Knowledge of Bat Rabies and Human Exposure Among United States Cavers

Robert V. Gibbons, Robert C. Holman, Stephen R. Mosberg, and Charles E. Rupprecht

Disclosures

Emerging Infectious Diseases. 2002;8(5) 

In This Article

The Study

We administered a survey to cavers attending the National Speleological Society Convention in Elkins, West Virginia, USA, in June 2000. The survey was included in the convention registration packet. Verbal reminders to return the survey were given, and collection boxes were located at several sites at the convention.

The survey asked respondents about demographic information, how long and how many times they had been caving, how often they encountered bats when caving, if they had been advised to receive the rabies PreEP and if they had received it, if they considered specific scenarios (bat bite, bat scratch, bat on skin, bat on clothing, indirect contact with bats) as a potential risk for rabies, if they had ever had a potential exposure to rabies, and if they had ever received rabies PostEP.

Categorical variables were compared using the chi-square test or the Fisher's exact test (2-tailed), as appropriate. Continuous variables were analyzed with the Wilcoxon rank-sum test[6]. Multivariate logistic regression was used for multivariate analysis.

Questionnaires were returned from 392 (26%) of 1,508 cavers attending the convention. The respondents' mean age was 47 (range 12-84) years, 68% were male, and 76% were college graduates. The respondents caved a mean of 23 (range 1-58) years and a mean of 16 (range 0-150) times in the past year. When asked how often they see bats on their caving trips, 1% responded never, 29% sometimes, 22% about half the time, 43% often, and 5% always. Respondents were asked to address whether specific scenarios with bat(s) were considered a risk for rabies ( Table 1 ).

The respondents who thought a bat bite was not a risk for rabies were younger (43 versus 48 years, p=0.009) and less educated (43% versus 21% were not college graduates, p=0.005) but did not differ significantly by gender, number of years caving, or number of times caving in the past year. The respondents who thought that indirect contact with bats was a risk for rabies were older (52 versus 46 years, p<0.001), and caved more years (28 versus 22; p<0.001). They did not significantly differ by gender, education, or number of times caving in the past year. Seventy-six (20%) respondents received PreEP ( Table 2 ). In multivariate analysis, having been advised to receive the vaccine was independently associated with having received it (odd ratio = 31; 95% confidence interval 15 to 61).

Eighty-eight (23%) respondents had been advised to receive PreEP. Those who caved more years (25 versus 22, p=0.05), and more times in the last year (25 versus 15, p<0.001) were more likely to have been advised to have PreEP. College graduates were more likely to be advised to have PreEP, but statistical significance was not found (24% versus 17%, p=0.14). Those advised to get PreEP did not differ by age or gender. Of the 66 respondents advised to get PreEP because of caving, 37 (57%) had done so; of the 20 advised to get PreEP for other reasons, 17 (85%) had done so. Twenty-four (1.6%) respondents felt they had been potentially exposed to rabies. Of the 24, only 5 involved exposures to bats (3 from bites), and only 1 indicated this exposure was directly associated with caving.

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