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Chessmann
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A couple of weeks ago I went to visit my daughter at a university dad/daughter weekend. During this time we witnessed a doggie get hit by a car. When we got to it, it wasn't able to move his lower legs much, but seemed lucid, otherwise. In our attempts to get the dog into our car, the doggie nipped me on the hand - I was slow and tentative in trying to put my hands on him, and in his scared state... But it drew a little blood.

We finally found an emergency vet (unfamiliar town for me, daughter hadn't needed a vet). Unfortunately, the doggie's injuries were too much for him to overcome. It was arranged for the dog to be sent Monday (the incident happened on Saturday) to another city to be tested for rabies to determine if I needed to be vaccinated (the dog was obviously a stray - no coller, no microchip, and other obvious signs of being a stray).

Over the next couple of days, checking sources to learn more about rabies, I saw that if bitten by a rabid animal, it takes time (incubation period) for the virus to work its way along the nervous system from the bite location to the brain. Once it hits the brain and symptoms start, survival is highly unlikely (another topic - I don't want this topic to go off on that tangent Smile ).

From a number of sources, I saw that the incubation period of rabies is (generally speaking) from 1-3 months, however, it can be 9-10 days, even less than a week. I assume the latter is very rare, but no explanations were given with regard to *why* it can sometimes be 10 days to less than a week.

On Monday, I made an appt. with my dr. to discuss, options, and he suggested I wait till the tests came back. He didn't have an explanation for the possible "less than a week incubation period," but suggested I wait. Now, I didn't get word until the 5th day that the doggie who bit me was free from rabies (thanks, God!). But I had decided earlier that same day that if I didn't hear by the end of that day (Thursday), I would start the ball rolling on the vaccination process on Friday. As rabies vaccinations aren't generally available, it would likely be Monday (the 9th day) until I could even start (my dr. said I would have to arrange to procure the needed vaccinations, which they would then administer, unless there were an governmant health agency that would do so).

BTW, the expense for the vaccinations, he said, could run as high as $3,000 (this was based on the only time in his 12 years of practice that he ever worked with a similar situation). I have seen another source that mentiond $1,600.

So, all's well that ends well with me...assuming there were no mix-ups in the reporting back to me! Smile

But my nagging question is this:

Why, when the incubation period of rabies *can* be less than a week, why is the 10-day quarantine of an animal who has bitten a human (to see if it has rabies) an accepted process? I've not been able to resolve this. If a quarantined animal develops rabies, the human it has bitten is immediately vaccinated. However, why wait if the incubation period can be less than a week? I have a feeling there is something I'm missing, but haven't found it yet.

PUBLIC SERVICE ANNOUNCEMENT: Most cases of human rabies in the USA and Canada are from bats. However, dogs/cats are also culprits. If you are bitten or scratched by an animal, get checked out by your vet asap to determine if rabies vaccination is needed. Do not ignore it. Even if no rabies is present, bacteria can be a serious issue. More serious than I certainly ever knew. Go to your doctor asap for any animal bite.
My ex-cat was named "Muffin". "Vomit" would be a better name for her. AKA "The Evil Ball of Fur".
magicalaurie
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"•The quarantine is set at 10 days because a rabies-infected animal can only transmit the disease after clinical signs have developed AND once these signs have developed, the animal will die within 10 days.
•If the animal lives beyond the 10th day, he/she can be said with certainty that it was not shedding the rabies virus at the time that the bite occurred."


http://www.americanhumane.org/animals/ad......ips.html

That doesn't completely lessen the stress for one involved in the situation, especially if the animal in question ends up positive for rabies. People seem inclined to go along with the status quo of "they don't test positive". Until they're on the receiving end of a bite, generally.


My question on the issue is if this is a fatal disease, and there is a vaccine why isn't the public vaccinated? Some of the protocols the government has in place instead call for thousands of animals, including healthy ones, to be killed for "public safety".

I used to work in a vet clinic. The vaccinated staff allowed me to handle fractious suspect animals while they stood back. I got tired of waiting for test results and went ahead and got myself vaccinated. That was more than 10 years ago, and I'm still immune, or I was last time I got the titer checked, anyway.

Dog mouths are cleaner than those of humans, they say, but a cat bite is a serious tetanus/blood poisoning risk. A lot of those require antibiotic treatment.

This blog post might be of interest. Obviously I think these things need saying, so find myself in disagreement with the title:
http://www.vin.com/vetzinsight/default.a......=5620284
Chessmann
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Yes, the reasoning to quarantine the animal for 10 days to see if it is/becomes symptomatic.

It just seems a timing risk to wait even upwards of 10 days when the incubation period in a human can be less than a week.

If there was an explanation for why/how it could be so short a time, that would be one thing. Apparently, there is no way to guess or determine this.

I suppose one reason could be that there needs to be a certain amount of time for the vaccination process to 'take root' and be effective. If the incubation period is less than a week or 10 days, the vaccination process may not have time to take root and be effective in an infected human.

As to vaccinating humans, Laurie, it could be an expense/need ratio, at least in the USA/Canada. As I mentioned, the vaccinations are extremely expensive (though in countries such as Thailand and the Phillipines, they can be free to humans (the problem is much greater, there). Another issue could be the risk/reward regarding side effects of the vaccination, itself.

One of the issues surrounding the Milwaukee Protocol is the expense involved, when (at this time, anyway) so few are saved by it.
My ex-cat was named "Muffin". "Vomit" would be a better name for her. AKA "The Evil Ball of Fur".
magicalaurie
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I'm sure it has something to do with the bottom line, yes, which was my point. I'm aware the vaccine is expensive for the recipient to purchase- as I mentioned, I've been vaccinated. My vaccines were pre-exposure- a series of three and I think came to about $300.00, though I don't remember that clearly. I think if the demand were there from the public, it would be worked out. The option's not presented to the public at all, really.
Chessmann
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That's true. There was much I didn't know about rabies until recently.

The first person to survive rabies without any form of immunization had been bitten by a bat. Neither she nor her parents thought anything of it. In fact, after the young lady became symptomatic, the bat bite only came up because the mom happened to remember it after they had exhausted all other possibilities. There's a documentary about this case on Youtube, and the parents said that when they mentioned the bat bite to the doctor, he went white as a sheet.
My ex-cat was named "Muffin". "Vomit" would be a better name for her. AKA "The Evil Ball of Fur".
magicalaurie
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Interesting. I've heard about a case a few years ago, a 19 year old guy died of rabies from a bat bite. A lot of people don't even realize they've been bitten by a bat. That's unnerving, pardon the term.

And how about this one?:

"Health officials confirmed Friday that a Maryland man who received a donated kidney a year and a half ago contracted rabies and died from it."

http://www.usatoday.com/story/news/natio......1990831/
tommy
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That's a lot of dough. Here they would give you a Tetanus jab on the NHS.
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magicalaurie
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Tetanus shot is free, here. Rabies not.

http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6031a2.htm

"In addition, officials attempted to reduce the local vampire bat population by capturing 120 vampire bats and applying a warfarin-containing jelly to their backs. After being released, the bats and their roostmates ingest the anticoagulant through communal grooming. Diagnostic rabies testing performed on one of the captured bats was negative."
Chessmann
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It is said that if you wake up in a room and find a bat, you should always assume you have been bitten, and if you can't contain the bat for testing, get vaccinated.

Also heard of others getting rabies via organ transplants.
My ex-cat was named "Muffin". "Vomit" would be a better name for her. AKA "The Evil Ball of Fur".
magicalaurie
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Quote:
On Nov 18, 2014, magicalaurie wrote:
A lot of people don't even realize they've been bitten by a bat. That's unnerving, pardon the term.


Well, I'm not sure how accurate that is. It appears some argue that's near impossible, but who knows for sure? is the problem, I expect. I don't care for the catching and testing of the bats, though. Especially if they appear healthy, I'd prefer they be released and those exposed get vaccinated. It's each individual's call to make, though. I'm already vaccinated.

Again, that's where my previous question comes in.

How rare is rabies in people really, if cases are getting missed and rabies isn't being included in the differential diagnosis? Maybe there have been more cases that just weren't diagnosed. The following are from old articles, but, for what they're worth:

"Clinical issues

In its classic furious form with hydrophobia or aerophobia, human rabies encephalitis is unmistakable. However, clinical descriptions over the past two centuries have shown the protean manifestations of this disease.49, 87 and 88 Local paraesthesia at the site of the bite (most commonly itching) is the only reasonably suggestive prodromal symptom. Paralytic forms of rabies and rare presentations with subtle seizures or with psychiatric disturbances are especially likely to be misdiagnosed."

http://www.sciencedirect.com/science/art......04157929

"CONCLUSIONS: In the United States, human rabies is rare but probably underdiagnosed."

http://www.uptodate.com/contents/clinica......tract/38
balducci
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Quote:
On Nov 18, 2014, Chessmann wrote:

Over the next couple of days, checking sources to learn more about rabies, I saw that if bitten by a rabid animal, it takes time (incubation period) for the virus to work its way along the nervous system from the bite location to the brain. Once it hits the brain and symptoms start, survival is highly unlikely

Well, how much time does this take (working its way along the nervous system to the brain)? If it takes more than a week, and you get the vaccination within a week if needed, is one protected?

Just reading online a bit, it seems a number of sources recommend getting vaccinated as soon after being bitten as possible. Maybe the bean counter at your HMO or whatever was just trying to save its shareholders a few bucks by delaying?

http://www.vaccines.gov/diseases/rabies/

"Anyone who has been bitten by an animal, or who otherwise may have been exposed to rabies, should clean the wound and see a doctor immediately ... A person who is exposed and has never been vaccinated against rabies should get four doses of rabies vaccine - one dose right away ..."

http://www.cdc.gov/rabies/medical_care/vaccine.html

"The first dose of the four-dose course should be administered as soon as possible after exposure."
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Chessmann
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Balducci, the average incubation time is 1 - 3 months. However, 'less than a week' is mentioned by more than one source as a possibility. This is what has me wondering about waiting for testing/quarantine, which can be up to 10 days, and are acceptable procedures, and why I feel it might be a case of, "If it gets to the brain in a week or less, the vaccination won't have time to control it, anyway." That's just my guess.

There was no, "If you find yourself in situation X, then you surely will have more than enough time for testing the animal or awaiting the 10-day quarantine."

The reason that people should get vaccinated asap, is that the vaccination is a process of shots, and it is possible to become symptomatic even after the vaccination process has started, if one has not received enough vaccination before the virus gets to the brain.
My ex-cat was named "Muffin". "Vomit" would be a better name for her. AKA "The Evil Ball of Fur".
magicfish
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Hydrophobia.
FatherWilliam57
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Quote:
On Nov 18, 2014, magicalaurie wrote:

My question on the issue is if this is a fatal disease, and there is a vaccine why isn't the public vaccinated?


In the United States, there were a little more than 100 cases of human rabies in 1900. Today, there are only 2 or 3 who contract rabies in a given year.

Chessmann: I'm very glad things turned out well for you.
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magicalaurie
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Quote:
On Nov 19, 2014, magicalaurie wrote:

How rare is rabies in people really, if cases are getting missed and rabies isn't being included in the differential diagnosis? Maybe there have been more cases that just weren't diagnosed. The following are from old articles, but, for what they're worth:

"Clinical issues

In its classic furious form with hydrophobia or aerophobia, human rabies encephalitis is unmistakable. However, clinical descriptions over the past two centuries have shown the protean manifestations of this disease.49, 87 and 88 Local paraesthesia at the site of the bite (most commonly itching) is the only reasonably suggestive prodromal symptom. Paralytic forms of rabies and rare presentations with subtle seizures or with psychiatric disturbances are especially likely to be misdiagnosed."

http://www.sciencedirect.com/science/art......04157929

"CONCLUSIONS: In the United States, human rabies is rare but probably underdiagnosed."

http://www.uptodate.com/contents/clinica......tract/38


"Despite recent developments of simple, rapid, and highly accurate diagnostic methods( 5), underdiagnosis and underreporting
contribute to rabies neglect. The true incidence of human rabies in Asia and Africa is estimated to be between 20 and 160 times
what is officially reported ( 3). The reasons for this are common among neglected diseases in low-income countries: The afflicted
often do not reach medical facilities ( 4, 6)
so are never recorded. For those who attend a medical facility, the similarity of rabies symptoms to other neurologic conditions,
including cerebral malaria ( 7), renders clinical diagnosis without laboratory support challenging. Even where laboratory facilities
exist, diagnostic samples are rarely collected, and where a clinical diagnosis is made, many cases are not reported to national or international authorities.

Coupled with this structural underdiagnosis and underreporting is the current approach to prioritizing disease interventions...."


"...A One Health approach, integrating medical and veterinary sectors, is important both to develop appropriate metrics for evaluating
the disease burden, and to ensure shared operational responsibility for zoonosis control and prevention...."

"...the most critical requirements are political commitment and building of trust and effective communication
between sectors..."

"...Establishment of an effective interministerial Zoonotic Disease Unit in Kenya, which has rapidly developed integrated national plans for rabies control and elimination, provides a recent example of One Health coordination
involving not only health and veterinary sectors but also wildlife services concerned with the threat that rabies poses to endangered
wildlife...."

"...International human and animal health organizations can play an important support role, for example, establishing mechanisms to ensure the affordable supply of human and animal vaccines and their effective cross-sectoral use...."

https://news.wsu.edu/wp-content/uploads/......2615.pdf
magicalaurie
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World Health Organization

"It is difficult, however, to estimate the global impact of rabies by using only human mortality data."

http://www.cdc.gov/rabies/location/world......d=cs_521
Chrystal
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Chessman,

Thank you to you and your daughter for stepping up and trying to save that dog. I hope the experience won't leave you hesitating should you ever come across something like that again.

Most stats report there are only 2-5 cases of rabies reported in the US annually and aprox the same number in Canada. It has been eradicated in the UK. The numbers as Laurie mentioned increase in countries where health care for humans and animals is lacking. Of those cases reported in North America, the culprit appears to be the bat in the US and in Canada it is most often raccoons. It is extremely rare for a domestic animal to be carrying rabies, unlike 100 years ago. Wildlife vs Domestic in our era whereas it use to be domestic previously.

One of the rescue groups I foster for who trap feral cats had looked extensively into this as there were concerns to the safety of the humans trapping them or caring for them.

Most people with domestic pets have had their pets innoculated - Rabies is given the first year and every three years afterwards to cats and dogs. There is increasing concern among pet owners of over vaccinating their animals but titers (a test to see if the anti-bodies still exist in the body so no need for futher innoculation at that time) is also accepted. Most dog obedience classes, kennels and even crossing the border require proof of rabies shots and innoculations up to date and will except the Titers test from a vet as proof as well. My vet of many years and numerous animals is currently the president of the Canadian Vet Association and I trust her judgement and have had many conversations with her regarding innoculations and the almost non existance of contracting rabies as a human.

But, back to you and the rabies scare. Thankfully you are okay!! Thanks again for helping an animal in need.
magicalaurie
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"...The New York State Health Department now plans to review computerized records for all patients hospitalized in the state in recent years to look for possible undetected rabies cases, said the department's Commissioner, Dr. Mark R. Chassin...."


"...'When you hear hoofbeats, don't think of zebras,' is a common dictum to remind doctors to think more about common conditions than rare ones. Still, Dr. Birkhead said, 'you have to think of the diagnosis to make it....'"

http://www.nytimes.com/1993/08/24/health......ted.html
magicalaurie
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More on organ donors:

This guy had a fever and was cleared as an organ donor. That's a huge red flag, far as I can see.

"...The American donor presented 4 days prior to hospital admission to an emergency room with nausea, vomiting, and difficulty swallowing. His drug screen was positive for cocaine and marijuana. He was subsequently admitted to a different hospital with fever and altered mental status and required intubation. His mental condition was attributed to a subarachnoid hemorrhage caused by hypertension and drug abuse. The
patient ’s condition deteriorated rapidly over the next days, and he was declared brain dead and cleared as a tissue donor...."

This girl, too:

"The 26-year-old German female donor first went to see a doctor because of severe headache, fever, mental changes, and aggressive behavior. A drug screen was positive for cocaine, and she was believed to have a toxic psychosis. She soon suffered a cardiac arrest and was pronounced brain dead and cleared as a tissue donor."

http://onlinelibrary.wiley.com/doi/10.11......95.x/pdf

The only reason these deaths ended up being diagnosed as caused by rabies is because the recipients of their organs were diagnosed and died of rabies. So, citing reported cases alone, misses the point in this discussion, since it's obvious, cases are being missed.

"Rabies can be difficult to diagnose where it is a rare disease. There is also lack of awareness of early-onset rabies as a cause of obscure behavioral and neurological manifestations. A rabies-infected person might be considered as an organ donor when admitted in a
brain-dead state without a complete occupational, travel, and past medical history. A street person was hit by a truck and admitted at a tertiary care hospital brain dead. No history was obtainable, and his corneas were immediately transplanted. Both recipients died of rabies (H. Wilde, unpublished). It is tragic that organ transplant rabies has not been as rare as one might suspect 7 – 11"
Chessmann
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Quote:
On Nov 22, 2014, Chrystal wrote:
Chessman,

Thank you to you and your daughter for stepping up and trying to save that dog. I hope the experience won't leave you hesitating should you ever come across something like that again.



Chrystal, after the fact, and having had time to think about it all, I can honestly say I am actually now more inclined to do the same thing than I would have before. I think this is because I know how the little guy would have likely suffered more had he not been picked up, and also that we were able to make his last couple of hours very pleasant. He sat on my daughter's lap, and she petted him the whole time going to the vet, and then in the office. I also think part of the reason is that I came away from all this very proud of my daughter - her instant reaction on seeing the car hit the doggie was, "Oh, Papa, we've got to go get him, hurry, hurry..." She has a very caring heart. So she, I believe, would kind of inspire me to be sure to act in the same way Smile
My ex-cat was named "Muffin". "Vomit" would be a better name for her. AKA "The Evil Ball of Fur".
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