A recent case from Northern Ontario, Canada

The recent publication of a case of rabies in a child in Northern Ontario, Canada, is a timely reminder that animal injuries aren't always obvious. According to the report the eleven-year-old child awoke to find a bat on his face. It covered his face and nose. He slapped it off in a reflex action and sustained no obvious injury.

No blood or puncture marks were identified and no follow up was considered necessary.

Less than 3 weeks after the incident, the child began to feel unwell. He developed neurological signs and despite intensive medical care could not be saved.

The parents agreed to publicise the case hoping to warn other families of the danger of rabies exposure in situations where there were no obvious signs of injury.

This is a very tragic case, and it would be easy as a parent to identify with the scenario. Children are often unattended and they don't always report a significant incident. Animal exposures, particularly with bats, are always significant. In most instances our concerns are more focused on dogs, cats and monkeys.

Rabies and lyssavirus in an Australian context

In 1987, a 10-year-old Australian child died from a monkey bite sustained more than 17 months prior to his death. In this case the cause of death was identified as rabies on postmortem. The carer of the child was unaware of any "warm blooded" animal exposure and only learned of the exposure when reading one of the child's school stories when going through his personal effects some months later. There was also a picture of the child feeding a monkey in a marketplace. He and his mother had travelled through several countries in Southeast Asia, including India, Pakistan, Singapore and Thailand. He was known as an animal lover and had experienced animal injuries in the past.

In 1987, a 10-year-old Australian child died from a monkey bite sustained more than 17 months prior to his death. In this case the cause of death was identified as rabies on postmortem. The carer of the child was unaware of any "warm blooded" animal exposure and only learned of the exposure when reading one of the child's school stories when going through his personal effects some months later. There was also a picture of the child feeding a monkey in a marketplace. He and his mother had travelled through several countries in Southeast Asia, including India, Pakistan, Singapore and Thailand. He was known as an animal lover and had experienced animal injuries in the past.

The two cases are different but both involve young children. While the most recent case is more about the early management of a possible exposure, both highlight the importance of educating children about the risks of interacting with wildlife and domesticated animals overseas.

Bats are a concern in Australia. A man died from bat lyssavirus in July 2025. He was exposed when trying to free a bat from an enclosed balcony in his home on the north coast of New South Wales. Lyssaviruses can cause a rabies like virus disease.

Many deaths might be prevented by timely management of the wound and post exposure prophylaxis (rabies immune globulin and rabies vaccine).

Rabies risk in travellers

Deaths due to rabies are occasionally reported amongst travellers. Healthy Travel reported on the death of a British traveller who was bitten by a stray dog on a beach in Morocco.

The disturbing feature of most cases in travellers is the failure to seek medical advice after a "warm blooded furry animal" exposure. The need for urgent medical advice in the event of exposure should always be part of any pre-travel advice for travellers to rabies endemic countries.

The consideration of a course of pre-travel rabies vaccinations should be based on individual circumstances.

Rabies occurs in more than 150 countries worldwide with dogs responsible for more than 99% of human cases.

Over half the deaths are in children under 15 years. Children are more likely to be savaged around the head and neck region. The proximity to the central nervous system can mean a shorter period before symptomatic disease. The disease is almost invariably fatal once symptoms occur.

It is estimated that more than 50,000 people die of rabies annually and many deaths go unreported. Three or four traveller deaths are reported each year.

Rabies deaths are preventable.

Excellent vaccines are available for long term protection and post-exposure prophylaxis is very effective, in the event of an exposure.

According to the World Health Organisation (WHO) an estimated 29 million people receive post exposure prophylaxis for rabies every year.

How travellers can reduce the risk

The risk of exposure can be dramatically reduced by just following some simple rules.

Do not:

• pat dogs
• pick up pussy cats
• feed monkeys

The message is a simple one:

Do not engage with animals while overseas.

If you are unfortunate to have an exposure, seek medical advice as soon as possible.

Prompt management of the wound is also vital. It should be gently cleaned with copious amounts of soapy water before applying a virucidal solution like povidone-iodine. This also helps to reduce the risk of bacterial secondary infection.

The Australian Immunisation Handbook provides very useful advice on the management of a possible exposure to rabies or lyssavirus. There are 3 categories of exposure.