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Home Eurosurveillance Weekly Release  2003: Volume 7/ Issue 17 Article 4
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Eurosurveillance, Volume 7, Issue 17, 24 April 2003

Citation style for this article: van der Poel W, Verstraten ER, Kramps JH, Lina PH, van der Heide R. The public health hazard of bat rabies. Euro Surveill. 2003;7(17):pii=2213. Available online:

The public health hazard of bat rabies

WHM van der Poel1 (, ERAM Verstraten2, R van der Heide1, PHC Lina3 and JH Kramps2

1 National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands.
2 Central Institute for Animal Disease Control (CIDC) Lelystad, The Netherlands.
3Naturalis Museum, Leiden, The Netherlands.

The European bat lyssaviruses (EBLVs) are not easily transmitted from bats to other species, but such incidents have occurred rarely. In humans EBLV infection can be fatal, and to date, worldwide, four such cases have been reported (1). The most recent was in November 2002, when a 56 year old bat worker in Scotland died of an EBLV2 infection, about six months after he had been bitten by a Daubenton's bat (Myotis daubentonii) (2). Other cases were a 15 year old girl in Ukraine in 1977, who died five weeks after she had been bitten on her finger by a bat. In Russia in 1985 an 11 year old girl died four weeks after a bat bite on her lower lip. Both girls were infected with EBLV1. In the same year as the Russian case, a 30 year old bat researcher in Finland died of rabies caused by EBLV2 (3). In both this case and the Scottish case, it has not been definitely determined when the fatal bites took place.

In North as well as South America, human rabies due to bat bites is observed more frequently, but in these continents this is always the result of a classical rabies virus infection and the vampire bat (Desmodus rotundus) is the main reservoir of this virus (4,5). The vampire bat is found from Chile in South America to as far north as the southern United States, but is not indigenous to Europe.

Rabies virus is a bullet shaped RNA virus, family Rhabdoviridae, genus lyssavirus. This genus can be divided into seven genotypes: Type 1, classical rabies virus (RABV); type 2, lagos bat virus; type 3, Mokola virus; type 4, Duvenhage virus; type 5, European bat lyssavirus 1 (EBLV1); type 6, European bat lyssavirus 2 (EBLV2); and type 7, Australian Bat Lyssavirus (ABLV). In north west Europe, genotypes 5 and 6 are of major importance because these can be transmitted by bats. Classical rabies virus has been eradicated from most of the countries of this region, but is still endemic in wildlife in eastern Europe. This means that there continues to be a risk of (re)introduction. There have been several such reintroductions in the last few decades. The European bat lyssaviruses are endemic in free living insectivorous bats in Europe (6). In the Netherlands, the serotine bat (Eptesicus serotinus) is the main reservoir of EBLV1 and the Pond bat (Myotis dascycneme) is the main reservoir of EBLV2. The serotine bat is seen in all the countries of Europe except Ireland, Norway, Iceland, Finland, and the northern parts of Great Britain and Sweden. The Pond bat is also a native species in North West Europe. Highest concentrations are reported from the Netherlands and the Baltic States, but it is assumed that this bat also lives in large parts of eastern Europe.

In almost all cases bat lyssaviruses are transmitted after a percutaneous wound, most often caused by a bite. Transmission of lyssavirus through aerosols via mucous membranes has been described (7) but not for EBLVs. No one should handle diseased or dead bats without protection such as gloves. People who work with bats should be immunised. In the Netherlands bats involved in biting incidents - if they can be captured - are tested for lyssavirus by fluorescent antibody tests (FAT) on brain smears (8) at the Central Institute for Animal Disease Control (CIDC) in Lelystad. People bitten by a lyssavirus infected bat, receive post exposure prophylaxis. In unvaccinated persons this consists of an immediate injection with antirabies immunoglobulins (20 IE / kg) and 5 injections (day 0,3,7,14, and 28) with commercially available rabies vaccine based on inactivated classical rabies virus (9).

From 1999 to 2001, a total of 280 bats were tested for lyssavirus at CIDC, Lelystad (, and 16 were found to be infected with EBLV1. All positive results were in serotine bats. The prevalence of lyssavirus in serotine bats in the Netherlands in this period was found to be 20% (16/82). Virus prevalence in the healthy free living population is probably lower than in the bats submitted routinely for testing. The National Institute for Public Health and the Environment (RIVM, and CIDC Lelystad are working in a cooperative project to gain more insight in EBLV prevalence in bats in the Netherlands. Sequence analyses of the nucleoprotein encoding region of reverse transcriptase polymerase chain reaction (RT PCR) amplified products of EBLVs detected in Dutch bats between 1997 and 2002 resulted in a 96-100% homology with EBLVs isolated in Europe the last 10 years. EBLV2 sequences have not been detected in bats in the Netherlands since 1993.

The United Kingdom (UK) remains rabies free. However, following the recent death of a bat handler from EBL2 infection acquired in Scotland, the UK has changed its policy and recommends pre-exposure vaccination of all bat handlers as well as postexposure vaccination of anyone who is bitten or comes into other close contact with bats in the UK (10). An agreed document detailing answers to frequently asked questions is now available through the website of the Department for the Environment and Rural Affairs ( This may be useful for anyone dealing with queries about bat bites and other bat exposures in the UK.


References :
  1. National Institute for Public Health and the Environment (RIVM). Hoe gevaarlijk is rabiës van vleermuizen? Infectieziekten Bulletin 2003; 3: 83-4. (
  2. Fooks AR, Finnegan C, Johnson N, Mansfield K, McElhinney L (2002) Human case of EBL type 2 following exposure to bats in Angus, Scotland. Vet Rec 2002; 151: 679.
  3. Lumio J, Hillbom M, Roine R, Ketonen L, Haltia M, Valle M, et al. Human rabies of bat origin in Europe [letter]. Lancet 1986; I: 378.
  4. Messenger SL, Smith JS, Orciari LA, Yager PA, Rupprecht CE. Emerging pattern of rabies deaths and increased viral infectivity. Emerg Inf Dis 2003; 9: 151-4.
  5. Romijn PC, Van der Heide R, Cattaneo CAM, De Cassia Figueira Silva R, Van der Poel WHM. Study of lyssaviruses of bat origin as a source of rabies for other animal species in the state of Rio de Janeiro, Brazil. Am J Trop Med Hyg. In press 2003.
  6. Schneider LG. Rabies Bulletin Europe, Geneva: World Health Organization, 1992.
  7. Dutta JK, Dutta TK, Das AK. Human rabies: modes of transmission. J Assoc Physicians India 1992; 40: 322-4.
  8. Dean, DJ, Abelseth, MK, Athanasiu, P. The fluorescence antibody test. In Meslin FX, Kaplan MM, Koprowski H, editors. Laboratory techniques in rabies. 4th ed. Geneva: World Health Organization; 1996. p. 88-93.
  9. Protocollen Infectieziekten, Landelijk Coordinatiestructuur Infectieziektenbestrijding (LCI), Editie 2003, p. 405-12.
  10. Crowcroft N. Rabies-like infection in Scotland. Eurosurveillance Weekly 2002; 6: 021212 (

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