Doctors in Canada say a child who awoke to find a bat resting on his nose and mouth while visiting an Ontario cottage eventually died of rabies, in an “exceedingly rare case” that highlights the need for better public awareness.

In a report published this week in the Canadian Medical Association Journal, infectious disease physicians confirmed that the 11-year-old boy died from rabies, a fatality that they said probably could have been prevented with greater awareness of how the virus is transmitted.

The child was in northern Ontario with his family in 2024 when he woke up and found a bat on his face. He swatted it away and his father quickly caught it in a pot and released it outside.

The parents didn’t see any scratches or bites on their son’s face and didn’t think the bat had been behaving oddly. As a result, they didn’t consider the possibility that their son had been infected by rabies, nor did they take him to a doctor at that time.

Rabies is “exceedingly rare” in Canada, the doctors wrote, with only 28 documented case since 1924 and the last confirmed case in Ontario dating back to 1967.

Experts wrote that while rabid bats may show unusual behaviour – such as appearing during the daytime, resting on the ground, having difficulty flying or being easily approached – “the absence of these behaviours does not exclude rabies”.

They also noted that although skunks, raccoons and foxes carry rabies in North America, the primary animal reservoir is bats. Bites and scratches are often so small they are “easily overlooked”. The virus can also enter humans through bat saliva coming into contact with cuts, the eyes, nose or mouth.

Nineteen days after his encounter with the bat, the boy developed tingling, numbness and swelling on the right side of his face. He was initially discharged with a presumed diagnosis of herpes gingivostomatitis but the bat exposure led the doctor to ask the local public health authority if anti-rabies medication should be given.

By the next morning his conditions had worsened and he was admitted to intensive care with staff “strongly suspect[ing] rabies”. An MRI found lesions on the brain stem and tests indicated rabies.

While the team considered administering rabies antibodies straight into the brain, the “invasive nature and lack of established efficacy” of the procedure led the family and medical team not to pursue further treatment.

The rabies virus typically has a relatively long incubation period before symptoms start to show, but once they do there is no treatment or cure and it is usually fatal.

If physicians suspect someone has been bitten or scratched by a bat, rabies postexposure prophylaxis (PEP) – a series of treatments given after someone may have been exposed – is administered as quickly as possible and is “nearly always effective”, the paper says, citing overwhelming success in 29m cases.

“Early recognition of exposure and timely PEP remain the only effective means of rabies prevention.”