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News From the Centers for Disease Control and Prevention
March 24/31, 2020

Hundreds of Health Care Workers Exposed to Rabies

JAMA. 2020;323(12):1125. doi:10.1001/jama.2020.2851

A Utah man who became infected with rabies after handling several bats potentially exposed 279 other people, most of them health workers.

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The case was first reported to the Utah Department of Health on November 3, 2018, but the 55-year-old man’s symptoms had begun 18 days earlier. The man initially sought chiropractic care for arm and neck pain he attributed to a previous injury. Two days later he went to the emergency department with ongoing pain, a burning sensation in his arm, and numbness in his hand. He had no fever or chills but reported being unable to drink. He received a prescription steroid and was discharged.

Two days later he returned to the hospital with breathing difficulties and lightheadedness. After being transferred to 2 more hospitals with worsening symptoms, he developed a high fever and became comatose. The man received steroids for presumed autoimmune encephalitis. He was then transferred to a fourth hospital after developing seizures. An infectious disease specialist there noted the man’s muscle spasms while swallowing could indicate rabies.

After the man died, CDC testing confirmed a rabies diagnosis. It was the first human rabies death in Utah since 1944. His family said the man had handled several bats that entered his home’s attic and master bedroom, but they weren’t aware of the rabies risk associated with bats. Further investigation identified 279 people, mostly health care workers, who were potentially exposed to rabies. More than 100 required postexposure prophylaxis, including 74 health workers. Public health workers distributed fliers and posters describing the rabies risk from bats.

“Educating the general public about the risk of rabies through bat exposure and advising health care providers to consider rabies in the differential diagnosis of unexplained neurologic symptoms could reduce exposures,” the authors wrote.

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