Rabies Exposure or Not?

February 2020
Bats hanging from roof

Nothing is ever simple.

Minnesota’s Department of Health, like many others, considers it an exposure to rabies when “a person wakes up in a room in which a bat is flying.” That’s known as a “case definition.” We are instructed to catch the bat and submit it for rabies testing or, if that’s not possible, the individual(s) is considered to have a presumptive exposure to rabies and is, as a result, directed to prophylactically begin rabies inoculations.

So, what’s the decision when:

  • It’s rest hour? A couple campers are sleeping but most are awake, and they see a bat begin flying around the cabin. The kids who are awake obviously know whether that bat came in contact with them. But what about those who were sleeping? Is it sufficient to rely on the testimony of the awake campers who say, “No, the bat didn’t go near the sleeping campers; it just flew around in the rafters”? The offending bat wasn’t caught; it got away.
  • A counselor returns to the cabin before midnight and sees a bat flying around? They follow the camp protocol; the “bat catchers” come to do their thing, but the darn bat disappears. Everyone vacates the cabin; they sleep someplace else while the bat catchers sit in the cabin waiting for the bat to fly. Dawn arrives and the bat still hasn’t made its presence known. After breakfast, the camp’s maintenance staff joins the watchful bat catchers and they begin a systematic search of the cabin. At mid-morning a bat is found wedged into a crevice near the ceiling joists. It’s removed and submitted for rabies testing — but was that the same bat as seen last night? Has too much time lapsed, enough so one must consider the potential that this is a different bat, thus raising the question of an escaped bat and, consequently, triggering the need for rabies shots for those who were sleeping in that cabin?
  • Sleeping under the stars, especially on nights with meteor showers or when the Northern Lights display, is a highlighted camp event? Campers and staff are doing just that, sleeping under the stars as they enjoy nature’s splendor. A counselor wakes during that pre-dawn time when darkness is just beginning to wane and sees bats flying overhead in search of their daytime roost. Do the sleeping campers and staff now need rabies shots?
  • These all happened at a camp. The incidents were brought to the state’s Department of Health so that official entity, the one that created the state’s case definition, could make a decision about the need to start people on rabies inoculations. Risk managers recognize this as transferring the risk, a more comfortable place to be when things fall into “gray” areas. In these situations, the decisions were as follows:
  • The kids sleeping during rest hour met the criteria for the case definition; the campers who were awake did not. Consequently, parents of the sleeping campers were informed of the Department of Health’s recommendation that their children be prophylactically started on rabies shots. Factors that influenced this decision were the age of the campers and the presence of counselors who were also sleeping rather than actively observing the campers.
  • The bat found wedged into the cabin’s ceiling joist was accepted as “the bat” seen flying during the night. The amount of time between seeing and finding the bat and the fact that no other bats were found during the search — yes, the team finished searching the cabin even after finding that first bat — made a difference.
  • For the campers and staff sleeping under the stars, it was determined that they did not meet the case definition. No one was “sleeping in a room.”

As camps become more articulate about the inherent risks associated with a camp experience (the presence of bats is certainly inherent to most camp experiences) and as we cope with incidents that fall into the gray zone of decision-making, situations like these hone our critical thinking (e.g., consideration of the age of campers, the presence of observing staff) and remind us to draw on resources such as the Department of Health.