Friday, April 13, 2012

Bat on a plane! What are the health risks to passengers?

Paging Samuel L. Jackson! No snakes this time, but authorities are grappling with the best way to handle bats on a plane. OK, just one bat. But still, it’s not the type of thing one expects to read about in the Morbidity and Mortality Weekly Report, a bulletin produced by the Centers for Disease Control and Prevention.

It may sound more like a movie than a true public health issue, but this report is indeed based on actual events. At 6:45 a.m. on Aug. 5, a flight took off from Madison, Wis., with 50 passengers, two pilots and one flight attendant on board. Plus a bat, which made his or her presence known shortly after takeoff. The bat “flew from the rear of the aircraft through the cabin several times before being trapped in the lavatory,” according to the MMWR. The plane, bound for Atlanta, returned to Madison so that passengers could deplane and a maintenance crew could apprehend the bat. In the end, the bat evaded capture: it “flew out of the cabin door, through the airport terminal, and was seen exiting the building through automatic doors,” the MMWR recounts.

The bat-on-a-plane incident raises several public health measures. Among them:

Were there other bats on the plane?
After a search, authorities declared that the answer was no.

Did the bat have rabies?
Since the animal was never caught, authorities will never know.

Were the airplane passengers at risk of contracting rabies from the stowaway bat?
This is the primary issue that concerned the Wisconsin Division of Public Health. Officials there conducted “a multistate investigation” with the help of the CDC to get to the bottom of the issue. After all, if passengers were indeed at risk, they should be treated right away with a shot of human rabies immune globulin, followed by a series of four vaccine injections over a two-week period.

One of the first steps was to track down the 50 passengers. It should have been easy, since the airline keeps track of passengers on a departure manifest. But in this case, the initial manifest was thrown out – the airline had to make a new one when the flight departed for the second time, though with only 15 of the original passengers. (The rest had made other arrangements to get to Atlanta.) Investigators used reservation lists and other means to find as many of the others as possible. In the end, they reached 45 of the original 50 passengers.

All of those passengers were interviewed by staffers from the CDC, and all of them reported having no contact with the bat or its saliva during the ill-fated flight. Two of the 45 passengers had been vaccinated against rabies before Aug. 5.

Meanwhile, the airline checked out the flight attendant, pilots and 16 members of the ground crew in Madison who worked on the flight.

You can read the report in the MMWR here.

It may seem like a lot of trouble for a single bat, but rabies is not something to be taken lightly.

According to the CDC, rabies can start out seeming like a typical case of the flu, with fever, headache and general aches and pains. But after a few days, symptoms progress and may include cerebral dysfunction, confusion, delirium, hallucinations and insomnia, among others. “Once clinical signs of rabies appear, the disease is nearly always fatal,” the CDC says.

There are fewer than 10 known cases of people who have lived after developing full-blown symptoms, and all but two of them were treated with rabies vaccine.

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