An 11-year-old boy woke up at a northern Ontario cottage in the summer of 2024 to find a bat resting on his nose and mouth. Within weeks, he was dead.
Infectious disease physicians at McMaster Children's Hospital in Hamilton published the case Monday in the Canadian Medical Association Journal, with a clear message for families across the province: any contact with a bat requires immediate medical attention.
That warning carries weight in Simcoe County, where bats are common in residential and cottage settings. The Simcoe Muskoka District Health Unit investigated more than 1,600 potential rabies exposure incidents in 2023 alone, and the province confirmed 121 rabies cases in Ontario wildlife in 2025, with 116 of those involving bat variants.
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What happened
The boy swatted the bat away after waking. His father caught it in a pot and released it outside. His parents checked his face and didn't see any scratches or bites. The bat hadn't been acting strangely. They didn't call a doctor.
Nearly three weeks later, he developed tingling, numbness and swelling on the right side of his face. A provider at an urgent care clinic suspected Bell's palsy, a temporary facial paralysis sometimes caused by viral infections, and prescribed an antiviral.
Days after that, he came to the McMaster emergency department with vomiting and pain while swallowing. His facial weakness worsened. He developed slurred speech. He was admitted to the pediatric intensive care unit.
By his fifth day in hospital, he had no reflexes in his brain stem, the part of the brain that regulates breathing and heart rate. He was eventually taken off life support and "died peacefully with his family at his bedside," the case report said.
Why the family came forward
Dr. Brian Hummel, a pediatric infectious disease physician at McMaster Children's Hospital and the case report's senior author, said publishing the case was a deliberate decision made with the family.
"It was important to us and to the family to take the opportunity to find learning experiences and lessons that we could take from his case to try and help spread awareness and understanding of rabies infection and risks," he said.
The boy's death was the first human rabies case in Ontario since 1967. The most recent case before his was a man in British Columbia who died in 2019 after exposure to a bat. Only 28 human rabies cases have been reported in Canada since 1924.
Why bats are the main concern
Rabies can be carried by skunks, raccoons and foxes, but bats are the primary risk for human exposure in Canada. Bats have tiny teeth that can break skin without leaving a visible mark. Even without a bite or scratch, saliva from a bat can enter through a cut, or through the eyes, nose or mouth.
In Simcoe and Muskoka, brown bats are a regular presence in residential neighbourhoods and cottage properties. According to data from the Simcoe Muskoka District Health Unit, roughly four to six per cent of brown bats submitted for testing in the region have tested positive for rabies.
The Ontario government notes that approximately seven per cent of bats submitted for testing carry the rabies virus province-wide, though that figure reflects bats flagged for potential human contact rather than the general population. Rabies is considered endemic in Ontario's bat population across all regions of the province.
"Any time a bat has touched the human skin, that would be a reason to go and see your health-care provider right away," Hummel said.
Treatment works, but only before symptoms begin
Once symptoms appear, there is no treatment. But the virus has a long incubation period, usually several weeks, which creates a window for prevention.
Post-exposure prophylaxis involves a series of vaccines and an injection of immunoglobulin, a ready-made antibody that begins fighting the virus immediately. The first vaccine is given right away, followed by additional shots on days three, seven and 14.
"If you get symptomatic rabies infection, it is near universally fatal. But if you get the prevention before symptoms develop, it is near universally successful," Hummel said.
Side effects from the vaccine are typically mild and short-lived, including fever, chills and fatigue. There is a very rare risk of anaphylaxis, which is why patients wait briefly before leaving after their shot.
Older versions of the vaccine carried a small risk of Guillain-Barré syndrome, a rare condition where the immune system attacks the body's own nerves. The case report confirmed there is no known causal link between Guillain-Barré and modern rabies vaccines.
"Given the near certainty of death with rabies infection, the benefits almost always outweigh the risks," Hummel said.
Primary care providers typically work alongside public health units to assess whether post-exposure treatment is needed. Residents in Simcoe County can contact the Simcoe Muskoka District Health Unit or visit their nearest emergency department if they believe they've had contact with a bat.
