Bats

[Bittersweet]

Ughhh, we have bats in our attic. The thought of them mere feet above our bedroom...shudder. Has anyone dealt with this before? I can't search the internet anymore. The pictures I'm finding are the stuff of nightmares. What the freak do I do?

[DCJenn]

Re: Bats

and remember, they eat thousands of pounds of insects. They're good to have around.

Jenn

Re: Bats

Yea, they eat insects but it isn't to swell when they bite your 3 year old and has to undergo rabies shots as well as your DH. Rabies is spread through saliva droplets in the air so even being in the same room with them puts you at risk. If there is no way for them to enter the house I wouldn't worry as much but I would definately call an exterminator. Problem is that its hibernation time and you may not get them all out till spring.

[Bittersweet]

Re: Bats

Holy crap Trisha, I didn't even think about rabies. Your poor kiddo and DH. I don't think there is anyway for them to get into the house. But let me tell you, if I see a bat flying in my house I may need therapy.

[Meenah]

Re: Bats

Call your local animal control officer and your local health department. We had a bat in our house and we all had to have rabies shots approx 3 years ago. The problem was the cat ate the bat so we had no bat to test for rabies. Unfortunately, rabies is 100% curable if treated with the vaccines and 100% fatal if not. Of course that is only if the bat does have rabies. We live in the Northeast, and rabies is really becoming more comon up here. If you live in the south, the risks of rabies are higher. Damn, I know more about this than I want to.

[Meenah]

Re: Bats

Also, if your DH is ID or has friends in ID, they are an excellent resource.

[peggyfromwastate]

Re: Bats

That is scary Luanne.... Scary. I hear that bat guano can be really bad for you too--- is that the rabies? Or something else entirely???

[Meenah]

Re: Bats

From Uptodate, more information than you ever wanted to know but important if you have or may be exposed to bats.

Patient information: Bites and rabies

Larry M Baddour, MD, FIDSA
Erin E Endom, MD


UpToDate performs a continuous review of over 375 journals and other resources. Updates are added as important new information is published. The literature review for version 15.3 is current through August 2007; this topic was last changed on August 4, 2006. The next version of UpToDate (16.1) will be released in March 2008.

INTRODUCTION — Animal bites are a common problem in the United States, with two to five million occurring each year. Children are bitten more often than adults. The vast majority of animal bites are caused by dogs (85 to 90 percent), with the remainder caused by cats (5 to 10 percent) and rodents (2 to 3 percent).

The most feared complication of an animal bite is rabies, although skin infection is the most common complication. Some bite wounds can be serious, causing injury and permanent disability. Bite wounds to the hand carry an especially high risk for serious complications because the skin's surface is so close to the underlying bones and joints.

TYPES OF BITES — The location and type of the injury depends upon the animal inflicting the bite.

Dog bites — Victims of dog bites frequently know the dog that attacked them. Most dog bites occur in children, with the highest number seen in boys between the ages of five and nine years old. The head and neck are the most common site of bites in children up to age 10 years, probably because a child's head is close to the level of a large dog's mouth. The extremities (arms and legs), particularly the right hand, are the most frequent site of injury for older children and adults. A dog bite can lead to a range of injuries, including scratches, deep open cuts, puncture wounds, crush injuries, and tearing away of a body part. Dog bites rarely cause death.

Certain breeds of dog are more commonly associated with bites. German Shepherds, pit bull terriers, and mixed breeds account for the majority of dog bite injuries.

Cat bites — Cats can cause wounds with their teeth or claws. Most of these bites are provoked, meaning that the cat was teased or bothered by the victim before the bite. Two-thirds of cat bites involve the upper extremities (arms and hands). Scratches typically occur on the upper extremities or face.

Deep puncture wounds are of particular concern because cats have long, slender, sharp teeth. When the hand is bitten, bacteria can get into the tissue that surrounds the bones or into a joint and result in osteomyelitis (infection of the bone) or septic arthritis (infection of the joint).

Infection generally progresses rapidly, causing skin redness, swelling, and intense pain as quickly as 12 to 24 hours after the bite.

Rodent bites — Rats cause the majority of rodent bites. Most bites occur at night on the face or hands in children five years old or younger. Rat bites are more common in areas where living conditions are poor.

Human bites — Children are the most common victims of human bites, usually as a result of aggressive play with another child. Human bites can cause a semicircular or oval area of skin redness or bruising, and the skin may be punctured. Human bites are typically located on the face, upper extremities, or trunk (chest or abdomen).

Other types of bites — The bites of most other animals, such as squirrels, rabbits, and guinea pigs, are generally treated the same way as cat bites.

Persons who are bitten by a raccoon, skunk, fox, coyote, or bat need immediate medical attention, even if the bite is small and does not appear to be infected. These animals can be carriers of rabies, and post-bite rabies prevention should be started as soon as possible (see "Rabies" below).

BITE TREATMENT — After being bitten by an animal or human, it is important to quickly and carefully clean the wound thoroughly with soap and a large amount of water; this can help to prevent infection. If there is bleeding, a clean towel or gauze should be pressed to the wound to slow or stop the bleeding.

Some persons should seek medical attention to determine if further treatment is needed and to ensure that there are no other wounds. Adults or children who have been bitten by an animal or human should see a healthcare provider in the following situations:

A cat has bitten and broken the skin. It is not necessary to be evaluated after a cat scratch unless there are signs or symptoms of infection (worsening pain, warmth, or redness, pus-like discharge, or fever).
A dog has bitten the hand, foot or head, or has bitten another area and caused a large wound.
A bite victim has diabetes, liver disease, cancer, HIV or AIDS, or takes a medication that could weaken the immune system.
Bleeding does not stop after applying pressure for 15 minutes, a bone may be broken, or if there is other serious injury.
A person who is bitten should watch for signs of wound infection (eg, worsening pain, redness, or warmth, fever, or pus-like discharge); if the bite is near a joint, then pain, swelling, and joint movement should be monitored. Medical attention should be obtained if any of these features develop or if the wound appears to be worsening rather than improving.

Sutures (stitches) — Some wounds can be sutured (stitched closed) within several hours of the injury, after the wound is thoroughly cleaned. Wounds to the face are usually closed immediately because healing without a scar is cosmetically preferred.

However, due to the risk of infection, some bite wounds may not be sutured immediately. These wounds may be left open and sutured 72 hours after the injury. When wounds are left open, they are flushed with saline (a salt and water solution), left open to drain, covered with a dressing, and examined daily to look for signs of infection.

Immediate suturing is not recommended for wounds at high risk of becoming infected, including:

Crush injuries
Puncture wounds
Bites involving the hands
Dog bite wounds that occurred many hours earlier
Cat or human bites, except those to the face
Bite wounds in people who have a weakened immune system
Management of an infected bite wound — Patients who do not seek immediate medical attention after being bitten may develop an infection in their wound. If this happens, surgical treatment and antibiotics may be required. Patients with an infected wound can be treated at home unless the patient is not able to take care of their wound or if there is concern that the infection is worsening; in these cases, hospitalization is recommended.

Persons with risk factors for wound infection should seek prompt medical attention even if there are no signs of redness. For example, a person who has a deep puncture wound in their hand from a cat bite should seek medical attention immediately to prevent infection. Medical care usually consists of cleaning and dressing the wound and oral antibiotics that can be taken at home.

An x-ray may be done to ensure that there is no bone fracture and that tooth fragments are not buried in the wound. Infected bite wounds are not generally sutured immediately. Severe wound infections may require intravenous therapy and hospitalization.

INFECTION PREVENTION — The most common complication of an animal bite is infection. Antibiotics are generally recommended to prevent infection for high-risk wounds, facial wounds, wounds involving a bone or joint, and for patients with other health problems, such as a weakened immune system or diabetes, which could increase the risk of serious infection.

Many experts also recommend antibiotics for any person bitten by a cat as there is a high rate of infection from cat bites.

Antibiotics are usually given in a pill form for a short duration to prevent infection. Some persons will require intravenous antibiotics or treatment for a longer time, especially if the wound becomes infected.

Tetanus immunization — Tetanus is a serious, potentially life-threatening infection that can be transmitted by an animal or human bite. Adults who are bitten should receive a tetanus vaccine (called a tetanus toxoid vaccine) if the last tetanus vaccine was greater than 5 years ago.

In addition, tetanus immune globulin may be recommended if the prior immunization history for tetanus is unknown. The immune globulin provides additional protection against tetanus infection.

RABIES — Rabies is a potentially fatal viral disease that can be spread through bites or scratches from an infected animal. The risk of getting rabies is greater for persons with multiple bites and bites close to or on the head.

In developing countries, dog bites cause 90 percent or more of rabies cases in humans. However, in the United States, rabies in dogs has been largely eliminated due to animal vaccination; wild animals, including bats, raccoons, skunks, and foxes, now pose the greatest risk. Unfortunately, most bat bites are not noticed since they are small and often occur at night while a person sleeps.

Post-bite rabies prevention — Rabies infection can be prevented, even after being bitten or scratched by an infected animal, by giving a series of rabies vaccinations and rabies immune globulin; this preventive strategy is called prophylaxis.

Several factors need to be considered in deciding whether to give post-bite rabies prophylaxis. These include:

The type of animal involved (show table 1)
Whether the exposure was provoked or unprovoked (unprovoked attacks are more likely to occur if an animal has rabies).
The vaccination status of the animal
The presence of rabies in that animal or species in that region
People who have received the rabies vaccine previously and then are bitten or scratched by an animal suspected of having rabies should have a dose of rabies vaccine on day 0 and 3.

Rabies vaccine and immune globulin — The rabies vaccine is first given as soon as possible, and again on the third, seventh, fourteenth, and twenty-eighth day after the bite.

One dose of human rabies immune globulin (RIG) is given on the first day. The RIG is given in the area in and around the wounds. As with the tetanus immune globulin and vaccine, RIG provides immediate protection from rabies infection while the vaccine begins to provide protection (approximately two weeks after the vaccine is first given).

Side effects of rabies vaccine and immune globulin can include discomfort at the injection site (similar to a flu shot), low-grade fever, and muscle aches. Rabies prophylaxis can be given to children and pregnant women.

When is rabies prophylaxis needed? — A person who is bitten should receive immediate post-bite vaccine and immune globulin if an animal is rabid or suspected to be rabid. If the animal is healthy and available for observation, rabies prophylaxis can be delayed while the animal is observed (in a secure facility, such as a veterinary clinic) for 10 days. If the animal develops signs of rabies, post-bite rabies vaccine and immune globulin should be started immediately (see "Rabies vaccine and immune globulin" below). If the animal remains healthy during the 10-day observation, then the bite victim does not need vaccine or immune globulin.

However, post-bite vaccine should be started immediately if the bite involves the head or neck. If the animal remains well for 10 days, the regimen can be discontinued.

If the animal is not available for observation, most experts recommend post-bite rabies prophylaxis because of the risk of serious illness caused by rabies virus infection.

Domestic animals — A dog, cat, or ferret in the United States that has received a rabies vaccination is unlikely to be infected with rabies. The number of rabies cases among domestic animals, such as dogs or cats, has declined markedly in the United States due to animal vaccination.

The likelihood of domestic animal rabies is small and varies by region. In the United States, rabies is most often reported in dogs along the United States-Mexico border. However, sporadic cases do occur outside of this area.

Wild animals — These animals are treated as if they are rabid until it is proven otherwise, and postexposure prophylaxis should be given immediately unless the animal was caught and can be observed. In the United States, raccoons, skunks, foxes, bats, and coyotes are the most commonly infected species.

Among large rodents, rabies has been reported in woodchucks and beavers in areas of the United States where raccoon rabies is common. Small rodents, such as squirrels, chipmunks, rats, hamsters, gerbils, guinea pigs, mice, and rabbits are almost never infected with rabies, and there has never been a case of transmission to a human from one of these animals.

Livestock — Rabies in livestock (cows, horses, goats, and others) is very rare. Persons who are bitten by livestock should be managed individually in consultation with local public health authorities.

Bats — Persons who are bitten or scratched by a bat should receive post-bite vaccination prophylaxis unless the bat can be collected and tests negative for rabies.

Bats can bite and transmit rabies without the victim being aware of the bite. As a result, the following precautions are recommended:

Post-bite vaccine is recommended when direct contact between a human and a bat has occurred, unless the exposed individual is certain that there was no bite or scratch.
When a bat is found indoors and there is no history of contact between the bat and human, post-bite vaccine is recommended for persons who were in the same room but are unsure if there was contact. This might include a sleeping person who awakens to find a bat in the room, an unattended child, or a mentally disabled or intoxicated person found in a room with a bat.
Where possible, contact with bats should be avoided. Bats should never be kept as pets and should not be picked up or handled by anyone except those who are trained and have received rabies vaccination.

SUMMARY

Bite care and infection prevention — Adults or children who have been bitten by an animal or human should see a healthcare provider in the following situations:

A cat has bitten and broken the skin. It is not necessary to be evaluated after a cat scratch unless there are signs or symptoms of infection (worsening pain, warmth, or redness, pus-like discharge, or fever).
A dog has bitten the hand, foot or head, or has bitten another area and caused a large wound.
A bite victim has diabetes, liver disease, cancer, HIV or AIDS, or takes any medications that could weaken the immune system.
There are signs or symptoms of infection, including worsening pain, warmth, or redness, pus-like discharge, or fever.
Bleeding does not stop after applying pressure for 15 minutes, a bone may be broken, or if there is other serious injury.
If the last tetanus shot was more than 5 years ago, or if the bite victim cannot remember when they received a last tetanus shot.
Rabies prevention

Post-bite vaccine and immune globulin are recommended immediately if an animal is rabid or suspected to be rabid. Persons who are bitten or scratched by a bat should receive post-bite immune globulin and vaccine unless the bat can be collected and tests negative for rabies.
If the animal is healthy and available for observation, it should be observed for 10 days. If the animal remains healthy during the 10 day observation, then the bite victim does not need rabies vaccine or immune globulin. If the animal develops signs of rabies, a person should receive rabies vaccine and immune globulin immediately.
Persons who are bitten on the head or neck should receive rabies vaccine immediately. If the animal can be observed (in a secure facility, such as a veterinary clinic) and remains well for 10 days, the regimen can be discontinued.
If the animal is not available for observation, most clinicians recommend post-bite vaccination because of the risk of serious illness caused by rabies virus infection.
WHERE TO GET MORE INFORMATION — Your healthcare provider is the best source of information for questions and concerns related to your medical problem. Because no two patients are exactly alike and recommendations can vary from one person to another, it is important to seek guidance from a provider who is familiar with your individual situation.

This discussion will be updated as needed every four months on our web site (http://www.patients.uptodate.com). Additional topics as well as selected discussions written for healthcare professionals are also available for those who would like more detailed information.

A number of web sites have information about medical problems and treatments, although it can be difficult to know which sites are reputable. Information provided by the National Institutes of Health, Centers for Disease Control, national medical societies and some other well-established organizations are often reliable sources of information, although the frequency with which they are updated is variable.

National Library of Medicine
(http://www.nlm.nih.gov/medlineplus/healthtopics.html)


Centers for Disease Control and Prevention (CDC)
Toll-free: (800) 311-3435
(http://www.cdc.gov)


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REFERENCES
1. Chen, E, Hornig, S, Shepherd, SM, Hollander, JE. Primary closure of mammalian bites. Acad Emerg Med 2000; 7:157.
2. Talan, DA, Citron, DM, Abrahamian, FM, et al. Bacteriologic analysis of dog and cat bites. N Engl J Med 1999; 340:85.
3. Cummings, P. Antibiotics to prevent infection in patients with dog bite wounds: A meta-analysis of randomized trials. Ann Emerg Med 1994; 23:535.
4. Dire, DJ. Emergency management of dog and cat bite wounds. Emerg Med Clin North Am 1992; 10:719.
5. Edwards, MS. Infections due to human and animal bites. In: Textbook of Pediatric Infectious Diseases, 4th ed, Feigin, RD, Cherry, JD (Eds), Saunders, Philadelphia 1998. p.2848.
6. Gandhi, RR, Liebman, MA, Stafford, BL, Stafford, PW. Dog bite injuries in children: A preliminary survey. Am Surg 1999; 65:863.
7. Goldstein, EJC. Bite wounds and infection. Clin Infect Dis 1992; 14:633.
8. Moran, GJ, Talan, DA, Mower, W, et al. Appropriateness of rabies postexposure prophylaxis treatment for animal exposures. Emergency ID Net Study Group. JAMA 2000; 284:1001.
9. Rabies Prevention—United States, 1999. Recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR 1999; 48(RR-1), January 8, 1999.
10. Weiss, HB, Friedman, DI, Coben, JH. Incidence of dog bites injuries treated in emergency departments. JAMA 1998; 279:51.


GRAPHICS


Postexposure rabies guidelines


Rabies postexposure guidelines
Type of animal Observation or testing of animal Postexposure prophylaxis recommendations
Dogs, cats, and ferrrets Rabid or suspicion of rabies Immediately begin prophylaxis
Healthy and available for 10 days observation Do not begin prophylaxis unless:

Bite or non-bite exposure is to the head and neck OR

Animal develops signs of rabies

Unavailable for observation or testing Consult public health officials; consider immediate vaccination
Raccoons, foxes, skunks, coyotes and other carnivores; bats Consider rabid unless available for testing and proven not to be infected Consider immediate vaccination
Large rodents, small rodents, livestock, lagomorphs and other mammals Consider on an individual basis Consult public health officials
Non-mammals Do not harbor rabies Prophylaxis never required