Anyone who may come into direct contact with bats at work is at risk of exposure to Australian bat lyssavirus (ABLV). This includes workers who may have accidental encounters with bats, such as bats trapped in nets set up to catch birds. ABLV is transmitted to people via bat bites and scratches, and from contact between a person’s nonintact skin or the mucous membranes lining their eyes, nose and mouth and a bat’s saliva or neural tissues (brain and spinal cord).
The prevalence of ABLV infection in free living bats is low, with infection more common in sick, injured or orphaned bats. However ABLV infection causes a rabies-like illness in people that is invariably fatal once disease develops. With simple precautions, including vaccination, training, using personal protective equipment (PPE) and the proper management of potential ABLV exposures, the risk of infection can be minimised.
Take care at work to avoid unprotected contact with bats. For example, spotter-catchers can use an inspection camera to look for wildlife inside areas that can’t be readily viewed and should avoid placing unprotected hands into crevices such as tree hollows. Handle bats only if you have current rabies vaccination, are trained in safe bat handling procedures and are wearing suitable PPE.
Workers who are at risk of exposure to ABLV should complete a course of rabies vaccination (called ‘pre-exposure prophylaxis’). Workers who are at ongoing risk should have a blood test every two years to measure their rabies antibody titre (a measure of protection against ABLV). If this is inadequate (<0.5 IU/mL), the person should receive a booster dose of rabies vaccine. Alternatively, a booster dose can be offered every two years without a blood test. Workers who work with live lyssaviruses in laboratories should have a blood test every six months.
PPE should be provided and worn to minimise the risk of exposure to ABLV. This may include puncture resistant gloves, long sleeved clothing, long pants, puncture resistant gauntlets to protect the forearms, enclosed footwear and eye/face protection (e.g. safety glasses, safety goggles or face shield).
If a worker sustains a bat bite or scratch, or if bat saliva or neural tissue has contact with a worker’s non-intact skin, the affected area should be washed thoroughly with soap and water for at least five minutes. An iodine or alcohol (ethanol) containing antiseptic should be applied to the area after washing. If the affected area involves the person’s eyes, nose or mouth, the area should be flushed thoroughly with water.
Once the affected area has been washed, the worker should seek immediate medical advice as it is likely that booster doses of rabies vaccine will be required (called ‘post-exposure prophylaxis’). This is important regardless of the person’s previous rabies vaccination, the severity of the wound, the bat species involved or its health status. Following a potential ABLV exposure, workers who have previously received pre-exposure prophylaxis (i.e. those who have previously completed a course of rabies vaccination) require a further two doses of rabies vaccine. Those who have not previously received pre-exposure prophylaxis require rabies immunoglobulin and a course of four doses of rabies vaccine.
Workers should be provided with adequate and accessible first aid and washing facilities, and know how to access medical advice, in the event of a potential ABLV exposure. Workers at risk of exposure to ABLV should not forego pre-exposure prophylaxis on the basis that rabies immunoglobulin and a course of rabies vaccination can be given following a potential exposure. This is because unnoticed exposure may occur when there is regular contact with bats, with potentially fatal consequences. For more information, contact your work health and safety regulator or health department.
Prepared by: Patricia Coward, Workplace Health and Safety Queensland, September 2018