Bats in the Bedroom, Bats in the Belfry: Reanalysis of the Rationale for Rabies Postexposure Prophylaxis
Bibliographic record
Abstract
BACKGROUND: We assessed the scientific basis and practical implications of recommendations made since the late 1990s to offer rabies postexposure prophylaxis (RPEP) for occult bat encounters, including recommendations to offer RPEP to persons with bedroom exposure to a bat while sleeping without evidence of direct physical contact. METHODS: The number needed to treat after bedroom exposure to a bat was calculated as the percentage of population exposed multiplied by the inverse of crude rabies incidence. Bedroom exposure was estimated in a population survey of 14,453 households. Incidence was based on reported human cases in Canada and the United States, 1990-2007. RESULTS: In the population surveyed, bedroom bat exposure while sleeping and without known physical contact occurred at an annual rate of 0.099%. We estimate that <5% of eligible persons with bedroom exposure receive RPEP as recommended. The incidence of human rabies due to bedroom bat exposure without recognized contact was 1 case per 2.7 billion person-years. The number needed to treat to prevent a single case of human rabies in that context ranges from 314,000 to 2.7 million persons. A total of 293-2500 health care professionals working full-time for a full year would be required to prevent a single human case of bat rabies due to bedroom exposure without recognized contact. Amounts of Can $228 million to Can $2.0 billion are additionally required for associated material costs. CONCLUSIONS: Human rabies acquired through bedroom exposure to a bat while sleeping and without recognized contact is rare. Conversely, such exposures are not uncommon in the population, and the resources required for associated RPEP are orders of magnitude higher than those required for most interventions that are considered to be reasonable. Current RPEP recommendations related to occult bat contact should be reconsidered.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.002 | 0.006 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.001 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.001 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.001 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".