Once Bitten, Twice Shy

Know the risks of rabies at home and abroad

By Dr Mitch Shulman

David*, a healthy 25-year-old man, entered the emergency room looking terrified. While David was out jogging earlier that evening, he felt something small and furry hit him on his right arm. When he looked up, he saw a bat flying away from him. He called Info-Santé and was told to get to the emergency room at once. He needed to rule out rabies.

Bats are fascinating and essential creatures but they are often the victims of misinformation and myth steeped in fear. But in this case, David’s referral to the emergency room was appropriate. Rabies is a viral illness that’s spread from an infected animal by a bite or by its saliva coming into contact with an open wound or mucous membrane (eyes, nose or mouth).

There is no cure. Only a handful of people survive with intensive care. So it makes sense to avoid infection in the first place. One way is to vaccinate pets and livestock. This has been so successful that it is extremely unusual to be exposed to rabies by dogs, cats or cattle in North America.

In Quebec, the animals most often infected with rabies are bats and raccoons while foxes and skunks can also be infected. The interesting thing about bats is that their teeth are so tiny and sharp that the bite might never even be felt. That’s why even a close encounter with a bat warrants a visit to the emergency room. With rabies, it’s better to start the appropriate preventive measures because the risk of death should infection set in is far too great.

If exposed to a suspected rabies-infected animal, wash the area with soap and water and rinse eyes and mouth with water. Next, get to an emergency room quickly. The faster therapy is initiated, the better. Medical staff will inject immune globulin around the wound and into the body to give it a head start because the body needs time to create its own. At the same time, doctors stimulate the patient’s own protection via vaccination.

Today’s vaccine is far safer with fewer side effects than the old one and requires only four injections over 14 days. This treatment plan has been proven to significantly reduce the risk of developing rabies.

David received his immune globulin injections partly where the bat had hit him in his arm (even though there was no visible wound) and the rest as injections into his behind and we gave him his first dose of the vaccine. He was referred to our infectious diseases clinic to follow up with the rest of the series. He’s expected to do well.



  • never touch a bat, dead or alive
  • avoid patting or feeding a wild or domestic animal you do not know even if it looks harmless
  • vaccinate your pets
  • if bitten, clawed or licked by an animal you suspect is rabid, wash the wound with soap and water for 10 to 15 minutes
  • call Info-Santé (811) or see a doctor at once



* Fictitious name


Dr. Mitch Shulman is attending physician in the emergency department of the MUHC, assistant professor in the Department of Surgery at McGill Medical School and a regular medical contributor to Global TV Montreal’s Morning News.

Fall 2015, Vol 7 N°4

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