BATS AND RABIES: IT DOESNT HAVE TO BE A BITE. D.S. Lindes 1 ; 1 University of California, San Francisco, San Francisco, CA LEARNING OBJECTIVES: 1) Recognize the risk of rabies from non-bite exposure to bats. 2) Provide post-exposure prophylaxis against rabies infection. CASE INFORMATION: A 40 year old woman living in the San Francisco Bay Area presented to her primary care physician with concern about the risk of rabies from contact with a bat. Three weeks prior to presentation, she had found a bat flying around in her living room. Her two cats had tried to catch it, without success. She used a window screen, held in front of herself and above her head, to gradually guide the bat towards an open window. The bat collided with this screen several times before it flew out the window, and the patient spent approximately 45 minutes in the room with the bat. She was not bitten, nor did she recognize any direct contact with the bat's saliva. At the time of presentation, she had no signs or symptoms suggestive of rabiesvirus infection. DISCUSSION: Rabies is a rare but nearly always fatal viral infection. Its clinical course is characterized by a nonspecific prodrome, with associated paresthesias or fasciculations at the inoculation site, followed by an encephalitis with agitation, confusion, hyperesthesia, autonomic dysregulation, paralysis, and progressive brainstem dysfunction. Death generally results from respiratory center depression. Wild animals, including racoons, skunks, and bats, are the principal vectors for human rabies. Since 1980, 21 (58%) of the 36 human rabies cases diagnosed in the United States have been associated with bats. Of these cases, there was definite history of a bite in only one or two. In another 10 ± 12, contact but no bite was reported; the other 7 ± 10 cases had no clear contact, but an undetected bat bite was the most plausible route of exposure. Rabid bats have been documented in all 49 Continental U.S. States. Current Centers for Disease Control and Prevention guidelines recommend consideration of post-exposure prophylaxis (PEP) against rabies whenever direct contact between human and bat has occurred, unless the exposed person can be certain that there was no bite, scratch, or mucous membrane exposure. Rabies PEP consists of the following measures: 1) thorough cleansing of all wounds with soap and water, as well as povidone-iodine irrigation if possible; 2) administration of rabies immune globulin, 20 IU/kg, with as much as possible infiltrated around the wound(s) and the remainder given intramuscularly at a site distant from vaccine administration (only needed for individuals not previously vaccinated); 3) rabies vaccine (human diploid cell vaccine [HDCV] , rabies vaccine adsorbed [RVA], or purified chick embryo cell vaccine [PCEC]), 1.0 ml administered intramuscularly on days 0, 3, 7, 14, and 28 . Because incubation periods of over one year have been reported, PEP is indicated regardless of the amount of time after exposure. If at all possible, the involved animal should be collected for rabiesvirus testing. In the above case, because of prolonged contact and possible mucous membrane exposure, the woman underwent PEP, as did her previously unvaccinated cats. Recognition of the significance of non-bite exposure to bats is important for primary care physicians because they are likely to encounter patients with such exposures, many of whom may be candidates for post-exposure prophylaxis.