Nobody Ever Said "I'm Glad I Touched That Bat"

“Since July 2026, multiple United States Jurisdictions have reported local increases in human rabies exposures involving known rabies vectors or animals in which rabies is less commonly reported.”

Centers for Disease Control and Prevention, September 10, 2026

“Despite being 100% preventable, nearly 70,000 people (worldwide) die from rabies each year.”

Centers for Disease Control and Prevention, August 30, 2026

World Rabies Day (WRD) is celebrated each September 28 to raise global awareness about rabies prevention and to honor Louis Pasteur, who developed the rabies vaccine. Despite being on the verge of WRD, I hadn’t been thinking about rabies recently. But in catching up on my medical reading, I learned that on September 10, 2026, the Centers for Disease Control and Prevention had issued a Health Alert Network Health Advisory in response to recent reports of increases in human exposures to rabid or possibly rabid animals and rabies post-exposure prophylaxis  administration errors. In addition, in reading our local newspaper, I learned that on September 15, 2026 a woman had picked up a bat from the sidewalk in downtown Minneapolis and that the bat had tested positive for rabies. Spurred on by these events, I thought it a good time to provide a recap on “the world’s most diabolical virus”—rabies.  (Wasik, B., and Murphy, M., Rabid: A cultural history of the world’s most diabolical virus, New York: Viking Press (2012)).

What is rabies (recap)? Rabies is an especially gruesome infection of the nervous system (brain and spinal cord) caused by an RNA virus of the genus Lyssavirus. The rabies virus is one of a surprisingly small number of infectious agents that kills virtually all of its human victims.

Epidemiology. Rabies is a zoonotic infection, that is, the virus is transmitted from animals to humans. Globally, bites from infected dogs are the main source of human rabies and are responsible for up to 99% of all rabies transmissions to humans. In addition, bites from infected bats, foxes, skunks, raccoons, and cats pose a risk for humans. Interestingly, bites from rodents, such as mice, rats, hamsters, gerbils and squirrels are not a problem nor are bites from lagomorphs (rabbits and hares).

Until 1960, dog bites were the main source of rabies in the U.S. Since then, a collaboration between veterinary medicine and public health to vaccinate all dogs against rabies has dramatically changed the epidemiology in America and in many other industrialized countries. Bats have now emerged as the main carrier of rabies in the U.S.

With the exception of Antarctica, rabies is present on all continents, with over 95% of human deaths occurring in countries in Asia and Africa. Only a handful of countries are considered rabies free—Australia and the Cayman Islands among them. World travelers, therefore, need to be alert to the risk of rabid animals.

Symptoms. The name “rabies” is derived from the Latin rabies meaning “rage, madness, fury.” The genus name of the rabies virus, Lyssavirus, comes from the Greek work lyssa meaning “violent.” Rabies virus is one of many RNA viruses that targets the nervous system. As the name suggests, rabies is a violent disease characterized by a frenzied madness.

After an incubation period lasting on average 2-3 months following a bite, fever with pain and an unusual tingling sensation at the bite wound site develop. As the virus spreads along nerves to the central nervous system, progressive and fatal inflammation of the brain and spinal cord develop.

There are two clinical forms of rabies: “furious rabies” and “paralytic rabies.” The furious form results in signs of hyperactivity, excitable behavior, hydrophobia (fear of water), and sometimes aerophobia (fear of drafts or of fresh air) and results in death. Paralytic rabies runs a less dramatic course, but eventually also ends with death. Like a majority of American physicians, I have never cared for a patient with rabies, but for training purposes I’ve viewed videos of patients with both forms of the diseases which have left a lasting impression on me—their deaths were horrifying.

Post-exposure prophylaxis (PEP). While rabies is a frightful disease, it is 100% preventable through timely administration of rabies vaccines, called Rabies Post Exposure Treatment. But time is of the essence to prevent death. The immediatetreatment of a bite victim after rabies exposure with rabies vaccine plus administration of rabies immunoglobulin (a regimen referred to as PEP), prevents viral entry into the central nervous system, thus saving lives.

What you need to know. A clinical tipoff that an animal is rabid is an unprovoked bite. A rabid bat, however, may transmit the virus in its saliva via an aerosol. Therefore, indoor exposure to bate, even without a witnessed bite, is a matter of concern.

If you, a family member or a friend is bitten by a bat, or another animal known to transmit rabies, immediately wash and flush the wound for a minimum of 15 minutes with soap and water. Then call for help. (This step applies if you’ve seen a bat flying in your home). Your doctor is a source of reliable information regarding the next steps. Moreover, your physician will work with officials at your state’s department of health coordinating the management of your treatment. Both will also work with veterinary medicine colleagues to decide what steps should be taken regarding quarantining of potentially rabid animals for observation or for euthanizing them for examination of the brain for the virus.

World Rabies Day 2026.  I finished this post and sent it off to be published on World Rabies Day, September 28, 2026. In July 1885, the French scientist Louis Pasteur  was the first to administer a rabies vaccine, thereby saving the life of a 9-year-old boy who had been attacked by a rabid dog. (Pasteur died on September 28, 1895,)  Rabies is a remarkable example of the benefit of vaccination. While rabies is close to 100% fatal, with PEP treatment, death is 100% preventable. Thank you, Monsieur Pasteur.