World Rabies Day: September 28, 2013

Not too long ago, I had a nightmare that my husband was bit by a rabid bat, and I could not find the telephone number for our local hospital to find out if they had any post-exposure immunoglobulin. I know that this came from watching a rabies documentary and watching a video of a cat with rabies the night before. I know that he has not been bitten by a bat and that I do not have to worry about him suffering from rabies today, but in the context of my dream, I was terrified. I could not wake up and come out of the dream despite telling myself to do so.

This was the video that started it all:

This was first published on April 4, 2013 by Bayside Animal Hospital in Cambridge, Maryland, USA. The cat had been acting normally a couple days before this video was taken. It is an unvaccinated 8 month old male stray cat that was being fed outside. Note his disorientation and aggression. This cat was positive for Rabies virus.

Rabies is a virus that until recently (2004) no one had ever survived being infected with the rabies virus without having received either pre-exposure vaccination or post-exposure immunoglobulin (PEP). In October 2004, while I was in my 4th and final year of veterinary school in Wisconsin, a young girl, Jeanna Giese, living 74 miles away from Madison and 39 miles from where I grew up was bit by a bat and contracted rabies. She did not obtain medical treatment until double vision and severe illness had her parents taking her first to the emergency room in Fond du Lac and then to Children’s Hospital of Wisconsin in Milwaukee.  You can read her story in her own words at Against all odds, Jeanna survived and went on to relearn to live, and then graduated in 2011 from Lakeland College in Sheboygan, WI. On August 2, 2013, Jeanna found a bat outside in her dogs’ kennel. The bat was tested and was found to be rabies positive. Her dogs, although vaccinated, are now in quarantine for 60 days after updating their rabies vaccination.

Jeanna’s story is a blessing, a miracle, and an enigma. The Milwaukee Protocol (the name commonly used for her treatment) has gone on to help save the lives of at least 5 other people (as of 2011). Although the protocol has been changed to remove one of the original medications used and it shows promise, it is not always effective and not universally available. It also appears that this treatment may be most effective in people that have an excellent immune system to begin with and that contract a weak bat strain of rabies (there are many strains of rabies around the world). This is great for them, but for the other 50,000 cases of rabies that occur world wide each year, it is generally out of their reach. In the United States, rabies is most commonly found in wildlife, although there are usually a couple cases of rabies in humans each year. The most common carriers are bats, raccoons, and skunks. In the rest of the world, the number one carrier is dogs. Stray dogs that are living among the people on the streets. Stray dogs that play with children until they “go wild” and the children are bitten and they both die. In one city in the Philippines, a rabies clinic sees 300-400 patients a day that have been bitten, generally by dogs. Each of these patients gets a post exposure injection.

Most of us in the United States and western Europe have very little contact or concerns when it comes to rabies. You may have heard about it, but it hasn’t touched your life other than to get your pet vaccinated. Be thankful, for that is not the case of people in other countries. I won’t post the videos of people with rabies on here, you can search for them if you want to see, but it is tragic and painful. The patient is trapped between moments of clarity and moments of intense madness while the rabies virus destroys brain function. As a veterinarian, I discuss rabies with many people, owners, doctors, the health department, and the local police departments. When a person gets bitten by an animal, there are protocols to be followed to protect that person from rabies. It does not matter if the animal has been vaccinated or not. It does not matter if the bite was intentional or if it was just a scrape by the tooth while playing. If a tooth breaks the skin and there is exposure to saliva, that is what we are worried about. If it is a domesticated animal in the USA and it has been vaccinated, then the chances of the animal having rabies is low, but not impossible. Last year, a dog in Florida was found to have rabies – it’s vaccine was overdue, but he had been vaccinated in the past.

So what do you need to know about animal bites? I will give you the run down with specifics from Wisconsin, but be sure to check with your local veterinarian, doctor, or health department for more specifics!

1. Clean the wound. You want to clean the bite with soap and warm water for at least 15 minutes. If you have access to, and are not allergic, betadine or chlorhexidine may also be beneficial to clean the wound.

2. Seek medical attention. What appears to be a small scratch or puncture wound may actually have quite a bit of underlying tissue trauma and other causes of infection (bacteria) in the wounds. Cat bites especially can result in major complications if not treated appropriately. I know many a person that has ended up in the hospital on intravenous (IV) antibiotics from a cat bite. If the doctor you see is not familiar with dealing with animal bites, have them contact the local health department or a veterinarian.

3. If the animal is wild or a stray, stay safe and try not to get bitten again, but if it is possible to isolate and confine it, that is ideal. If the animal must be killed, DO NOT SHOOT IT IN THE HEAD. Ideally, the animal would be humanely euthanized and tested for rabies, which requires a sample from its brain.

4. If the animal is owned by someone, the owner will need to provide proof of previous rabies vaccination and be placed in quarantine.

  • If the animal’s rabies vaccination is current, then the local health department will likely require an in-home 10-day quarantine with veterinary checks during those 10 days (Day 1, 10, and one day in between).
  • If the animal’s rabies vaccination is not current or it has never been vaccinated, then a 10-day in-facility quarantine will likely be required with the same 3 veterinary checks.
  • An animal that is bitten by another animal, that is either known or suspected to have rabies, will require either a 60 or 180 day quarantine based upon rabies vaccination status and will require vaccination to be updated.
  • If an animal that bites someone dies within 10 days of a bite, then it must be tested for rabies. This is because once the virus is being shed in the saliva, an animal will die within 10 days.

5. Do not try to cover up or hide a bite that has occurred. The long term consequences are not good for anyone. Every bite would should be treated medically. Every bite occurrence should be evaluated for cause and repeat prevention.

Stay safe and rabies free!


One thought on “World Rabies Day: September 28, 2013

  1. Pingback: Rabies Vaccine Dropped from the Sky — State of Globe

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