An 11-year-old boy in Ontario died from rabies after a bat sat on his face while he was sleeping, according to a recent report in the Canadian Medical Association Journal. The case, which occurred in northern Ontario in 2024, marks the first locally acquired rabies infection in the province since 1967.
Incident and Initial Response
The boy was awakened by a bat on his nose and mouth. After swatting the bat away, his father caught it and released it outside. The parents did not seek medical attention because there were no visible signs of bites or scratches on the boy's face. According to the report titled "Fatal Rabies in a Child," rabies is extremely rare in Canada, with only 28 cases reported since 1924.
"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 wrote. PEP, or post-exposure prophylaxis, involves a combination of antibodies and a vaccine given to the patient. The report notes that if the bat or other animal is available for testing, results can be obtained within 48 hours.
Symptoms and Diagnosis
More than two weeks after the incident, the boy developed tingling, numbness, and swelling on the right side of his face. He was taken to a clinic and prescribed an antiviral drug. A few days later, he was admitted to a hospital, where his condition deteriorated. Symptoms included facial weakness, slurred speech, fever, trouble swallowing, confusion, and visual hallucinations.
"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," the report said. Doctors eventually diagnosed rabies, and the Canadian Food Inspection Agency confirmed a bat rabies virus variant. However, "no proven effective therapy exists after symptom onset." On day 17 of hospitalization, the boy died "peacefully with his family at his bedside."
Public Awareness Gap
The report highlights a critical gap in public awareness about rabies risks from bats. "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," the authors stated. In North America, bats, skunks, raccoons, and foxes are primary carriers, with bat exposures accounting for most human cases.
Rabies has a fatality rate of nearly 100% if not treated early after exposure. Only 34 survivors have been documented, most with severe neurologic sequelae — long-term after-effects affecting the brain, spinal cord, and nerves. The report emphasizes that rabies PEP is highly effective if administered promptly after any direct human contact with a bat, even without visible lesions.
Prevention and Awareness
According to the Ontario Nature website, eight bat species reside in Ontario: the hoary bat, eastern red bat, silver-haired bat, big brown bat, tricolored bat, little brown myotis, northern long-eared myotis, and eastern small-footed myotis. Health Canada provides online resources about rabies and its treatments.
"This case illustrates several critical points about rabies. Rabies is almost always fatal, with no established efficacious therapies, making prevention crucial," the report concluded. "Clinicians should ask patients with progressive neurologic symptoms compatible with rabies about exposure to potentially rabid animals."
