Amber Kunkel, Sc.D., from the CDC in Atlanta, and colleagues reported three human rabies deaths in the United States during Sept. 28 to Nov. 10, 2021, all of which occurred in individuals who did not seek postexposure prophylaxis (PEP) after bat exposures that occurred in August 2021. During the previous 48 months, there were only three bat-associated human rabies deaths in the United States.

The researchers note that the cases in fall 2021 occurred in two adults and one child, all male. Pain and paresthesia near the site of exposure were included as initial symptoms, which progressed to dysphagia, altered mental status, paralysis, seizure-like activity, and autonomic instability. All three patients had recognized direct contact with a bat about three to seven weeks before onset of symptoms and died about two to three weeks after onset of symptoms. The deaths were associated with Lasionycteris noctivagans, Tadarida brasiliensis, and Eptesicus fuscus, all of which are common in the United States. Due to a long-standing fear of vaccines, one patient refused PEP, despite the bat testing positive for rabies. The other two patients did not realize their risk for rabies after exposure.

"Avoiding contact with bats is the best way to protect both bat and human health," the authors write. "When human-bat contact is unavoidable, bat rabies testing and PEP are highly effective strategies to save human lives."