Rabies Scare Leads to Quick Public Health Action

By Jacquelyn Lickness

When a hospital in South Carolina spotted bats flying through its facility, officials sprang into action launching an investigation to prevent a possible rabies outbreak. Because bats are commonly infected with the virus, any contact with the flying mammals is taken very seriously. The hospital quickly involved state public health officials, who then reached out to CDC to help investigate any possible exposure to the rabies virus.

Rabies is a disease typically acquired through the bite of a rabid animal, and can be deadly if the exposure (e.g., bite) is not recognized early enough. Across the globe there are more than 55,000 human deaths from rabies each year. However, in the U.S. human cases are extremely rare, with approximately two human deaths annually. Most exposures to the rabies virus in the U.S. occur through contact with animals that are commonly infected with the virus, including bats, raccoons, skunks, and foxes.

Participation in the response effort

The response effort in South Carolina is ongoing and has involved collaboration among hospital staff, state public health officials, and CDC rabies experts and volunteers. Because hundreds of patients and hospital staff might have come in contact with bats, it was important to assess each individual’s risk of exposure.

In this event, it was critical to understand any interaction with a bat. It is possible that bat bites can go unnoticed if the person is sleeping or sedated, thus placing a person at risk for rabies. As a result, the investigation team asked about certain activities such as bat handling and touching, heavy sleeping or sedation, and other medical history that may indicate exposure.

Rabies expert and CDC Epidemic Intelligence Service (EIS) Officer Dr. Neil Vora orchestrated a response that included the administration of hundreds of phone-based surveys to hospital patients and staff. This large-scale investigation was managed through the CDC Emergency Operations Center. EIS officers, veterinary and medical students, and public health students from nearby Emory University eagerly offered their support for the data-gathering activities. The Student Outbreak and Response Team (SORT), a public health organization from Emory University that assists in outbreak responses, organized a contingency of nearly 20 students to assist the efforts. In the span of four days, a total of 55 volunteers made 817 calls.

The investigation wasn’t just limited to patient questionnaires. Other activities included the distribution of letters and flyers to patients and visitors to warn of bat exposure, mapping and creation of a timeline of bat sightings, and testing of bats for rabies. A quick response was made possible through collaboration between the hospital, South Carolina public health officials, a local pest control company, and all participants at CDC.

Determining the extent of exposure

In total, 53 bats have been sighted in the hospital, of which 12 were tested and have results available, all of which were negative. That said, other bats in the colony that have not been tested could still have had rabies. After the removal of the bats and other interventions to prevent their re-entry, the bat sightings have decreased. As a result of the collaborative effort among CDC, the state public health department, and the affected hospital during this response, partnerships were strengthened and new public health tools and practices were developed. Most importantly, all involved continue taking measures to understand best practices in rabies prevention and treatment to ensure the safety of the public’s health.