An emergency physician friend texted me about whether I thought he should get rabies postexposure prophylaxis (RPEP). He said that while he was out for an evening stroll, a bat flew into him, hitting him in the forehead not just once but twice. Although he could not find evidence of a bite or wound, he wondered what he should do.
Emergency physicians are presented with these types of patient questions frequently, usually related to dog bites but from other types of exposures, too, with various degrees of circumstantial bite evidence. The calculous around the decision to give RPEP is portentous. Rabies, with extremely rare exceptions, is an untreatable fatal disease, but if the exposure is identified and prophylaxed, it’s also 100 percent preventable.