On 22 November 2024, a Fresno, California teacher died of rabies after being bit by a bat in her classroom. It is an awful story that could have been completely preventable with the rabies vaccine. But once symptoms appear, usually within a few days or weeks of being bitten by a rabid animal like a bat, rabies is 100% fatal.

I have written previously about a child who developed rabies but their parents did not get the child the vaccine treatment after the bite.

This post will review rabies, the rabies vaccine, and the sad story of this Fresno teacher.

All about rabies and the rabies vaccine

Rabies is a viral disease that causes inflammation of the brain in humans and other mammals. The virus is transmitted by a bite or scratch from an infected mammal.

The rabies virus is slow to infect humans, although the course of infection is highly variable, depending on how much virus was transmitted from the infected mammal. The incubation period (the period between initial infection to first symptoms) is about 1-3 months in humans but can be as short as four days and as long as six years.

The initial signs and symptoms of rabies are nonspecific – it includes fever and headache which can be misdiagnosed as many other diseases. As the infection progresses and causes meningoencephalitis, an inflammation of the brain and/or meninges, it leads to more severe symptoms. These signs and symptoms can include paralysis, anxiety, insomnia, confusion, agitation, paranoia, terror, and hallucinations. This eventually leads to coma and death, usually 2 to 10 days after the first symptoms appear.

Once someone presents with the earliest symptoms of rabies, the prognosis is poor – nearly 100% of those individuals who present with rabies symptoms will die. The “Milwaukee protocol” treatment has been used to treat patients who have become symptomatic, although its success rate is limited, and many researchers dispute that it even works at all.

Many scientists who research rabies infection in humans are highly critical of the Milwaukee Protocol and have urged hospitals to abandon it. There is little solid evidence that the protocol is effective. Because some individuals can survive the disease, it appears that the effectiveness rate for the protocol is essentially random – those that recover probably would recover irrespective of the use of the protocol.

The only prevention and treatment for rabies is the rabies vaccine. Although the vaccine is strongly recommended (and probably legally mandated) for your pets, it is generally not given to humans before infection except when someone is frequently in contact with rabies-infected mammals.

However, the CDC’s Advisory Committee on Immunization Practices (ACIP) has established a postexposure prophylaxis protocol to treat a rabies infection. The recommendation needs to be implemented immediately after exposure from an infected animal (either confirmed or suspected) – once again when symptoms appear, it’s too late.

This protocol includes the following steps:

• Thorough cleansing of the wound site with a virucidal soap and water.
• A proper injection dose (based on the patient’s weight) of human rabies immunoglobulin which attacks the rabies virus.
• Four doses of the rabies vaccine, at days 0, 3, 7, and 14, boosts the immune system to destroy the rabies virus. In this case, the vaccine is not a prevention but a treatment.

The old method of several painful injections in the abdomen is long gone. All of these injections are done intramuscularly in the deltoid muscle. The success rate of this protocol, if done immediately after exposure, approaches 100%.

Thus, if you get immediate treatment for rabies after a bite or scratch from a confirmed or suspected rabies-infected mammal, your chances of living are quite large. If you wait until symptoms appear, the chances of survival drop to almost nothing. This should not be much of a choice.

Fresno teacher gets rabies from a bat

About a month before her death, the teacher was bitten by a bat. Although the details weren’t clear, she found the bat in her classroom and attempted to move it outside. It was during this time that she was bitten or scratched which she apparently dismissed or ignored.

Typical of the pathophysiology of rabies, the victim did not show any symptoms of rabies during the following days. She developed symptoms and checked herself into the hospital on 18 November and died of rabies on 22 November.

According to health officials, bat bites are often too small to be detected and rabies could go unnoticed or undiagnosed. Anyone who comes into contact with a bat, alive or dead, should report the encounter to their healthcare provider. Additionally, anyone who wakes up with a live or dead bat in their room should also report it. In either case, the rabies treatment protocol can begin and lives can be saved.

Summary

I know many of my readers find bats to be cute (I do not, they freak me out), but they can carry rabies. A small cut or bite, which may be dismissed as minor, will lead to a rabies infection that must be treated with the immunoglobulin plus the vaccine. That is your ONLY hope in avoiding a tragic death.

Also, it is not just bats that can be dangerous. A dog or cat that has not received the vaccine may carry the disease. Many wild animals can also carry the disease. If the public health department cannot capture the actual animal to determine if it has rabies, then the victim of the bite or scratch needs to have rabies treatment as a precaution.

I hope that anyone who reads this story about the teacher will be careful with wild animals, especially bats, in the future. If you handle a wild animal, even if you don’t think you were bitten or scratched, you need to see a healthcare provider immediately to determine the best course of action, which will probably include the CDC-recommended treatment strategy.

And this isn’t the time for whining and complaining about vaccines — that bat bite will lead to rabies and, once symptoms appear, you will have a nearly 100% chance of dying. And that is a tragedy.

Citations

• Jackson AC. Human Rabies: a 2016 Update. Curr Infect Dis Rep. 2016 Nov;18(11):38. doi: 10.1007/s11908-016-0540-y. PMID: 27730539.
• Manning SE, Rupprecht CE, Fishbein D, Hanlon CA, Lumlertdacha B, Guerra M, Meltzer MI, Dhankhar P, Vaidya SA, Jenkins SR, Sun B, Hull HF; Advisory Committee on Immunization Practices Centers for Disease Control and Prevention (CDC). Human rabies prevention–United States, 2008: recommendations of the Advisory Committee on Immunization Practices. MMWR Recomm Rep. 2008 May 23;57(RR-3):1-28. PMID: 18496505.
• Zeiler FA, Jackson AC. Critical Appraisal of the Milwaukee Protocol for Rabies: This Failed Approach Should Be Abandoned. Can J Neurol Sci. 2016 Jan;43(1):44-51. doi: 10.1017/cjn.2015.331. Epub 2015 Dec 7. PMID: 26639059.