The British Columbia Centre for Disease Control (BCCDC) has changed its rabies exposure guidelines and gone against established protocols used elsewhere. Typically, anyone who has slept in a house where a bat was present at the same time is considered to have been exposed to rabies if the bat was rabid or the bat’s rabies status is not known. This is because bats can bite people while they are sleeping and the bite wounds can be so small that someone may not even notice after they wake up. People who get rabies from a bat bite almost always die. Because of the severity of this disease, the general rule has been to err on the side of caution and consider anyone even possibly bitten by a bat as exposed to rabies.
Yes, rabies is a very rare disease in people in this part of the world… but you don’t want to be the rare person that gets it. I understand that risk analysis may indicate that there is, overall, low risk from sleeping in the same house with a bat, and that almost all people that receive post-exposure treatment didn’t actually need it. However, for a fatal disease with the potential for uncertain exposure in such a situation, I think this is important to err on the side of caution. It’s always difficult to reconcile risk analysis data with human lives. The BCCDC estimates that this new policy will only result in one (1) additional rabies death every 675 years. That’s not a lot, but how would you like to be that one person?
I hope this isn’t a decision influenced by cost. Post-exposure treatment costs about $1500 per person, and they expect that this protocol will result in "hundreds" of fewer people receiving treatment. The treatment of all people sleeping in houses with bats actually costs a huge amount of money to prevent a small number of cases. However, what is the cost (financial and otherwise) of even a single case of rabies that could have been prevented? That’s a lot harder to incorporate into a risk analysis. Personally, if I had a bat in the house overnight and my kids were potentially exposed (again!), I’d go for post-exposure treatment without any hesitation. Call me a paranoid parent if you will, but I’d sleep much better at night (for years, since the incubation period following exposure can be a long, long time).