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Australia: Infectious diseases experts - stay away from bats

Warning issued by infectious diseases experts to stay away from bats

Infectious diseases experts at a major international infectious diseases conference have issued a stark warning for people to stay away from bats, after releasing details of the treatment of an 8-year-old boy in Queensland, Australia, who died from Australian Bat Lyssavirus (ABLV) earlier this year. Dr Joshua Francis and Dr Clare Nourse (Paediatric Infection Management Service, Mater Children’s Hospital, Brisbane, QLD) and colleagues issued the warning at the Australasian Society for Infectious Diseases (ASID) meeting taking place this week in Canberra, Australia.

ABLV was first identified in Australian bats and flying foxes in 1996 and remains common in both animals, though human infection is extremely tare. Two adult cases were confirmed in 1996 and 1998, and followed a similar disease course to rabies before being fatal in both cases. One was a woman bitten by a flying fox after trying to remove it from a child, the other a carer who looked after these animals. Other lyssavirus strains circulate in bats in the USA and Europe, and multiple cases of human infection, and subsequent deaths, have been reported. Thus this warning issued by experts applies to wherever bat or flying fox populations exist.

There is no proven effective treatment for lyssavirus infection in humans. Only experimental treatments have been applied, such as the antiviral amantadine and other measures such as maintaining sedation and glucose balance, which have not been shown to be effective. Once the disease has progressed, it is almost always fatal.

The 8-year-old boy is just the third reported case of ABLV and the first in a child. At the ASID meeting, Dr Francis described what happened to the 8-year-old boy, who was bitten during a family holiday to northern Queensland in December 2012. The boy did not tell his parents he had been bitten, and three weeks later began to suffer convulsions, severe abdominal pain and fever, followed by progressive brain problems, with intermittent periods of lucidity. The boy was intubated and ventilated while doctors frantically tried to establish what was wrong with him. Analysis of his brain and spinal fluid were normal at first, but on day 10 of his admission increased levels of lyssavirus were detected. The boy’s neurological condition deteriorated, characterised by symptoms such as abnormal movements, and he then went into a coma. Treatment with amantadine was unsuccessful, and he tragically died on February 22, 2013.

Dr Francis says the warning has been issued not just for the danger from bats themselves, but the risk, however remote, that the disease can spread between humans. He says: “Human to human transmission of lyssaviruses had not been well documented, but it is theoretically possible. Local and international guidelines recommend post-exposure prophylaxis (PEP) for anyone who has had skin or muscosal contact with saliva or neural tissue from an infected person. This involves immunoglobulin treatment and vaccination. Following the diagnosis, we identified 175 potential contacts of the boy, and of these five household members and 15 healthcare-workers were offered PEP.”

He concludes: “ABLV has proved fatal in all cases reported to date. There is a need for increased public awareness of the risk associated with bat contact. In short, people should stay away from bats. For anyone exposed, PEP is effective at preventing progression to disease, and should be considered as soon as possible in all cases that constitute a potentially significant exposure.”

Click here for the full abstract.


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