Stay away from bats

Infectious diseases experts have warned people to stay away from bats after releasing details of the treatment of an 8-year-old boy in Queensland who died from infection with the Australian Bat Lyssavirus (ABLV) earlier this year.

The boy was the third reported case of ABLV and the first in a child. There is no proven effective treatment for lyssavirus infection in humans.

Drs Joshua Francis and Clare Nourse and colleagues, from the Mater Children’s Hospital in Brisbane, issued the warning at the Australasian Society for Infectious Diseases meeting held last week in Canberra.

ABLV was first identified in Australian bats and flying foxes in 1996 and is common in these animals.

Human infection is rare, but once the disease has progressed, it is almost always fatal.

Two adult cases were confirmed in 1996 and 1998 - one was a woman bitten by a flying fox after trying to remove it from a child and the other was a carer who looked after these animals.

ABLV is one of 12 known lyssavirus strains. Other strains circulate in bats in the USA and Europe, and multiple cases of human infection and subsequent deaths have been reported.

The 8-year-old boy was bitten during a family holiday to northern Queensland in December 2012 and did not tell his parents. Three weeks later he began to suffer convulsions, severe abdominal pain and fever, followed by progressive brain problems.

Analysis of his brain and spinal fluid were normal at first, but on day 10 of his admission increased levels of lyssavirus were detected. The boy’s neurological condition deteriorated and treatment with the antiviral, amantadine, was unsuccessful. He died in February 2013.

The warning applies to wherever bat or flying fox populations exist and is not just for the danger from bats themselves, but the risk, however remote, that the disease could spread between humans.

“Human to human transmission of lyssaviruses has not been well documented, but it is theoretically possible,” Francis said.

“Local and international guidelines recommend post-exposure prophylaxis (PEP) for anyone who has had skin or muscosal contact with saliva or neural tissue from an infected person. This involves immunoglobulin treatment and vaccination. Following the diagnosis, we identified 175 potential contacts of the boy, and of these five household members and 15 healthcare workers were offered PEP.”

The lyssavirus is closely related to the rabies virus - the rabies vaccine is used to protect against ABLV infection. Only vaccinated people who have been trained in the care of bats should handle bats or flying foxes.