A man in his 50s has died from lyssavirus in New South Wales after being bitten by a bat several months ago.

This is Australia’s fourth human case of bat lyssavirus and the first confirmed case in NSW since the virus was first identified in 1996 in a black flying fox in Queensland.

So what is lyssavirus? And how can you protect yourself if you come into contact with a bat?

A close relative of rabies

Australian bat lyssavirus belongs to the Rhabdoviridae family, the same group of viruses that causes rabies.

It primarily infects bats. Active monitoring suggests fewer than 1% of healthy bats carry the virus, though prevalence rises to 5–10% in sick or injured bats.

In bats, the virus often causes no obvious symptoms, though some show neurological signs such as disorientation, aggression, muscle spasms and paralysis. Some will die.

The virus has been confirmed in all four mainland flying fox species (Pteropus alecto, P. poliocephalus, P. scapulatus and P. conspicillatus) as well as the yellow-bellied sheathtail bat (Saccolaimus flaviventris), a species of microbat.

However, serological evidence – where scientists test for antibodies in bats’ blood – suggests other microbats could be susceptible too. So we should be cautious with all Australian bat species when it comes to lyssavirus.

Rare, but potentially deadly

Unlike rabies, which causes roughly 59,000 human deaths annually, predominantly in Africa and Asia, human infection with bat lyssavirus is extremely rare.

Australian bat lyssavirus, as the name suggests, is unique to Australia. But other bat lyssaviruses, such as European bat lyssavirus, have similarly caused rare human infections.

Human infection with bat lyssavirus occurs through direct contact with infected bat saliva via bites, scratches or open skin. It can also occur if our mucous membranes (eyes, nose, mouth) are exposed to bat saliva.

There’s no risk associated with bat faeces, urine, blood, or casual proximity to roosts.

If someone has been exposed, there’s an incubation period which can range from weeks to more than two years. During this time the virus slowly moves through the body’s nerves to the brain, staying hidden and symptom-free.

Treating the virus during the incubation period can prevent the illness. But if it’s not treated, symptoms are serious and it’s invariably fatal.

The nature of the illness in humans mirrors rabies, beginning with flu-like symptoms (fever, headache, fatigue), then quickly progressing to severe neurological disease, including paralysis, delirium, convulsions, and loss of consciousness. Death generally occurs within 1–2 weeks of symptom onset.

All four recorded human cases in Australia – three in Queensland (in 1996, 1998 and 2013) and the recent NSW case – have been fatal.

There’s no effective treatment once symptoms develop

If someone is potentially exposed to bat lyssavirus and seeks medical attention, they can be treated with post-exposure prophylaxis, consisting of rabies antibodies and the rabies vaccine.

This intervention is highly effective if initiated promptly – preferably within 48 hours, and no later than seven days post-exposure – before the virus enters the central nervous system.

But no effective treatment exists for Australian bat lyssavirus once symptoms develop. Emerging research on monoclonal antibodies offers potential future therapies, however these are not yet available.

So what’s the best protection? And what if a bat bites you?

Pre-exposure rabies vaccination, involving three doses over one month, is recommended for high-risk groups. This includes veterinarians, animal handlers, wildlife rehabilitators, and laboratory workers handling lyssaviruses.

It’s important for members of the public to avoid all direct contact with bats. Only vaccinated, trained professionals, such as wildlife carers or veterinarians, should handle bats.

Public education campaigns are essential to reduce risky interactions, especially in bat-populated areas.

If you get bitten or scratched by a bat, it’s vital to act immediately. Wash the wound thoroughly with soap and water for at least 15 minutes, apply an antiseptic (such as betadine), and seek urgent medical attention.

This tragic case in NSW underscores that while extremely rare, bat lyssavirus is an important public health threat. We need to see enhanced public awareness and ensure vaccination for high-risk groups, alongside ongoing bat monitoring and research into new treatments.

Vinod Balasubramaniam, Associate Professor (Molecular Virology), Monash University

This article is republished from The Conversation under a Creative Commons license. Read the original article.

This week’s ABC Four Corners episode Pain Factory highlighted that our health system is failing Australians with chronic pain. Patients are receiving costly, ineffective and risky care instead of effective, low-risk treatments for chronic pain.

The challenge is considering how we might reimagine health-care delivery so the effective and safe treatments for chronic pain are available to millions of Australians who suffer from chronic pain.

One in five Australians aged 45 and over have chronic pain (pain lasting three or more months). This costs an estimated A$139 billion a year, including $12 billion in direct health-care costs.

The most common complaint among people with chronic pain is low back pain. So what treatments do – and don’t – work?

Opioids and invasive procedures

Treatments offered to people with chronic pain include strong pain medicines such as opioids and invasive procedures such as spinal cord stimulators or spinal fusion surgery. Unfortunately, these treatments have little if any benefit and are associated with a risk of significant harm.

Spinal fusion surgery and spinal cord stimulators are also extremely costly procedures, costing tens of thousands of dollars each to the health system as well as incurring costs to the individual.

Addressing the contributors to pain

Recommendations from the latest Australian and World Health Organization clinical guidelines for low back pain focus on alternatives to drug and surgical treatments such as:

• education
• advice
• structured exercise programs
• physical, psychological or multidisciplinary interventions that address the physical or psychological contributors to ongoing pain.

Two recent Australian trials support these recommendations and have found that interventions that address each person’s physical and psychological contributors to pain produce large and sustained improvements in pain and function in people with chronic low back pain.

The interventions have minimal side effects and are cost-effective.

In the RESOLVE trial, the intervention consists of pain education and graded sensory and movement “retraining” aimed to help people understand that it’s safe to move.

In the RESTORE trial, the intervention (cognitive functional therapy) involves assisting the person to understand the range of physical and psychological contributing factors related to their condition. It guides patients to relearn how to move and to build confidence in their back, without over-protecting it.

Why isn’t everyone with chronic pain getting this care?

While these trials provide new hope for people with chronic low back pain, and effective alternatives to spinal surgery and opioids, a barrier for implementation is the out-of-pocket costs. The interventions take up to 12 sessions, lasting up to 26 weeks. One physiotherapy session can cost $90–$150.

In contrast, Medicare provides rebates for just five allied health visits (such as physiotherapists or exercise physiologists) for eligible patients per year, to be used for all chronic conditions.

Private health insurers also limit access to reimbursement for these services by typically only covering a proportion of the cost and providing a cap on annual benefits. So even those with private health insurance would usually have substantial out-of-pocket costs.

Access to trained clinicians is another barrier. This problem is particularly evident in regional and rural Australia, where access to allied health services, pain specialists and multidisciplinary pain clinics is limited.

Higher costs and lack of access are associated with the increased use of available and subsidised treatments, such as pain medicines, even if they are ineffective and harmful. The rate of opioid use, for example, is higher in regional Australia and in areas of socioeconomic disadvantage than metropolitan centres and affluent areas.

So what can we do about it?

We need to reform Australia’s health system, private and public, to improve access to effective treatments for chronic pain, while removing access to ineffective, costly and high-risk treatments.

Better training of the clinical workforce, and using technology such as telehealth and artificial intelligence to train clinicians or deliver treatment may also improve access to effective treatments. A recent Australian trial, for example, found telehealth delivered via video conferencing was as effective as in-person physiotherapy consultations for improving pain and function in people with chronic knee pain.

Advocacy and improving the public’s understanding of effective treatments for chronic pain may also be helpful. Our hope is that coordinated efforts will promote the uptake of effective treatments and improve the care of patients with chronic pain.

Christine Lin, Professor, University of Sydney; Christopher Maher, Professor, Sydney School of Public Health, University of Sydney; Fiona Blyth, Professor, University of Sydney; James Mcauley, Professor of Psychology, UNSW Sydney, and Mark Hancock, Professor of Physiotherapy, Macquarie University

This article is republished from The Conversation under a Creative Commons license. Read the original article.