering PEP for situations where a bat is found in a room with someone who cannot reliably report a bite (sleeping person, child, etc.) 4, 1
• Assuming that absence of visible bite marks means no exposure occurred 5

Remember that rabies is nearly always fatal once symptoms develop, making prompt PEP crucial for preventing death 5, 6. The risk of untreated rabies far outweighs the minimal risks associated with PEP.