Human
rabies is rare in the United States; however, an estimated 40,000 patients receive
rabies postexposure prophylaxis each year. Misconceptions about the transmission of
rabies are plentiful, particularly regarding bats. Most cases of human
rabies caused by bat variants have no definitive history of animal
bite. Three hypotheses are proposed and reviewed for the transmission of
rabies from bats to human beings. They include nonbite transmission (including
aerosol transmission), the alternate host hypothesis (an intermediate animal host that acquires
rabies from a bat and then transmits
rabies to human beings), and minimized or unrecognized bat
bites. Nonbite transmission of
rabies is very rare, and
aerosol transmission has never been well documented in the natural environment. The known pathogenesis of
rabies and available data suggest that all or nearly all cases of human
rabies attributable to bats were transmitted by bat
bites that were minimized or unrecognized by the patients.