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Majority of the cases have an incubation period between 31 and 90 days. In the literature, the overall reported incubation period varies from 30 days in 30% of the cases, 31–90 days in 54%, greater than 90 days in 15% and in 1% of the cases beyond 1 year is recorded.[3] In a cohort of 47 cases studied following autopsy at a single center in South India, the median incubation period recorded was 60 days (range 7 days to 4 years).

In July 2024, a Minnesota woman who lived alone reported to family members that a bat or bird had been trapped in her house for several days. After discovering a bat in the sink, she reportedly killed it with a hammer and disposed of it. A bite was not mentioned; however, the method reportedly used to kill the bat could have produced splatter resulting in inoculation of infectious nervous tissue onto broken skin or mucous membranes. In addition, family members reported that the patient wore a hearing aid, was a deep sleeper who used a continuous positive airway pressure machine, and routinely consumed alcohol, factors that might have reduced her awareness of having had direct bat contact.