One hot July night, I awoke at 3 a.m. to find two bats fluttering above my bed. So I did what any sensible person would do: I dove onto the floor, crawled out of the room, slammed the door, slept on the couch and waited until morning to tell anyone who would listen.
So when my mother started flooding my email inbox with warnings to look into rabies shots, I quickly dismissed them. I was rattled but not bitten.
But I’m a deep sleeper and had no idea how long the bats had been hanging out in my bedroom in the weeks I’d been sleeping with my balcony door open. So I called San Diego County’s health department to inquire about rabies, a viral infection that is spread through the saliva of some animals, affects the central nervous system and is nearly 100 percent fatal.
While bats do carry rabies, it’s still relatively rare. According to the U.S. Centers for Disease Control and Prevention, of all the bats that have been captured or tested for rabies in the U.S., only 6 percent had the disease. The CDC counted only 13 rabies deaths from bat transmissions in the past decade.
Health officials uniformly recommend you get the rabies vaccine if you have been bitten. But they’re not in agreement on whether to get shots if you might have been bitten because you were merely exposed in a bat-in-the-bedroom scenario.
I was referred to county epidemiologist Lisa Yee, who explained that sleeping with bats in your bedroom is considered high-risk exposure. She told me about a case in Texas in which a teenager died of rabies after failing to seek medical attention when he found a bat in his room. He didn’t realize he’d been bitten.
“We advise you get the vaccine,” Yee said. “And I’d appreciate you letting us know that you got it.”
But my primary care doctor didn’t feel the same way. His nurse commented that I was the fifth bat call she’d received in recent months and suggested I should come in only if I had a visible wound. That’s counter to the CDC recommendation to seek treatment for “both bite and non-bite exposures.”
My doctor’s office didn’t have the vaccine anyway, which in San Diego County is available only in emergency rooms and a handful of urgent care centers.
At my local ER, the attending physician looked puzzled about why I was there if I didn’t have a bite mark. She consulted with the hospital’s infectious disease specialist and called Yee before ordering the shots. When I received my second shot, another ER doctor who was tending to actual sick people rolled his eyes, saying it was “highly unlikely” I had come in contact with rabies.
“We get the bat-in-the-bedroom question at least once a day in the summer,” said veterinarian Ryan Wallace, a rabies expert at the CDC’s Division of High Consequence Pathogens and Pathology. He said there are more than 2,000 laws in the U.S. regarding rabies, meaning there’s no consensus among county health departments, but said people should use “critical thinking skills” in evaluating their risk of having been bitten.
That’s trickier than it sounds. Since bats have such tiny teeth, their bites are hardly obvious.
“They look like you’ve been punctured with a stapler, and the marks disappear within a couple of hours,” explained Cindy Myers, bat team leader at Project Wildlife, a program of the San Diego Humane Society, who supervises about 50 bat rescues a year.
Other exposure criteria to consider: Were you an unusually deep sleeper or inebriated? Were children involved or someone with special needs who might be unable to communicate?
Rabies prevention in America has been effective
Despite the uncertainty of who should get vaccinated, the rabies story in the United States is a major public health victory. There have been only 26 human deaths due to rabies in the last decade, and half were from bats. Yet to drive home the point of what could happen, a handful of bat cases have been deemed “cryptic” because the victims didn’t know they were bitten.
“That means they were exposed, trivialized the risk and didn’t seek medical care,” Wallace said.
By comparison, there are 59,000 deaths from rabies each year around the world, and 98 percent are from dog bites. Before the U.S. government made dog vaccinations mandatory starting in the 1950s, there were several hundred deaths each years from rabies contracted from dog bites in the U.S.
“We pretty much eliminated dog rabies in this country,” Wallace said. As a result, bats now account for 90 percent of human rabies cases and in 2015 surpassed raccoons in the “wildlife most likely to be rabid” category, thanks to a recent government push to vaccinate East Coast raccoons by spreading an oral version of the vaccine hidden in marshmallows or fish bait.
Wildlife experts say there’s no evidence of increased interactions between bats and humans, although bats might be more visible these days as steady housing construction encroaches on their habitat.
“Those Spanish tile roofs are perfect for roosting,” said Drew Stokes, wildlife biologist and bat specialist at the San Diego Natural History Museum. He speculated that the bats in my neighborhood north of San Diego, near Carlsbad’s Batiquitos Lagoon, are probably the Mexican free-tail or Yuma myotis species.
“My guess is that they’re juvenile bats. They’re learning to fly this time of year and finding their way around. It lends an element of endearment,” Stokes said. “They’re not coming after you or a pet. They’re looking for shelter and food.”
Why we need to protect bats despite rabies fears
Bats shouldn’t be known for their risk of rabies and late-night visits. They are good for the ecosystem because they produce guano, the gold standard of animal fertilizer, and the majority of North America’s 47 species eat bugs.
But they’re under threat. “Despite the perception there are more bats, their populations are in decline,” said Susan Loeb, research ecologist at the U.S. Forest Service’s southern research station.
From 2006 to 2012, nearly 5 million bats died of white nose syndrome, a fungal disease introduced from Europe or Asia that’s common in the Northeast and is spreading south and west. That’s in addition to the several hundred thousand bats that die annually after flying into wind turbines.
The risk to humans might increase over the next couple of decades as climate change brings species like the so-called vampire bat of Mexico and Central America, which feeds on cattle, dogs and people, into the southern states.
“There’s no indication they’re here yet,” said the CDC’s Wallace. “But we’re actively monitoring it.”
The good news is that rabies prevention is no longer a horrific series of 21 painful shots in the abdomen. Since the mid-1980s, a new vaccine became available that consists of four small shots given over two weeks combined with several shots of immune globulin on the first day to provide antibodies until your body can start producing its own. The bad news is that the shots are expensive, however, especially without insurance coverage.
I’ll never know whether my decision to fork over $600 in ER co-pays and suffer from days of flu-like side effects was a ridiculous overreaction to a minimal risk. But it was a risk nonetheless. And when I hear about the tragedy of 59,000 deaths annually around the world, I’m grateful to have access to lifesaving medicines.