Ontario boy dies of rabies after bat encounter

Ontario boy dies of rabies after bat encounter

An 11-year-old boy in Ontario has died of rabies after waking in the middle of the night to find a bat resting on his nose and mouth. The fatality represents the first locally acquired rabies case in Ontario since 1967, according to medical experts.

The incident occurred in 2024 while the child and his family were staying at a cottage in northern Ontario. According to a report published in the Canadian Medical Association Journal, the boy immediately swatted the bat away. His father then caught the animal in a cooking pot and released it outside.

Because the boy had no visible scratches or bite marks and his parents did not believe the bat was behaving oddly, the family did not seek immediate medical care. Doctors noted in the report that the absence of unusual behaviors does not exclude rabies and that bat bites are often so small they are easily overlooked.

The rabies virus typically has a long incubation period, but once symptoms manifest, the disease is almost always fatal. For this child, the onset began 19 days after the encounter. He first experienced numbness, tingling, and swelling on the right side of his face, as well as vomiting and pain.

The boy visited clinics and emergency rooms over several days as physicians struggled to diagnose the cause of his symptoms. He was initially treated for herpes and Bell’s palsy — a temporary paralysis of facial muscles on one side. At one point, he was discharged with a presumed diagnosis of herpes gingivostomatitis, a viral infection of the mouth and gums. However, the history of bat exposure led an emergency physician to contact local public health authorities to determine if anti-rabies medication was necessary.

His condition deteriorated rapidly the following morning. While waiting in a hospital, the boy developed a fever of 39C (102F), confusion, difficulty swallowing, excessive salivation, and severe visual hallucinations. He was intubated and admitted to the pediatric intensive care unit at McMaster Children's Hospital in Hamilton, Ontario.

Medical teams, including doctors from the University of Manitoba’s Department of Pediatrics and Child Health, strongly suspected rabies. Tests later confirmed the diagnosis, and the Canadian Food Inspection Agency identified a bat rabies virus variant. An MRI revealed lesions on the boy's brain stem.

The medical team and the family considered administering rabies antibodies directly into the boy's brain, but they decided against it due to the invasive nature and lack of established efficacy of the procedure. Because there is no proven cure once symptoms appear, the patient received supportive care. He eventually lost brain stem function, and life-sustaining therapies were withdrawn on the 17th day of his admission. He died with his family at his bedside.

The case highlights a critical public health warning regarding post-exposure prophylaxis (PEP), a series of treatments involving human rabies antibodies and a vaccine. According to the Canadian Medical Association Journal, PEP is nearly always effective when administered promptly after exposure, citing success in 29m cases.

Rabies is exceptionally rare in North America. The Canadian Veterinary Medical Association reports only 28 human deaths in Canada since 1924. The association attributes this low rate to widespread vaccination programs, warning that a failure to continue these programs can and will result in a return of disease.

While skunks, raccoons, and foxes can carry the virus, bats are the primary animal vector in North America. Specifically, silver-haired bats (Lasionycteris noctivagans) are responsible for the majority of Canadian cases, according to a 2013 report in the Journal of Virology. The virus enters the body through infected saliva, often through bites, scratches, or contact with the eyes, nose, or mouth.

Physicians urge that any direct human contact with a bat — regardless of how the animal behaves or whether a wound is visible, is an indication for immediate medical evaluation and PEP. The boy's parents consented to the publication of the case to help increase public awareness of these risks.