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Dec 09 2012

Rabies vaccinations: now without agony.

Salon writer Irin Carmon was bitten by a strange dog in Brooklyn this weekend, and though the wound itself wasn’t too bad the call is out for people who might know the dog:

Hours later, I found a small actual wound and went to the ER, where they told me I have ten days to either find the dog to find out if it’s up to date on its shots, or get a miserable suite of shots. Or die of rabies.

So if you have any recollection of this dog in the Park Slope area, especially paired with the characteristics above, email me at [email protected] or, if you know me, contact me on whatever platform you want.

Irin has a lot of friends online, so the message is spreading quickly among the Park Slope dog set, and I wish her luck finding the dog.

But some of the messages going out to try to help her might end up reinforcing an inadvertent anti-vaccination message, to wit: the notion that rabies shots are an experience that you really, really want to avoid, because they involve two dozen painful injections in the abdomen with very long needles.

And who wouldn’t bend over backwards to avoid that kind of experience? Possibly even to the point of not seeking medical advice after a potentially dangerous bite?

But the urban-legend-style description of rabies vaccinations just isn’t true. Hasn’t been for a generation.

In 2004 my ex-wife took it upon herself to capture, tame and adopt out a gigantic crop of feral kittens in my old neighborhood in the SF Bay Area. One of them we caught almost too late to tame.

Did Not Want

I foolishly picked the kitten up with my bare hands, and after about 45 seconds of me not listening to it as it told me to put it down immediately, it escalated to a physical demonstration of its displeasure. Dissolve to me standing over the sink, losing copious amounts of blood from my right hand.

We had the choice of quarantining the kitten for a couple of weeks at animal control, destroying almost any chance that we could tame it during its last couple weeks of kittenhood, or me going in for rabies vaccinations. I picked that second option, and so over the next week and a half I got a pair of 11-milliliter rabies immunoglobulin injections in the ass, and five rabies vaccine shots in the upper arm. And a tetanus booster.

Some people do react to the vacccine, but for me the tetanus booster was more unpleasant by an order of magnitude, and that was less painful than the bite. The rabies vaccinations themselves, if given by someone good with a syringe, are nothing to fear. The worst part of the whole thing was driving to the hospital. And the kitten got adopted by someone who wanted a challenge.

The risk of dogs being carriers of rabies is a lot lower than it used to be in the United States, due to a decades-long interagency government vaccination campaign targeted at all dogs in the country. Some authorities use the phrase “eradicated,” which is probably slightly optimistic. But wild animals are still reservoirs; a sick animal doesn’t need to bite you to inoculate you with the disease, and the rabies virus can multiply quietly in your body for decades while you remain asymptomatic. And if you are infected, the math is pretty simple:

  • 100 percent of people infected with rabies who become symptomatic will die of the disease, assuming they don’t get hit by a truck first;
  • 100 percent of people exposed to rabies who are properly vaccinated before they become symptomatic will survive exposure.

It’s hard to argue against getting the vaccine, in other words.

Notice

[Update and clarification: I said here that 100% of humans who develop rabies without vaccine treatment die of the disease, and 100% of those vaccinated in time do not. A reader has noted that six people who developed rabies symptoms have survived as a result of a still-experimental protocol involving induced coma and anti-viral drugs whose first successful use was in 2004.  Worldwide, about 70,000 people died of rabies in 2011, and as the new treatment has rescued an average of .75 people per year since 2004, the global mortality figure for those who develop rabies symptoms worldwide should actually be on the order of 99.999989%. I regret the sloppiness.]

 

Of course, since the health care distribution system in the United States is almost irremediably fucked, it turns out that the rabies immunoglobulin injections can be ridiculously costly if you don’t have good insurance. Not quite rattlesnake antivenin expensive, but high enough, in the four figure range, to ensure that if we did have a lot of rabid dogs in the US the poor would die of rabies and the affluent would be only mildly inconvenienced. (Another reason I’m lastingly grateful for my ex’s teachers’ union and its sane, humane health plan with the $5 and $10 co-pays.)

But that disincentive only means that it’s even more important not to add more disincentives to vaccination, especially those that border on urban legend. The shots were invasive and painful from the 1960s through the 1980s. Since then, not so much. The prospect of needing rabies shots is daunting enough without untruths about scary pain being spread around on Facebook and Twitter. Anti-vax myths can take a lot of different forms, mutating into strains spread by pro-vax people. Let’s not keep spreading this one.

And let’s hope Irin Carmon finds the people who own the dog that bit her, so they can cover her medical expenses.

67 comments

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  1. 1
    Inaji

    People still believe that nonsense about abdomen shots? Oy, the stupid. I had rabies shots last year after rescuing a baby bat and it had spent time climbing all over my head. Easy, peasy. The first shot is in the arse, as that’s the one that’s supposed to hurt, but it didn’t.

    The most annoying bit was having to travel into town so many effing times for the shots. (I’m 55 miles from the nearest peoples with handy dandy hypodermics & meds.)

  2. 2
    Nepenthe

    I had rabies shots last year after rescuing a baby bat and it had spent time climbing all over my head.

    Cutest. Disease vector. Ever.

  3. 3
    The Mellow Monkey: Non-Hypothetical

    Good of you to fight this bit of ignorance, Chris.

    If the situation arose and my insurance would make it affordable, I can’t imagine not getting the vaccination. I’m not immune-compromised and I like peace of mind. Temporary discomfort is nothing in comparison to that.

  4. 4
    SC (Salty Current), OM

    But that disincentive only means that it’s even more important not to add more disincentives to vaccination, especially those that border on urban legend. The shots were invasive and painful from the 1960s through the 1980s. Since then, not so much. The prospect of needing rabies shots is daunting enough without untruths about scary pain being spread around on Facebook and Twitter. Anti-vax myths can take a lot of different forms, mutating into strains spread by pro-vax people. Let’s not keep spreading this one.

    Thank you for this. I’ve long thought it was bizarre for the treatment not to have improved at all in such a long time, so I’m happy to learn that it has. (Not that I ever thought the shots sounded so terrible in comparison to rabies. But then shots don’t bother me particularly. But then a death from rabies for a member of any species sounds horrific.)

    I’m curious: Have they given the shots to nonhuman animals they know have been bitten, and if so were they effective?

  5. 5
    jeevesmkii

    Having had the rabies vaccine for travel, which I understand is actually milder than the vaccine given post-exposure, I can report that although it doesn’t involve giant needles in the abdomen, it’s an exceptionally unpleasant experience I wouldn’t care to repeat. Dizziness and nausea doesn’t begin to cover it. If you ever need it, plan on someone else driving you back from the clinic, otherwise you could be there a while.

    Still, I suppose it beats rabies. And since on that trip, I did have a fairly close call with a pack of wild dogs, and also a troupe of monkeys aggressively protecting their young I suppose I shouldn’t complain. Though 100% mortality rate isn’t /quite/ right, people have been known to survive without treatment prior the onset of symptoms. Just not many, and sometimes not a great quality of survival.

  6. 6
    Mattir, Another One With Boltcutters

    The only problem is the immunoglobulin shot, half of which goes in the butt, which is bad. The other half goes into the wound site. Not good if the wound site is a scratched raw mosquito bite on the ankle that got licked by a rabid raccoon. Took a bodybuilder male nurse, the doctor, and me to hold DaughterSpawn down for that, and she was actually trying to cooperate. Otherwise, the shots are less annoying than tetanus.

    I learned from Pharyngulites that there’s a reason the vaccine itself is purple – the color is from a staining agent which changes if the vaccine degrades.

  7. 7
    Inaji

    it’s an exceptionally unpleasant experience I wouldn’t care to repeat. Dizziness and nausea doesn’t begin to cover it.

    I suppose it depends on the person. I had no reaction to mine at all.

  8. 8
    Pteryxx

    compulsive researching yields:

    http://www.wired.com/wiredscience/2012/08/rabies-survivor-mystery-deepens/

    Until recently, a human rabies infection was considered inescapably fatal. But a teenage girl who defied this death sentence eight years ago has had doctors and scientists debating how she survived ever since. And now a surprising report from remote Amazonia is adding to the mystery.

    In our feature for Wired this month, we explore the controversy over the Milwaukee Protocol: an experimental treatment regimen for rabies that may have saved the teenage girl in 2004 and five more patients since then. But many top rabies scientists still doubt whether the treatment method, which involves inducing a medical coma, is the best way to treat rabies patients.

  9. 9
    chigau (違う)

    Reading the Pffft article on rabies…
    wholly fuck

  10. 10
    davidgibson

    i had a dog bite while Xcountry skiing ,i think the guys dog did not like the poles flashing around as i passed.i just said no problem as the pants were not damaged.
    home i saw i had two nasty marks.i had no idea about the dog so the Dr had me get shots and it was a bunch.globulin,tetanus and back for the follow up rabies in the arms..no pain and no reaction.

  11. 11
    Pteryxx

    from the wiki, there’s the survival rate:

    Death almost invariably results 2 to 10 days after first symptoms. Once symptoms have presented, survival is rare, even with the administration of proper and intensive care.[11] In 2005 Jeanna Giese, the first patient treated with the Milwaukee protocol,[12] became the first person ever recorded to survive rabies without receiving successful postexposure prophylaxis. An intention to treat analysis has since found this protocol has a survival rate of about 8%.[13]

  12. 12
    Tsu Dho Nimh

    @4 I’m curious: Have they given the shots to nonhuman animals they know have been bitten, and if so were they effective?

    Yes. Although there has not been a true “vaccine trial” where 1/2 the bitten people get the new shots (5 in the arm) and half get a placebo. That’s never going to happen.

    For a while in AZ, where rabies is endemic in the skunks, the public health departments were delicately implying that people go get the rabies shots in Mexico because the 5-in-the-arm shots were approved there and the USA was still stuck in the 14-in-the-abdomen phase.

  13. 13
    dropkickpa

    Pre-exposure vaccination is easy peasy, no different than getting any other 3 shot series (1, 7, and 28 days). I was vaccinated 10 years ago for work (have the potential to be exposed to animals infected with rabies for tracing studies). My titres are still very good, so, if I should receive a bite from a suspect animal, I can opt to wait and see or get 2 boosters (no immunoglobulin).

    People working in animal rescue really should get vaccinated, especially those working with feral cats, as they are the most likely companion animal to contract it (usually through fighting with infected wildlife – raccoons, foxes, etc).

    I am a bit disappointed that I didn’t get a tag after I was vaccinated like my dog.

  14. 14
    SC (Salty Current), OM

    Yes. Although there has not been a true “vaccine trial” where 1/2 the bitten people get the new shots (5 in the arm) and half get a placebo. That’s never going to happen.

    Huh?

    We might be posting at cross-purposes. I mean – nothing to do with humans – have people given the shots to, say, dogs or raccoons they know to have been exposed, and if so what has been the result?

    But it’s a stupid question, because the shots for humans would have no doubt been tested on deliberately infected nonhumans, so there’s my answer. I was thinking, naively, about animals infected in the wild. Probably don’t want to know.

    But wait…

    We had the choice of quarantining the kitten for a couple of weeks at animal control, destroying almost any chance that we could tame it during its last couple weeks of kittenhood, or me going in for rabies vaccinations.

    Why couldn’t you both have had shots?

  15. 15
    SC (Salty Current), OM

    And why isn’t there just a good test for rabies?

  16. 16
    Pteryxx

    SC: the post-exposure treatment is HRIG, human rabies immunoglobulin, purified from human blood plasma so it doesn’t cause anaphylaxis from a different species’ immune proteins. Any nonhuman animal exposed would theoretically have to receive a similarly expensive and labor-intensive immunoglobulin treatment from blood plasma of their same species. From the searching I’ve done so far, except maybe for equine plasma, no such products even exist; and the equine version’s being produced for treatment of humans.

    The use of homologous immunoglobulins for human post-exposure treatment virtually eliminates the risk of anaphylaxis and serum sickness associated with heterologous serum products. In 1965, approximately 16% of persons treated with antirabies serum of equine origin were reported to have developed serum sickness; among persons over 15 years of age, the incidence was 46%. In the past few years, purified equine immunoglobulins have become available, and in recent studies, the incidence of serum sickness among recipients was reported to be <1-6.2%.

    To avoid such reactions, human rabies immunoglobulin (HRIG) preparations have been developed and used for post-exposure treatment in most industrialized countries. HRIG is well tolerated, but it is expensive and available in only limited quantities. Since 1975, this product has been administered to more than 250 000 people in the United States and no cases of serum sickness have been reported.

    http://www.who.int/rabies/vaccines/other_rabies_biolog_product/en/index.html

  17. 17
    didgen

    Was bitten by my own puppy, just a tiny nip to the finger in early 1970′s. Found a home for puppy a couple of days later, long story short puppy rapidly became ill, destroyed by animal shelter. They did not test for disease despite knowing about the bite. Treatment 3cc shot to site of bite, 30 days of shots to abdomen. Totally sucked, better outcome for me though, since the bats in my neighborhood were known as a vector. The treatment now is so much better. I didn’t get tags either

  18. 18
    SC (Salty Current), OM

    What will happen to the animal after person has been bitten or otherwise exposed?

    If the animal is a healthy domestic dog, cat or ferret it should be confined and held for observation for 10 days. A licensed veterinarian must examine the animal at the beginning and end of the 10-day observation period. If the animal develops symptoms suggestive of rabies, it should be humanely destroyed and the brain sent for testing. If the animal is healthy at the end of the 10-day period, then no rabies exposure occurred and the person bitten will not need rabies shots.

    If the animal is not a domestic dog, cat or ferret, it should be captured, humanely destroyed and the brain sent for rabies testing. If the animal is a domesticated farm animal (cow, horse, etc.), consult with your physician and veterinarian.

    Something deeply wrong with this.

    ***

    SC: the post-exposure treatment is HRIG, human rabies immunoglobulin, purified from human blood plasma so it doesn’t cause anaphylaxis from a different species’ immune proteins.

    Ah – thank you.

    Any nonhuman animal exposed would theoretically have to receive a similarly expensive and labor-intensive immunoglobulin treatment from blood plasma of their same species. From the searching I’ve done so far, except maybe for equine plasma, no such products even exist; and the equine version’s being produced for treatment of humans.

    Ah. Well. That’s terrible. It doesn’t seem like it should be outrageously difficult to develop vaccines for other species.

    And I still don’t understand why no test.

  19. 19
    F [i'm not here, i'm gone]

    And why isn’t there just a good test for rabies?

    You mean one that doesn’t involve Gumby brain surgery? AFAIK, there is no way for a good test until it’s already too late. As far as the existing multi-test check for rabies in humans goes, you may as well just get the shots.

  20. 20
    SC (Salty Current), OM

    AFAIK, there is no way for a good test until it’s already too late.

    Hence my question.

  21. 21
    chigau (違う)

    Something deeply wrong with this.

    Agreed.
    It is crude and extremely primitive.
    I hope they are all praying during those 10 days.

  22. 22
    Pteryxx

    Wiki cites a research paper that demonstrated a skin biopsy test for rabies in 2008. I’d guess it hasn’t become widespread knowledge, and/or isn’t available in kit form yet.

    As I understand it, there’s no *research* needed to develop immunoglobin treatments for exposed animals – but immunoglobin’s made by collecting blood plasma from individuals with sufficiently high titers; for humans IIRC this means identifying donors who’ve been exposed for whatever reason and who get paid money for the valuable antibodies in their blood. For other animals it’d mean having some sort of population of healthy animals of *each* species that needs a treatment, most likely farmed by a company, and regularly drawing their blood to extract the antibodies.

  23. 23
    SC (Salty Current), OM

    It is crude and extremely primitive.

    And nonhuman animals are regarded as entirely disposable.

  24. 24
    chigau (違う)

    I understand (I googled some stuff) that it was not easy to develop the rabies vaccine.
    So doing it for non-humans would take some powerful Will™ and lots of money.
    But surely by now we should have easier tests and vaccines for cats and dogs.

  25. 25
    Paul K

    I was bitten by a stray dog as a grade-schooler, in the mid 1960s. I was on my way to get the old-fashioned shots when the dog was found. The fear my parents gave me was not so much the pain of the shots, but the supposed danger of the vaccination. I was told that a significant percentage of folks actually died from the shots. I don’t know if this was bogus, but I just checked the CDC (Centers for Disease Control) website, and it’s certainly not a problem nowadays.

  26. 26
    Pteryxx

    The *preventive* vaccine, the one that protects mammals who have NOT been exposed, works fine on just about everything – there’s an oral vaccine that’s scattered in baits, to reduce or eliminate rabies reservoirs in wild populations. The expensive multi-shot immunoglobin treatment is for the un-vaccinated who’ve gotten exposed; and it’s species-specific.

  27. 27
    SC (Salty Current), OM

    I understand (I googled some stuff) that it was not easy to develop the rabies vaccine. So doing it for non-humans would take some powerful Will™ and lots of money.

    That doesn’t necessarily follow.

    Even if it did…

  28. 28
    Pteryxx

    Paul K:

    I was told that a significant percentage of folks actually died from the shots.

    That might’ve been from the risk of serum sickness from equine-derived treatment, which used to be the standard; that cite above says rates of 46% in adults. But the probable anaphylactic shock still had better odds of survival than the rabies…

  29. 29
    Paul K

    Sorry, borked the link above, and can’t figure out how to fix it. The preview is looking messed up.

  30. 30
    chigau (違う)

    SC
    I meant that there is a powerful will and money in the WesternWorld™.
    People love their pets.
    It should be easier by now.

  31. 31
    Paul K

    Pteryxx:

    Yes, that sounds right. I remember being told it was about half. 50% survival chance is better than zero, but my parents didn’t do a good job of hiding the chances from me. They tried to, but I don’t think they knew I could understand what they were talking about, even when they used coded speech. It was the most scared I ever saw them, which is touching in hindsight, but damn scary to me at the time.

  32. 32
    SC (Salty Current), OM

    SC
    I meant that there is a powerful will and money in the WesternWorld™.
    People love their pets.
    It should be easier by now.

    That might be true, though it’s not relevant to the question of whether it would be expensive (which it might, but…evolution).

    But even if that’s true, it continues to divide nonhuman animals between those humans love – those with value to us, who are only partially disposible – and those who are completely disposible because not our pets. That’s a problem. (Compare raccoon with orphaned hooker.)

  33. 33
    chigau (違う)

    SC
    [naive]
    If there had been more effort toward solving this for those animals we love (and those we love to eat), wouldn’t it (shouldn’t it) have rippled-out or trickled-down by now?
    [/naive]
    —-
    Pteryxx #26

    … there’s an oral vaccine that’s scattered in baits, to reduce or eliminate rabies reservoirs in wild populations…

    So why is its use not more wide spread?
    —-
    [I know I will regret not refreshing before posting.

  34. 34
    chigau (違う)

    馬鹿 keyboard!
    Ièll be back.

  35. 35
    Pteryxx

    Um, more widespread than what? Multiple state and country campaigns? (Which probably suffer from lack of funding and follow-through…)

    Abstract from 2005:

    Persistence of multiple variants of rabies virus in wild Chiroptera and Carnivora presents a continuing challenge to medical, veterinary and wildlife management professionals. Oral rabies vaccination (ORV) targeting specific Carnivora species has emerged as an integral adjunct to conventional rabies control strategies to protect humans and domestic animals. ORV has been applied with progress toward eliminating rabies in red foxes (Vulpes vulpes) in western Europe and southern Ontario, Canada. More recently since 1995, coordinated ORV was implemented among eastern states in the U.S.A. to prevent spread of raccoon (Procyon lotor) rabies and to contain and eliminate variants of rabies virus in the gray fox (Urocyon cinereoargenteus) and coyote (Canis latrans) in Texas. In this paper, we describe the current cooperative ORV program in the U.S.A. and discuss the importance of coordination of surveillance and rabies control programs in Canada, Mexico and the U.S.A. Specifically, several priorities have been identified for these programs to succeed, which include additional oral vaccines, improved baits to reach target species, optimized ORV strategies, effective communication and legal strategies to limit translocation across ORV barriers, and
    access to sufficient long-term funding. These key priorities must be addressed to ensure that ORV has the optimal chance of achieving long range programmatic goals of eliminating specific variants of rabies virus in North American terrestrial carnivores.

    http://ddr.nal.usda.gov/bitstream/10113/37735/1/IND44315049.pdf

    though I expect it’d be very difficult to remove rabies from the bat populations, until someone invents oral vaccine baits that mimic tiny flying insects.

  36. 36
    didgen

    Dang those bats.

  37. 37
    SC (Salty Current), OM

    SC
    [naive]
    If there had been more effort toward solving this for those animals we love (and those we love to eat), wouldn’t it (shouldn’t it) have rippled-out or trickled-down by now?
    [/naive]

    Excellent and not at all naive question. Judging from the basis of the different treatment of pets vs. farmed animals, even developments that can help domestic animals wouldn’t be extended to others. But knowledge can, and in a sense demands to, spread. So if we seriously considered domestic dogs and cats in this context, it might eventually increase the possibility of treating other animals as nondisposible in research and practice.

    …Oh. I missed this:

    animals we love (and those we love to eat)

    What to say? How could these be joined without utterly demolishing any meaningful concept of love?

  38. 38
    chigau (違う)

    Pteryxx

    (Which probably suffer from lack of funding and follow-through…)

    Yes. That problem.

  39. 39
    Pteryxx

    Reading further into that pdf (because why not eh) – there’s only one manufacturer of oral vaccine, therefore no competitive incentive to improve or optimize it; it’s not highly effective in *all* species or against all virus variants, thus skunks for instance can only be vaccinated via trap-and-release; and they do in fact identify bats as problematic to reach.

    (The table formatting’s completely gone, but what the hey)

    Table 2
    Summary of ORV bait distribution by species and state for 2003
    State
    Area baited (km2)
    No. of baits distributed
    Raccoon
    AL
    3215
    175839
    FL
    6293
    500507
    GA
    1058
    69317
    ME
    4308
    276104
    MA
    420
    54822
    NH
    385
    18140
    NJ
    Cape May Co.
    39000
    NY
    19657
    1367777
    OH
    8156
    621148
    PA
    24900
    2002005
    TN
    3232
    231865
    VA
    5669
    389667
    VT
    6403
    327405
    WV
    25356
    1702585
    Coyote
    TX
    31080
    700000
    Gray fox
    TX
    49210
    1800000
    Totals
    189342
    10276181

  40. 40
    Pteryxx

    whoops, thought I was data-dumping in an otherwise quiet thread. Scuse me.

  41. 41
    SC (Salty Current), OM

    Good night, all.

  42. 42
    chigau (違う)

    SC

    quoting me “animals we love (and those we love to eat)”
    How could these be joined without utterly demolishing any meaningful concept of love?

    English language is bad.

  43. 43
    chigau (違う)

    Good night SC.
    —–
    Preview still weird.
    unless veddy simple

  44. 44
    katansi

    I wonder how many homeless people die of rabies. Rats, bats, possums, feral cats, all possible vectors. Of course those aren’t REAL people since they’re poor so it’s probably not accurately counted if counted at all!

  45. 45
    Avicenna

    Not that many… Rabies is actually pretty rare as a disease and bats tend to leave humans alone. Homeless people aren’t “rolling around” playing with these.

    You are more likely to get bitten as a child than as an adult.

    The protocol for vaccination actually varies according to severity of bite but for most people it is 3 to 4 shots. Most people are bitten rather than “mauled” and those need more shots.

    Amusingly enough? In the UK the two cases of rabies that we have had in the last 10 years were both sourced to the rabies capital of the world. India. Close to 10,000 cases a year here.

  46. 46
    Avicenna

    I apologise! It’s not 10,000 cases a year. It’s closer to 25,000. Half the world’s rabies cases happen in India.

  47. 47
    madscientist

    “… two dozen painful injections in the abdomen with very long needles …”

    Uh … not for a very long time, dude – unless you specifically opt for the duck embryo vaccine – but hey, while we’re being sadistic we may as well demand the goat’s brain vaccine. Over 20 years ago a more effective vaccine was developed and you only get 5 shots + 2 boosters if you care to get the boosters.

    As for unvaccinated people surviving the rabies – that’s also a brilliant accomplishment in the past 30 years. If a victim is very lucky, they may get human rabies immune globulin (HRIG) and live (mortality rate with the immune globulin treatment only is still very high) – but going for the immune globulin treatment rather than the vaccine is simply insane – the vaccine is far cheaper by many orders of magnitude, far less painful, and far more effective. Current use of HRIG tends to be as a prophylaxis in tandem with the rabies vaccine.

    As for finding the dog – people seem to have a propensity to do things like that but it’s got to be one of the goddamned dumbest things people do. The shots are cheap and if you’ve ever seen anyone die of rabies (I’ve seen many preventable cases) you’ve got to have something seriously wrong with your head to be wasting time trying to track down the animal that bit you. Get the shots and don’t worry – the chances that you get rabies if you’ve got the shots early are very low and the longer you wait, the more likely you are to die if the animal was in fact rabid. The other thing that drives me mad in that article is that the victim only went to see the doctors because they found an injury – hell, if you have a goddamned crack in your skin and you get rabid animal drool in it, you’re going to die. If an animal bites – get the goddamned shots. The inconvenience and cost of the shots is nothing compared to the inconvenience and cost of getting the goddamned disease.

  48. 48
    madscientist

    @chigau#24: There have been rabies vaccines available for animals for a great many decades now. In fact in many places around the world in the 1960s and 1970s, city governments mandated that cats and dogs receive rabies vaccines every 2 years and the city paid for the vaccine and its administration.

    Here’s a more up to date blurb on veterinary rabies sera: http://www.who.int/rabies/vaccines/veterinary_vaccines/en/index.html

  49. 49
    Nerdette

    Such timing. This summer, my field station hosted 10 Research Experience for Undergrads (REU) students. The night before final presentations were due, the power went out for the entire property, leaving posters unprinted, computers dim, and nothing but the emergency lights working. While waiting for the power to return, some of the REUs whiled away the hours by exploring the dorm/office building. In the screened in hallways, a bat had found himself trapped, and one undergrad from Pennsylvania, with a grab-the-organism-first-ask-questions-later mentality, snagged the little mammal. He gnawed on her fingers pretty well before she let him go. Unaware that bats are the major rabies carrier in Virginia, she casually told the director of the station that she had found a bat and it had bit her. They immediately went to the emergency room, where they waited for about four hours for treatment. I think the director of the station got all of two hours of sleep that night, since the following morning were the final presentations, a lab dedication ceremony, and dinner.
    The REU that was bitten had let the bat escape, so no beheading testing occurred, and she didn’t find the treatment terrible (and even drove three hours back to the treatment facility for her follow-up shots, since the wait-time in PA was over three hours). We do tease her mercilessly though.

  50. 50
    blogofmyself, writer of papers

    When I was about 6 or 7 years old, my family’s goats were attacked by some loose dogs. They all survived, thank goodness, but it was pretty nerve-wracking there for a while. After we knew the goats were fine, my whole family had to go and get a series of rabies shots because we had all handled the goats after they were attacked. I remember getting the shots, but I don’t remember them being terribly painful. I was able to get my shots in the arm, maybe because I was so young, and I don’t remember it hurting that badly. The tetanus shots I got at that age were a lot worse. Of course that was in the mid 90s, so I guess they had the new vaccines by then. Anyway, the most memorable part of the rabies vaccination process for me was that after every shot I got a coupon for a free hamburger from some fast food place. That means that I got a hamburger for lunch for 7 days in a row. At that age, it was like heaven on earth.

  51. 51
    ledasmom

    For those who don’t know, waking up in the same room as a bat is considered good reason to get post-exposure vaccination – bats have rather small teeth, and people often don’t notice being bitten.
    Also, a minor quibble – rabies is fatal when hydrophobia is present; there is such a thing as abortive rabies that does not progress to the full illness. Known for years in feral dogs, of whom a certain (low) percentage show evidence of antibodies against rabies despite not having been vaccinated, and documented a couple of years ago in humans. Not a good option to shoot for. Vaccination is better.
    I’ve had the pre-exposure rabies vaccinations; not bad – some soreness. If you have the pre-exposure series you still have to get shots after exposure, but not so many.
    Incidentally, the guidelines for submitting rabies specimens require that only the head be submitted, except for bats, which you can send whole, and also specifies that you should make sure the animal is dead.

  52. 52
    viajera

    It really does depend on who gives the shot. I got the rabies vaccine a few years ago because I was going to be handling bats as part of my work in Central America. I got the first round of shots here in the States. The nurse noticed that the (HUGE) needle that came with the vaccine was dull, so she transferred the vaccine to a sharper needle, and it wasn’t too bad. But the next two rounds I got at a free clinic in Costa Rica, and not only did they not use a sharper needle, they really jabbed it in there. I couldn’t move my arm for a couple days.

    Then, too, there’s the financial cost. Since mine was preventive rather than treatment, I had to pay out-of-pocket. That cost me about $600-800 altogether. Also, too, the vaccines were hard to find and had to be shipped in, even here in my city of nearly 1 million.

    But all that said, I’ll take the physical and financial pain any day over the chance – however small – of catching rabies. No contest there.

  53. 53
    SC (Salty Current), OM

    http://www.who.int/rabies/vaccines/veterinary_vaccines/en/index.html

    That’s good to see. Also this. Both seem to be talking only about the pre-exposure version (which I didn’t know existed before reading this thread), so I’m still slightly confused.

  54. 54
    Chris Clarke

    Uh … not for a very long time, dude… Over 20 years ago a more effective vaccine was developed and you only get 5 shots + 2 boosters if you care to get the boosters.

    Which the reader would have noticed was kind of the point of the post, had one read past the first paragraph before commenting.

  55. 55
    HappyHead

    I had the misfortune as a four year old child to have been bit by a stray dog back in 1978, and had to go through the old style “through the stomach” method. I don’t remember the shots themselves, but I do remember being carried in to the hospital to get them, grabbing everything along the way and screaming like I was being killed. I’m surprised I never developed any kind of aversion to hospitals or dogs as a result.

    Much more recently, a friend of mine was complaining about how horrible it was that they had to get shots for rabies over the summer due to an encounter with wildlife, and when I explained to them how it used to be done, they suddenly felt better about their own experience.

  56. 56
    Thomathy, Gay Where it Counts

    SC (Salty Current), OM, you may want to consider that it is often too late to administer treatment to any animal that has bitten a human. In order for a post exposure vaccination to work it has to be administered quite early on and before symptoms are present. The vaccine cannot work after the virus infects the host brain.

    Any animal that is at the stage of the disease where the virus has caused it to exhibit biting behaviour is too far along to be treated. Humanely destroying the animal really is the best option. However, if the animal isn’t symptomatic and there’s no reason to suspect it has rabies, I really don’t see why an observational period, without treatment no less, should be enforced at all. If the animal has rabies it is all too often, and sadly, very noticeable.

    As for testing, there are many human diseases which can’t even be accurately tested for, let alone tested for at all, including most of the most common gastrointestinal infections. I can think of one reason why there is no good test for rabies and that is because it lives in nerve cells and travels directly to the brain from the bite wound. You’d need to isolate the virus from the saliva of the animal that bit or to isolate it from the nervous tissue of the victim. That’s something that takes time and with rabies, time is not something anyone has.

    The very reason that rabid animals exhibit such extreme saliva production is because the virus replicates in the salivary glands. The reason animals become rabid is due to the virus high-jacking the brain to cause a number of behavioural changes that effectively make the animal an excellent vector for the transmission of the disease through biting and anxiousness/paranoia. It’s a truly horrific disease and I’m not sure even if it could be treated, or cured, in an animal (humans included) that late in the disease progression that it would be a good thing. The virus does, to put it mildly, very bad things to mammalian brains.

  57. 57
    v. h.hutchison

    I have had experience in collecting and handling bats, including the mist-netting of vampire bats in South America. I had never been bitten until an episode in my own yard.
    A few years ago while pulling weeds during the day, I reached down to grab the base of a plant and was suddenly bitten by a little brown bat at the base of my thumb. The bat hung on and kept biting. I slung the bat to the ground, stomped it, ran into the house, place the bat in a plastic bag, washed the wound with alcohol and took off to the emergency room. Some year previously a child in our neighborhood was bitten by a rabid bat, and was treated quickly. Given the strange behavior of the bat and the previous history of a rabid bat in the area, I was concerned.
    At the emergency room local animal control was called to pick up the bat and take it to the state health department for analysis. I was first told that they would await a report on the bat before treatment, but then they decided that since it was a bat bite under unusual conditions they would go ahead give shots of immunoglobulin, tetanus, and rabies vaccine. The only painful shot was those injected with the vaccine injected all around the bite in the muscle at the base of the thumb. The other injections in hip and arm were not painful and were without sequelae.
    The next day the health department reported the bat was not rabid. The cost of the ER visit was in the thousands of dollars and the cost of the vaccine was several hundred dollars alone, all fortunately covered by health insurance.

  58. 58
    SC (Salty Current), OM

    SC (Salty Current), OM, you may want to consider that it is often too late to administer treatment to any animal that has bitten a human. In order for a post exposure vaccination to work it has to be administered quite early on and before symptoms are present. The vaccine cannot work after the virus infects the host brain.

    Yes, I know. I wasn’t suggesting that animals clearly showing symptoms should be vaccinated.

    Any animal that is at the stage of the disease where the virus has caused it to exhibit biting behaviour is too far along to be treated.

    The problem with this is that not all biting is the biting behavior associated with rabies. In the case CC describes in the post, it wasn’t: “I foolishly picked the kitten up with my bare hands, and after about 45 seconds of me not listening to it as it told me to put it down immediately, it escalated to a physical demonstration of its displeasure.” People aren’t perfect about assessing whether an animal’s behavior (including another human’s, often) is strangely aggressive or a response to the situation or just an odd anomalous act, so there’s always going to be a range of biting about which there’s some question. In that situation, I think an observational period is probably best. (My suggestion above that the kitten should have been given the shots was probably silly.)

    Humanely destroying the animal really is the best option. However, if the animal isn’t symptomatic and there’s no reason to suspect it has rabies, I really don’t see why an observational period, without treatment no less, should be enforced at all. If the animal has rabies it is all too often, and sadly, very noticeable.

    I agree with this.

    My primary objection, I suppose, is to the practice of killing any animals not out of compassion but for the purpose of determining whether a human needs to get the shots, and of distinguishing between domestic and wild animals: “If the animal is not a domestic dog, cat or ferret, it should be captured, humanely destroyed and the brain sent for rabies testing. If the animal is a domesticated farm animal (cow, horse, etc.), consult with your physician and veterinarian.” (In any case, humans should get the shots to be sure, and a rational and just health care system would include them.)

    As for testing, there are many human diseases which can’t even be accurately tested for, let alone tested for at all, including most of the most common gastrointestinal infections.

    Yes, I know that.

    I can think of one reason why there is no good test for rabies and that is because it lives in nerve cells and travels directly to the brain from the bite wound. You’d need to isolate the virus from the saliva of the animal that bit or to isolate it from the nervous tissue of the victim. That’s something that takes time and with rabies, time is not something anyone has.

    Thanks for this response. It just seems like given how long rabies has been around, faster ways to do this should have been devised.

  59. 59
    Crissa

    Being as I pass out from a tetanus shot and have bad reactions to most injections, I don’t know what I’d do. I haven’t ever really been injured by an unknown animal, although I have handled wild animals in the past – bats, rats, mice, squirrels, possum, raccoon… Mostly I just make sure they don’t have an opportunity or desire to injure me. I guess a rabies active animal might not give me that option, tho.

  60. 60
    madscientist

    @blogofmyself#50: You definitely got one of the newest vaccines. The older duck’s egg embryo vaccine and the even older (and not terrribly effective) goat’s/sheep/rabbit’s brain sera required numerous shots; about 14 recommended for duck egg and the brain sera took something like 20 shots. You didn’t get those older shots in the arm because of the number of shots required; duck’s egg was typically injected in the stomach and the goat’s brain was injected in any muscle that didn’t already have a needle mark. The vaccines around the time you got your shots were from cultured cells.

  61. 61
    Crissa

    PS, why the heck is rattlesnake antivenom so expensive? I know it goes bad, but… We’ve had the stuff for half a century at least and it only takes a minority of lab equipment (and a snake to milk) to produce. The random pricing on this stuff and markups is crazy and possibly criminal.

  62. 62
    Pteryxx

    and it only takes a minority of lab equipment (and a snake to milk) to produce.

    no, that’s just the starting point; that just gets you the venom itself. To make antivenom with it you then need a herd of animals:

    Antivenom is created by milking venom from the desired snake, spider or insect. The venom is then diluted and injected into a horse, sheep or goat. The subject animal will undergo an immune response to the venom, producing antibodies against the venom’s active molecule which can then be harvested from the animal’s blood and used to treat envenomation.

    In the U.S. the only approved antivenom for pit viper (rattlesnake, copperhead and water moccasin) snakebite is based on a purified product made in sheep known as CroFab.[6] It was approved by the FDA in October, 2000. U.S. coral snake antivenom is no longer manufactured, and remaining stocks of in-date antivenom for coral snakebite expired in the Fall of 2009, leaving the U.S. without a coral snake antivenom.

    single producer, no competitors or patents or easy profit, etc.

  63. 63
    davem

    As far as I’m aware, in the UK, the rabies vaccine is a needle into the arm. Nowhere else. To quote the NHS at http://www.patient.co.uk/doctor/Rabies-Vaccination.htm
    “Other cell-culture derived vaccines are available in other countries but these are no longer recommended.”

  64. 64
    psocoptera

    I want to thank Chris for this post. It has been a personal pet peeve of mine to listen to people speak fearfully of rabies vaccines. Every time I encounter it on TV, I pause the show and launch into my soap box, usually with only my dogs to listen (and they already know the shots aren’t that bad). I didn’t have any problems with my state mandated series, except that I knew I didn’t need them (it was a scared house cat). The original immunoglobulin shot in the wound site hurt like hell, but that was mostly because it was infected and on the boney part of my wrist. It was my fault anyway, since I was trying to be tough and told them I didn’t need a local anesthetic. And since it happened at work, it was all free! love worker’s comp, but socialized medicine would be better…

  65. 65
    Thomathy, Gay Where it Counts

    SC (Salty Current), OM, I agree that the distinction between wild and domestic animals doesn’t make sense and that killing animals just to find out if a human needs treatment is barbaric (in most cases). In first world countries, particularly those with a public health care system, the vaccine is trivially expensive. It’s just as well to vaccinate. I heard somewhere recently that the incidence of an actual infection is orders of magnitude smaller than the number of vaccinations given. In the cases where an animal vaccine is at hand, it’s just as well to vaccinate the animal and otherwise to keep it for observation then release/return it when it doesn’t develop symptoms.

    The justification for killing seems to be to positively confirm infection by analysing the brain tissue, albeit for human benefit. However, this could make sense in a wild animal that’s suspected to have rabies, but only from a conservation perspective. An authority might take preventative action on local populations given positive infection in an individual. Of course, you can be pretty sure the animal is rabid before destroying it by observing it, so there shouldn’t really be a need to kill any healthy animals.

    I’m pretty sure that if anyone in a position to make recommendations took on a review of current practice that some significant changes could be made. As it is, it’s unnecessarily brutal for the non-human animals involved.

  66. 66
    Karen Locke

    Chris, just out of curiosity, were you ever able to tame the kitten?

  67. 67
    Chris Clarke

    As far as I know, it was eventually tamed by the woman who adopted it: She had experience with ferals and really wanted a seal-point himalayan cat.

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