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An 85-year-old man is brought to the office by his daughter the same day that she discovered a bat in his bedroom. The bat was not noticed the night before and flew out the window this morning. The man is not aware of any bite.

On physical examination, his vital signs are normal. His skin shows no evidence of a bite, scratch, or puncture wound. Neurologic examination is normal.

Which of the following is the most appropriate prophylaxis for this patient?

( A ) Give rabies immune globulin only if he begins to behave abnormally
( B ) Give rabies immune globulin now
( C ) Begin a rabies vaccine series now
( D ) Give rabies immune globulin and begin a rabies vaccine series now
( E ) No prophylaxis is required

D
The ACIP makes the following recommendations regarding bats:

Postexposure prophylaxis should be considered when direct contact between a human and a bat has occurred.
Postexposure prophylaxis is not necessary if the person was aware of the bat at all times while in an enclosed space and is certain that there was no bite, scratch, or mucous membrane exposure.
If the bat is captured and can be tested for rabies, postexposure prophylaxis in persons without direct exposure can await the results of prompt testing. If uncertainty about the need for prophylaxis still exists, the local public health authority should be consulted.
The ACIP also recommends that postexposure prophylaxis should be considered for an individual who has been in a room with a bat and who may be unable to rule out any physical contact. Such individuals might include: 1) a sleeping person who awakens to find a bat in the room; 2) an unattended child; 3) a mentally disabled person; or 4) an intoxicated person.