Two Rabies Deaths in 2024 Began With Bats the Victims Knew About

Both women knew a bat had been close. One killed a bat in her kitchen sink; the other picked up a bat she thought was dead and felt it move. Neither told a doctor or health officials, neither bat was tested, and neither woman got postexposure prophylaxis (PEP) — the shots that prevent rabies if given in time. In 2024, both died of rabies: in Minnesota in September and in California in November.

Why bats matter

Rabies circulates in wild mammals across the continental United States and usually spreads by bite. Without PEP before symptoms begin, it is almost always fatal. Human deaths are rare: each year about 1.4 million people seek care after animal contact, and 100,000 (7%) receive PEP.

Bats are the leading source. Of 42 human rabies cases acquired in the United States during 2000–2024, 35 (83%) came from bat contact. North American bats are small, and their bites can leave tiny or invisible wounds.

The Minnesota case

The encounter, July 2024. A woman who lived alone told family that a bat or bird had been trapped in her house for several days. Finding a bat in the sink, she reportedly killed it with a hammer and threw it away. No bite was mentioned, but killing it that way could have splattered infectious nervous tissue onto broken skin or mucous membranes. She also wore a hearing aid, was a deep sleeper who used a CPAP machine, and drank alcohol routinely — all things that could have kept her from noticing direct contact.

The illness. About 3 weeks later, in August, she developed shoulder pain and weakness. Over the next 9 days she sought care several times; her records never mention the bat. On day 10 she came to an emergency department with tremors, weakness, confusion, anxiety and rigid muscles and was admitted. On her first hospital day she became minimally responsive and was intubated. Her family then mentioned the bat, and rabies was considered — but public health officials weren't consulted, because tests for more common causes were still pending. The next day she was moved to a hospital in North Dakota, where doctors found encephalitis.

The diagnosis. Twelve days after admission, with no cause found, her family chose palliative care. After consulting state officials and CDC, doctors sent her remaining samples to CDC. She died that day; her family declined an autopsy. Rabies antibodies in her plasma confirmed the diagnosis.

The California case

The encounter, October 2024. A woman found a bat indoors at her workplace. It seemed dead, but when she picked it up with her bare hands she felt it move — and possibly bite. She saw no wound, threw the bat away and told no doctor or health official.

The illness. About a month later she felt tingling and muscle spasms in her arm. Three days after that she was hospitalized with seizures. This time the bat was mentioned on admission, and doctors contacted public health officials about rabies testing that same day. Her seizures worsened, she was intubated, and over the next 3 days her liver and kidneys failed. She died 4 days after admission. Tests of a skin biopsy from the back of the neck and saliva, by the California state laboratory and CDC, confirmed rabies, and sequencing showed a bat rabies variant.

Tracing contacts

Health departments assessed everyone who might have touched the bats or been exposed to the patients while infectious — conservatively, from 14 days before symptoms until death. A rabies exposure means broken skin or mucous membranes meeting an infected person's or animal's tears, saliva or nervous tissue. All the possible exposures were to the patients; no one else was exposed to the bats.

Whether those advised actually received and finished PEP is not known. Minnesota and California issued press releases urging people to report any bat contact, even without a visible bite.

What to do about a bat

• Never touch a bat with bare hands. CDC advises leather or bite-proof gloves. Sick bats may look dead, and are more likely than healthy ones to carry rabies. Healthy bats usually avoid people.
• Report any direct bat contact to a health care provider or public health officials. The Advisory Committee on Immunization Practices (ACIP) recommends a risk assessment for any direct contact, and PEP whenever a bite or scratch can't be ruled out and the bat can't be tested.
• Some people may not notice contact: those with reduced mental capacity or trouble communicating, people affected by alcohol, drugs or medication, and deep sleepers. ACIP recommends PEP for such people if they slept in a room with a bat. The Minnesota patient would have met those criteria.

At least 44 bat species live in the continental United States, and rabies has been found in nearly every species tested. About 5% of bats submitted for testing carry the virus. Watch for bats in occupied buildings, and report encounters right away.

Sources

Based on Ireland M, Fritz CL, Holzbauer S, et al., "Human Rabies Deaths — Minnesota and California, 2024," Morbidity and Mortality Weekly Report 75(2), CDC; a work of the United States government in the public domain. The paragraph on PEP recommendations and its table, cut from the imported copy, were taken from the report's full text in PubMed Central (PMC12806951).