More Rabies

why-animals-do-the-thing:

theexoticvet:

I never thought a post about rabies would be re-blogged as many times as it has! I’m glad that people are paying attention and hopefully learning something after reading it. Since that post I have gotten a few questions and am also seeing questions as well as some blatant misinformation in re-blogs so I would like to hopefully clear all of that up.

First let’s make sure we all understand what rabies is. Rabies is a virus, specifically a Lyssavirus. The virus is found all over the world although there are some places where it has been eliminated or never existed in the first place. Australia doesn’t have rabies but it does have a bat Lyssavirus which is similar although they don’t really like to talk about it. Rabies is only really a problem for mammals (we now believe some birds can be infected but let’s not go there). Any mammal can be infected but in the USA there are different varieties of rabies that tend to infect specific mammals based on geographic location. The Eastern U.S. has lots of raccoon rabies, North is skunk, Central/South is skunk and fox, Southwest has fox, and the West is mainly skunk. Puerto Rico is unusual because their main rabies vector is the mongoose. Bats are also rabies reservoirs pretty much everywhere. This does not mean that if you are bitten by a skunk in Puerto Rico you don’t have to worry about rabies, just that a mongoose is more likely a carrier. We in the U.S.A. are lucky. Because of our relative isolation from other land masses and our vaccination campaigns, we don’t worry about rabies so much. In other parts of the world like India or Africa, people are killed by rabies every single day. The biggest carriers there are not wildlife but dogs and cats. Can you imagine? Walking down the street and being bitten by a stray dog and then you’re dead in a few weeks. That happens every single day.

Luckily rabies virus only exists in a few select types of body tissue/excretions, specifically saliva and nervous system tissue. Bites are the main way people and other animals are infected although getting saliva in an open wound or on a mucus membrane could also result in infection. Most people are not going to rub brain or CNS tissue on open wounds so that is not a common route of exposure. Theoretically an animal could have saliva on its claws and then scratch you, infecting you with rabies but this is so far of the realm of probability that a scratch is not usually considered exposure. Blood, urine, and feces do not contain rabies virus.

Once an animal or person is bitten the virus makes its way into a nerve and travels up the nerve toward the brain. This can take weeks or months depending on the location of the bite and the species infected. After the virus gets into the brain and multiplies it will head into the salivary glands. Dogs and cats can have enough virus in the saliva to spread it even before they are showing signs. This is likely the same with other species as well. This means that just because an animal is behaving normally does not mean it isn’t rabid.

Animals tend to manifest rabies in two different ways: “dumb” rabies or furious rabies. With dumb rabies animals seem slow, they will just stare off into space or wander around seeming confused. Furious rabies is where animals become highly aggressive, froth at the mouth, and lose inhibition. Again, behavior is not a great indicator of rabies status and some animals will exhibit some signs but not others.

What happens if a pet is bitten? This really depends on the vaccine status of the animal, the species of animal, and where the pet lives. Generally a dog or a cat that is up to date on rabies will be quarantined for a prescribed amount of time and re-vaccinated. A dog or cat that is overdue for vaccination will be quarantined for a longer period of time and then vaccinated. This quarantine is to make sure if the pet was infected, we give the virus time to show symptoms without being a danger to the public.

Because wild animals have not been studied to see if the rabies vaccine is effective, they are always euthanized and tested for rabies. Even a pet skunk, raccoon, etc. is considered wild and will be euthanized. We just do not know if the rabies vaccine is effective in them and the risk to human life is too great. Even in dogs and cats the rabies vaccine is not always 100% effective.

People that get rabies tend to feel sick, as if they have the flu. This then turns into CNS signs like confusion, aggression, delirium, difficulty sleeping, ataxia, etc. ONCE A PERSON SHOWS SIGNS OF INFECTION THERE IS NO TREATMENT! This is why rabies is such a huge health concern and why we play safe and test animals even if there is a suspicion of infection. People die. That’s it. Let that sink in.

If you are infected with rabies and do not get immediate treatment you will die. There is no alternative. 10 people in the entire world have survived rabies, 8 of those people had been vaccinated against it previously. 2 people without pre-exposure vaccination have survived rabies, in the entire world. And these people are not “normal”, they will have medical problems for their entire lives. The fact that they survived is the closest thing to an honest to goodness miracle that I can think of.

RABIES WILL KILL YOU. YOU WILL DIE IF EXPOSED TO RABIES AND DON’T GO TO THE HOSPITAL.

Ok. So what will happen when you go to the hospital? Many people are afraid of rabies treatment because they have heard it’s an ungodly number of shots into their abdomen and horribly painful. That is not the case but let’s pretend for a moment it is. Let’s say you need 50 injections directly into your abdomen and they hurt a lot. The alternative is death. I think the shots are preferable. In reality, if you have never been vaccinated against rabies here is what happens:

Your wound will be cleaned
You will get an injection of immune globulin
You will get a rabies vaccine (day 0) in your arm
You’ll come back on days 3, 7, and 14 for rabies vaccines

That’s it. 5 total injections spread out over a two week period. None of them given in your abdomen.

If you have previously been vaccinated you will simply get two vaccines, 4 days apart.

It is ridiculous that we even have to discuss paying for life saving medical care, but that is the case here in the USA. As someone who had to pay off an emergency surgery over a decade, I completely understand the fear of medical bills. Again though, the alternative is death. Bills are better than death.

If you have medical insurance your rabies treatment should be covered. If you don’t, you still need the treatment. Bills are better than death. Many hospitals have discount programs if you ask, you will have to fill out lots of paperwork but it will lower the cost. You can also sign up for prescription assistance via https://www.pparx.org/prescription_assistance_programs/sanofi_patient_connection it’s free and it covers the rabies vaccine and immune globulin. Unfortunately the less money you have, the more paperwork you will need to fill out but your life is literally on the line.

Lots to read but I hope that it helps clear up some confusion. Speak to your vet and human physician if you have questions and please, always go get medical help if you are bitten by a wild animal or pet that might have rabies.

@theexoticvet, thanks for throwing out some more basic rabies information! Some stuff I want to add. 

Many exotic animals species are vaccinated for rabies off label – pretty much any zoo mammal, for instance, will have had one – but this does not mean they are legally protected and they will still be euthanized if they bite someone. This is something a lot of people are unaware of. The rabies vaccine has not be proven effective by the government for non-domestic animals, which means nobody is not willing to accept the liability if it doesn’t work. There’s a good amount of anecdotal evidence that it does protect exotic animals (from known exposure situations that were quarantined monitored), but this is not a guarantee of safety and does not change the fact that any non-domestic animal must be euthanized and tested, no matter if they were vaccinated off-label or not. 

Rabies shots, from what I know of them, contain about 1ml-2ml of fluid. It’s a similar amount of fluid as the intra-muscular birth control injection (depo) – so it’s uncomfortable for a day or so, but not nearly the same as the horror stories you’ve heard about what the shots used to be. 

If you’ve encountered a potentially rabid animal, do not try to take care of it yourself. Get anyone who might be nearby further away, call animal control, and keep an eye on it. Animal control will have the correct tools and training to safely capture and contain a rabid animal.  Please don’t try to shoot it if you’re somewhere that’s legal – the last thing you want to worry about is exposure to aerosolized brain matter. This is one of those really important times to let the professionals do their job.