Has anyone here ever been treated for post rabies exposure?

[JanMichael]

We had a bat in our bedroom this week; we were both sleeping. Trapped the bat in a net, and thought he was dying, so left him in the net on the front porch. In the morning the bat was gone-- found out that we had to be treated at the ER-

We have good insurance....and right now, the cheapest out of pocket cost we are looking at will be around 2 grand--- maybe. We haven't been able to get a straight answer on the prices from either the hospital or the insurance company.

The disconnect of the medical professionals and insurance companies in the US is amazing. If the damned bat had just waited a year, ObamaCare would have at least forced the two institutions to show their hand. This has GOT to be the only damned thing Americans buy and have to guess how screwed they are going to be.

btw...should you ever wake up to a bat...leave the room, and contact animal control to get it asap. It must be alive when it reaches the lab for an accurate post mortem. We did not know any of this--- we have always liked bats...still do, and he's probably flapping around above the house right now, chomping down mosquitoes- but, we are just screwed.

Don't assume you weren't bitten either--- over 80% of bat related rabies deaths in the US were from an undetected bite.

[hfojvt]

1. I understand it is a series of shots in your stomach

very painful according to a woman I know who was getting them. She said they made her feel like crap. In fact, she died in the middle of treatment and I wondered if that was a cause.

She said that most of them carry rabies, so there was not much point to testing the bat anyway. She had gotten scratched by a bat that she picked up.

I don't know why you should assume you have been bitten just because one was in your bedroom. I had one in my store several times (while awake) and just opened the front door and let it fly out. My grandmother used to get them in her house and would take them out with a tennis racket.

"Over 80% of rabies deaths were from an undetected bite"

I understand there are only about two deaths per year.

I wonder how many people are treated. I wonder how many people are treated who don't really need the treatment.

[JanMichael]

3. Hate to say this, but you are wrong on just about everything you wrote

The treatment now consists of an initial 4 IM shots administered in the ER; then 4 more shots on a strict schedule, all in the deltoid muscle. None of the shots hurt anymore than any other shot, and actually less than antibiotics.

A rabid bat was caught less than 3 blocks from us, a few months ago. The ER doc had seen 5 other people who were exposed in the past 3 weeks. We live in a medium sized town in NC.

There is almost no way to tell if you have been bitten. If a bat is found in a room with a sleeping person, you have to assume you have been exposed.

[enlightenment]

9. Well, it's definitely better now

but for many, many years that was the treatment. My brother was bitten by a squirrel on the White House lawn (back when it was still the People's House and you could stroll the lawn - 1950s) and had to have that whole painful process, just as described. He was seven.

I'm glad the treatment has improved.

[kestrel91316]

19. They don't even bother to investigate rodent bites WRT rabies anymore,

because wild rodents simply don't get bitten by a carnivore with rabies and live to spread it.

A client of mine got bitten by an injured squirrel last year and I sent it in to the county. They didn't do a thing. No point. I just felt I needed to fulfill my obligation as a professional.

[enlightenment]

22. That is interesting.

What is the difference with bats? Do they just live longer with the disease than squirrels and such?

[kestrel91316]

27. Bats commonly carry rabies. Squirrels, NEVER.

http://www.cdc.gov/rabies/transmission/index.html

[enlightenment]

47. Okay - maybe it was a different critter.

I wasn't around yet - so just relating the story as I heard it from granny and brother. This website suggests squirrels can have roundworm brain parasites that cause symptoms that look like rabies; since any mammal can "get" it, maybe they were just acting out of an abundance of caution?

http://www.humanesociety.org/animals/resources/facts/rabies.html

All I know for certain is that my brother remembers the event in excruciating detail, 60 years later.

[kestrel91316]

49. Oh, I don't doubt that he got treated. I just think back then

they didn't have a good grip on what species were a risk and what weren't. So they treated him.

Now we have enough data to know what the situation is. Thank heavens.

[enlightenment]

68. Can't disagree with that.

It was a brutal treatment, and erring on the side of caution meant that undoubtedly quite a few people had the distinct displeasure of experiencing it even if they didn't need it.

On the other hand, if they did need it, they're alive to complain about the treatment.

I'm delighted that medical science has advanced!

[kestrel91316]

72. You and me both!! As a vet student I had a single dose of the

old duck embryo vaccine prior to the HDC vaccine's availability (as the first dose in the pre-exposure series). It was an incredibly painful injection that incapacitated me completely for an hour, and then left me too sick to function for 24 hours.

[enlightenment]

73. Yikes.

My sympathy! I didn't realize (though I would have if I gave it some thought. I hope.) that Vets had to get those kind of preventative vaccines. ouch.

[kestrel91316]

76. That was over 30 years ago. Since 1981 we have been able to get the human diploid cell vaccine, and

human-derived vaccines IIRC, and the process is no worse than getting a flu shot now.

ETA: Plus the newer post-exposure vaccines are virtually 100% effective if given in a timely manner and the schedule is followed. The old duck embryo vaccine didn't always work if completed, and many people didn't even complete the series.

[LisaL]

79. Not never.

I know of a boy who died from rabies after bitten by a squirrel.

[kestrel91316]

82. I doubt that. I don't think it's ever been documented in wild squirrels.

Where and when did that happen? I'd like to look into it.

http://www.cdc.gov/rabies/resources/publications/2010-surveillance/rabid-wild-animals.html

ETA another link: http://rabies.emedtv.com/rabies/rabies-and-squirrels.html
"....Squirrels are almost never found to be infected with the rabies virus. Squirrels also have not been known to cause rabies in humans within the United States. Bites from a squirrel are not considered a risk for rabies unless the animal was sick or behaving in an unusual manner, and rabies is widespread in the area....."

[ChairmanAgnostic]

101. what about them black squirrels with a white stripe down their back?

My dog keeps catching them and bringing the carcasses back as a gift.

The smell is something else, too.

[kestrel91316]

104. Those, my dear, are a HUGE rabies problem in some states.

Where there is skunk rabies, there tends to be a lot more domestic animal rabies because skunks like to scavenge around human habitation.

http://www.cdc.gov/rabies/resources/publications/2011-surveillance/rabid-skunks.html

[ChairmanAgnostic]

110. I graduated from tomato juice to hydrogen peroxide and baking soda

last year. With 100+ very furry lbs, it was a miserable task. Repeated all too often.

[kestrel91316]

120. I hear it works 1000% better, though, than tomato juice.

[MADem]

38. A SQUIRREL....on the WHITE HOUSE LAWN???? In the FIFTIES??????

My dear, that's a terrible way to refer to Vice President Nixon, notwithstanding his failings as a politician!!!





Sorry....just could NOT resist......

[enlightenment]

46. *SNORK*

I seem to recall my granny making a rather caustic crack when she retold this story (brother was spending some holiday time with her - she taught sculpture at a school for children with disabilities in DC - she was also a life-long and staunch progressive.)

[LeftishBrit]

61. SNORT! And that would explain why people would be scared that he could spread rabies!

[hfojvt]

14. that's cool

things change, and I was not the one getting the shots.

But the rest is not wrong. She did say they made her feel like crap, and she did die.

Her death may or may not have had anything to do with the shots. More than likely just a coincidence. But I did not like the timing, especially since I felt responsible for the fact that she got the shots.

She said that almost all bats carried rabies, because I asked if she wanted to try to find the bat. But that town was loaded with bats and they really took care of the mosquitoes. Not sure how many people got treated for rabies.

[JanMichael]

15. About 3 percent of bats in the US

are rabies positive- (trust me, we have been through so much bat crap this week, it's ridiculous)...but, because most people can't tell if they were bitten, they are the ones who delay or don't get treated at all- and die.

You know when a fox has nailed you; bats...apparently not. And like I wrote, you have 72 hours to start treatment.

It's an ugly death. Disgusting. I wouldn't wish it on anyone-

[MH1]

102. Wow. Glad I didn't know that when I was a kid.

I caught a bat in my room. I'm pretty sure I woke up to the sound of it flapping around. Being an outdoorsy, science-oriented kid (i.e. nerd) I thought to turn the light on right away. The bat settled down and I scooped it into a container pretty easily. I don't remember if we let it go or what. I had no idea that I could have been bitten and not known it - I just assumed one would know that! So of course I didn't go to the ER.

I assume the incubation period for the disease is something less than decades, so I guess I'm ok.

Sorry to hear about your dilemma though.

[kestrel91316]

106. You are fortunate. You could have become a mere statistic or,

worse yet, died with no one knowing what the heck it was.

[MH1]

108. Yeah, I know that now, and more importantly, if it happens again I'll know to go to the doctor.

And thanks to your additions to this thread, if there's anyone else in the house they'll be going to the doc too.

[Curmudgeoness]

7. I don't believe that the shots are in the stomach today.

They are not nearly as bad as they were in the past. How long ago was this woman's treatments?

Also, most bats do not carry rabies. Although bats are one of the vector animals, one of the animals that are more commonly infected with rabies, that is not the same as that most bats have rabies. Bats are really great animals, so please don't scare people into starting to kill every bat because they "have rabies".

[JanMichael]

11. Exactly...we have always enjoyed them

and love seeming them darting around chowing down on bugs at dusk. Unfortunately, their teeth are so small that you cannot tell if you have been bitten.

Fortunately, our bat is out happy (we assume he's a happy bat) and probably thrilled to be away from the fish net wielding loons he encountered by accident.

Unfortunately for us, we live in the most medically stupid and expensive country in the world.

[kestrel91316]

21. The "Pasteur" treatment with the duck embryo vaccine in the abdomen

became completely obsolete over 30 years ago with the development of human diploid cell rabies vaccine. My vet school class were the guinea pigs in its Phase 3 trials. We all got outstanding immunity, and human-derived vaccines are all that is available now. They are of no more consequence than any other vaccine, and they are given in the arm.

If you get bitten, of course, Day 1 is no picnic because of the need for immunoglobulin shots in the area of the bite.

Modern rabies post-exposure prophylaxis is virtually 100% effective if administered correctly and in a timely manner.

[Barack_America]

37. How long does immunity last?

I've often wondered why we haven't expanded our vaccination program given the frequent ambiguity regarding possible exposure.

We had an issue with rabid skunks in my area 2 years ago and had one that was almost certainly rabid turn up in our yard. I was livid that my husband didn't contact animal control (I was at work). Our dogs are vaccinated, but our toddler is not.

[kestrel91316]

45. Duration of immunity is an individual variable.

The PEP protocol does take into account previous PREVENTIVE vaccinations, but I think if you get PEP and then need it again later on for another exposure you get the same PEP.

They use an abundance of caution, because PEP is virtually 100% effective for THAT exposure, and rabies is essentially 100% fatal if you come down with it.

Some people who get exposed and don't get PEP manage to not get rabies, but that's taking a hell of a risk. Once you get sick with it, you are a dead person walking.

[Curmudgeoness]

91. Are you saying that the pre-exposure shots

are the same shots that are given after exposure? I had the pre-exposure regime years ago when I was doing wildlife rehabbing, and it does sound like there is that same time-sensitive timing of the shots with both.

[kestrel91316]

93. Day 1 of the post-exposure protocol involves a gigantic injection of immunoglobulin

(around the bite site if you have a bite, yikes, and in the butt if not), but other than that as far as I know it's the same vaccine before and after exposure. The number of doses and timing varies depending on whether or not you have had prior vaccinations for rabies and if you are immunocompromised I think there's an extra dose of vaccine.

http://www.who.int/rabies/human/postexp/en/

[Curmudgeoness]

94. It is amazing how much the OP is looking at for a cost then.

I got the pre-exposure shots from the health department for a nominal cost.....I think it was $60 for the set. I realize that was 30 years ago, but the cost cannot be that much higher today. Sounds like another one of those health care ripoffs.

[kestrel91316]

96. Exactly. And under Single Payer that would vanish - Uncl Sam would say we'll pay you 3x cost, period

[kestrel91316]

18. That whole process became obsolete OVER 30 YEARS AGO.

Please stop perpetuating that myth.

[pnwmom]

20. If you are sleeping or otherwise unconscious you could be bitten and not know it.

That's why they say to assume that a sleeping person was bitten.

[Curmudgeoness]

2. I am sorry that you have to go through this.

It is bad enough that you have to go through the treatments, although I have been told that they are not nearly as bad as they used to be. I suppose that the treatment is better than the chance of getting rabies.

I completely understand your frustration with trying to compare prices or even find out how much it will be. I get really pissed at the people who say we should be doing price comparisons to keep the costs down. What a crock of shit. I will bet money that none of those people have tried to find out how much something will cost.

I was told that I had to go to physical therapy. I have health insurance with a $5000 deductible, so it is in my best interest to know the cost. So I went to the place that my doctor recommended. They could not tell me how much it would cost. They could not even give me a guess. They said that they don't know the price until it is billed, based on my insurance coverage, etc. I said, well here is my insurance card, figure it out. Nope, can't be done. I went to 2 other facilities, and also could not get a cost, not even an estimate. WTF.

I have also had the same problem with prescription drugs. My cat needs a prescription on an ongoing basis, and it is filled at a pharmacy. He has no insurance, so it is whatever the price would be. I could get no price from five different pharmacies. Every one of them told me that they could not give a price until it is filled....at which time I would no longer have the prescription to go somewhere else. Not that it would matter....the other place may even cost more. Who knows!

It is a sorry state that we are in, and I will knock the crap out of anyone who preaches to me that I should check prices for anything health care related.

I hope all goes well for you. This is a shame. But you did give us some very good information about what to do----and not to do, if a bat gets in the house. I would not have knows, nor would I have done it right. Actually, I would not have contacted a doctor about it.

[JanMichael]

6. We would not have known to call the county health dept.

either. My wife is a librarian who works with medical students, and one of the nursing instructors told her to call the wildlife dept. asap.

Treatment has to be started within 72 hours to be effective.

And you are correct; calling the insurance company and asking the hospital told us exactly nothing. Zero. It's a guessing game. We didn't have any other choice... we couldn't exactly wait and see what would happen in the case. We do have friends that said they would have opted out due to the costs that you can find on google.

[Warren Stupidity]

4. Uh, get the treatment. Rabies is nearly 100% fatal.

And if your insurance doesn't cover it your insurance sucks, but they all suck at this point.

[JanMichael]

8. We started treatment as soon as we found out

we get out second series of shots on Monday, then on the next three Fridays.

Yeah, no way we were playing this game. We both cried when Ol Yeller was shot-

[MissB]

5. I don't know how quickly you have to have the shots.

But perhaps the County health department can help. I know some of our County health departments can provide the shots.

[JanMichael]

10. Nope. Not in our county

We looked into that; TX starts in the ER only. It's a very, very ugly monopoly on the drug (globulin), and the administrators. Worse, in parts of the South, the states are no longer buying the drugs...it's all privatized.

[dflprincess]

12. My friend had a bat in her bedroom several years ago

and what woke her up was something hit her leg. She wasn't sure she had been bitten but there were two little puncture holes in her leg that looked suspicious. Also, the bat was crashing into things including the floor so clearly something was wrong with.

She tolerated the shots pretty well. When she got hers, the first one was given right above the apparent bite and the rest were in her butt. She was renting a place in an old house that had been converted to several apartments and the landlord's insurance paid for the shots because there were some obivous gaps in the eaves and another tenant had had some problems with bats in her apartment.

[broiles]

13. About 70 yrs. ago when I was an infant

I was around a dog suspected of rabies. A deputy sheriff shot him from across the yard while the dog was next to me. So I had to have the 14 shots in the stomach. Turns out the dog was rabid. I suffered no ill effects from the shots nor from the deputy, but the deputy scared the hell out of my dad.

[JanMichael]

16. That is a great story!

Ours isn't that dramatic!

[kestrel91316]

17. I have. I got the preventive shots in vet school but was sick with the flu the day

they drew blood for titers so I never had a confirmed protective response (everyone else in my class did, so I wasn't worried). When I got exposed to rabies back in 1987, though, because I had no documented titer they had to initially handle me as unprotected. In a couple of days they verified I was protected, so that whole immunoglobulin horror on Day 1 was unnecessary, lol. The followup two vaccinations were inconsequential.

[JanMichael]

23. You were lucky

The shots weren't bad....but, we have NO idea how much we are in the hole. None. No one can tell us. We had a relative go through this a couple of years ago, and we are guessing our best case scenario is about 2 grand. Worst? 9 grand. And that's with very good insurance.

[kestrel91316]

25. I feel so bad for you. But because it is prevention, you

might be able to get it covered. Under Obamacare, preventive vaccines are 100% covered. I believe that has already kicked in. Do look into it. NO ONE should have to foot this bill themselves, especially if they have "insurance".

Mine was completely covered by the county health department. I suffered complications from the immunoglobulin and they even covered my stay at County-USC in the infectious diseases ward. Lots of people got exposed to the cat and they all got taxpayer-funded preventive measures.

[JanMichael]

28. Yep...and nope. Obamacare rules haven't quite kicked that in yet

if the damned bat had just waited six months....

AND the stupid bat has a perfectly good, huge Baptist church across the street from us...with not one, but two perfectly good belfries to hang out in.

But, no. He came to see us.

BTW, the dog was in bed with us....she got a booster too...even though she is up to date. The cat was never in the same room, or even on the same floor as the bat. I know because I was with her right up til I went to lie down.

[kestrel91316]

32. Take your cat in for a rabies booster just in case.

Sez kestrel the cat vet. Trust me on this.

PLEASE.

[JanMichael]

33. She just had one

less than 2 months ago...she is 14...our doctor didn't think it was neccesary....do you? We will...we aren't going to skimp on cat care...but, she was on the couch with me.... and was alone for maybe 5 minutes...she isn't the type to have even tried to get the bat--

The dog went deeper under the quilts and went back to sleep...but, was sleeping on the "quilt nest" while our bat was flying around-

[JanMichael]

34. also need to add

she is strictly indoors.

[kestrel91316]

40. There are at least 2 documented cases in the US of cats who never

set foot outdoors who got exposed to rabid bats in the home and died because their owners did not respond appropriately to the bat thing.

The bat got indoors. That makes the whole in/out cat thing moot.

[kestrel91316]

39. I do believe that the protocol calls for all pets inside the home to

get a booster immediately. Her age is not a problem - if anything it makes it even more critical to do so because immune systems get weaker as we all age, cats included. I think your vet probably isn't as up to speed on the current protocols as me, but then I am sort of an unusual case with my personal/professional rabies experience.

This is your only opportunity to protect her. If you guess wrong and she comes down with it, not only do you lose a beloved friend, but you and your household will have to go through this whole thing ALL OVER AGAIN.

[Sgent]

41. This wouldn't be considered

a preventive vaccine. Its precautionary, but its not recommended for the general population.

Generally in the human medical world (at least on the payment side), preventive medicine refers to tests, vaccines, exams, etc. which are recommended to large swaths of the population regardless of disease status. For instance, a cholesterol screen is recommended for all adults every five years.

A test given more often than the general baseline is not considered preventive medicine. For instance, for diabetics a cholesterol test is recommended every year -- but because the increased frequency in screening is due to the presence of diabetes, its not considered a preventative service but part of the diabetes disease management process.

A vaccine subsequent to possible exposure would be considered treatment -- not preventative.

I grant its somewhat an arbitrary distinction, but obama care will not cover this as a preventative service.

[kestrel91316]

48. What is your expertise in this area, and do you have a link of some sort?

I'm not challenging you. I am curious as to whether or not there has been an official determination of this or it's just your opinion.

ETA: Because of the public health implications of this deadly infectious disease, it is not remotely comparable to diabetes management. I believe your view is incorrect, and if it is not, then you can expect me in the future to stop wasting time on DU and start working to change that shameful insurance policy that courts death for so many.

PEP should be covered just like hepatitis exposure management: as a public health priority. Insurance companies have to be dragged kicking and screaming out of the Gilded Age, I guess.

[Sgent]

52. Check you DUMail

regarding my credentials -- but I have an extensive medical practice background which I PM'd you.

Traditionally, insurance policies (including Medicare) only covered care for disease and injury.

Health status diagnosis' were not covered in general, although often there are specific policy exceptions or allowances for particular situations (ie the diabetic cholesterol test I mentioned above) when used in conjunction with a diagnosed disease or injury. Its also under this criteria that the OP's ER visit and subsequent vaccination would be covered.

More recently, insurance companies have started providing an often limited amount of preventative coverage -- each insurance company sets their own requirements with Medicare being the most stingy, but most using the recommendations of the USPTF (US Preventative Services Taskforce) and CDC general vaccination schedules. For a relatively easy look a the technical side take a look at http://www.cigna.com/assets/docs/health-care-professionals/807467_d_PreventiveHealthCovGuide_v8_HR.pdf which although specific to cigna is fairly representative.

In the case of the original poster, his services will be billed with the following diagnosis cods:

V01.5 PERSONS WITH POTENTIAL HEALTH HAZARDS RELATED TO COMMUNICABLE DISEASES - Rabies

This has been traditionally treated as a disease / injury process, and therefore covered under medical insurance guidelines -- not as a preventative service.

This is a good thing, because until very recently very little was covered in preventative medicine or the coverage was poor. Even now there are significant limits. Take a look at http://www.medicare.gov/coverage/preventive-and-screening-services.html which details all preventative services covered by fee for service (traditional) Medicare.

[Sgent]

53. TL;DR

Traditionally preventative services were not covered under most insurance plans.

Therefore... treatment subsequent to an injury or other exposure (as in the OP's case, tetanus vaccine, etc) were not considered preventative because they are a reaction to an external event, and were covered as medical treatment rather than prevention.

All was good....

ACA passed...

Now these type of treatments are considered treatment rather than prevention, so the benefits differ (and are usually worse) than if they were preventative.

Changes have not yet been made.

[kestrel91316]

55. The policy with respect to universally fatal infectious diseases

MUST change. It is shortsighted, wrongheaded, foolish, and uncaring.

This is not India. It is not China. It is not Iran, or any of a hundred other medically medieval countries where people are left to fend for themselves when faced with a horrifically expensive preventive measure.

This is one of many reasons why medical "insurance" must cease to exist. And the corporations who profit from needless death and bankrupting the under-"insured" or uninsured need to be the ones to go bankrupt.

SINGLE. PAYER. NOW.

ETA: THIS tradition needs to go the way of Chinese footbinding:

"V01.5 PERSONS WITH POTENTIAL HEALTH HAZARDS RELATED TO COMMUNICABLE DISEASES - Rabies

"This has been traditionally treated as a disease / injury process, and therefore covered under medical insurance guidelines -- not as a preventative service."

~~~~~~~

Idiocy knows no bounds. And bean counters have no place in the decision making process when it comes to universally fatal infectious diseases.

[Sgent]

57. Originally this was a good thing

historically there was no or very limited preventative coverage.

So covering it as a preventative service would have meant no coverage -- instead it was considered a coverage of a disease process and given the same coverage as a heart attack, etc.

Now -- there's a separate public health issue specifically dealing with communicable diseases. Up until relatively recently, the state health departments would cover something like this as a public health threat -- but that would only be covered under their specific protocols and often only if administered by them or a select group of contracted persons. If you wanted to go to a private physician or hospital the health department didn't cover the service.

In today's world the health departments (at least in my part of the world) are often limited to tracking disease and rarely get involved with treatment or direct intervention -- they no longer have the cache they did for funding purposes when they were fighting small pox, polio, and endemic tuberculosis, and are often subject to political infighting when they try to fight things like HIV, STD's, etc.

[Marrah_G]

89. I agree

[kestrel91316]

24. Everything everybody ever wanted to know about rabies, and then some:

http://www.cdc.gov/rabies/

[JanMichael]

26. Thanks....there is also a link

in there for people without insurance to apply for coverage for the prophylaxis treatment that we are receiving now.

Without insurance, you can be looking at 20 grand....per person.

It's scary out there in the American Medical field. We are going to pay out the nose, and we know it....and no one can even tell us how much. The option? Wait longer than 72 hours and possibly DIE.

[Marrah_G]

90. Currently listening to a great book on this

it's called Rabid (nonfiction)

I also just finished a great book on zoonosis (virus making a leap from animal to human) called Spillover.

[kestrel91316]

92. Oh thanks for reminding me, I keep forgetting to pick up a copy of Rabid. Now that

we don't have bookstores anymore, new stuff just slips past me.

ETA: I know a bit about zoonoses, rofl, I'm a vet with a side interest in zoonoses/pubic health (as evidenced by my near-obsession with rabies.

[Marrah_G]

95. It's a favorite topic of interest for me :)

My friends think I am nuts.

There is a whole section in Spillover about the Q virus and the vets that were involved in the initial outbreak.

[kestrel91316]

97. I love infectious diseases, period. That's probably because of my undergrad degree in microbiology.

My nephew is studying for his MPH in epidemiology, so we will always have lots to talk about at family gatherings.

[kestrel91316]

29. Current PEP protocol:

http://www.cdc.gov/rabies/resources/acip_recommendations.html

[kestrel91316]

30. Wildlife rabies in the US:

http://www.cdc.gov/rabies/location/usa/surveillance/wild_animals.html

No surveillance data since 2010. This is what happens when RWers decide that taxes are evil and the government should be drowned in a bathtub.

[kestrel91316]

31. Human rabies in the US:

http://www.cdc.gov/rabies/location/usa/surveillance/human_rabies.html

[hibbing]

35. 2K out of pocket? Wow

Hey,
I certainly hope you are okay, so much for "insurance" eh? They take a boatload out of my paycheck for insurance then when I ever need treatment for anything it still ends up costing a ton. And I'm supposed to have "good" insurance too. This was an interesting thread to read, I learned a lot. I never knew you could get bit by a bat and not know it, that just seems so weird. Of course I woke up one day with a huge spider bite that caused a bruise the size of a softball and never felt a thing.

Peace

[kestrel91316]

42. Once Obamacare kicks in in 2014, this treatment

(which is the very epitome of PREVENTIVE IMMUNIZATION) will be fully covered - 100%.

That is isn't right now is a crime against humanity.

[karmaqueen]

36. I was treated with 21 shots in my stomach.

I was bit by a rabid dog in Sinop Turkey and he died the next day. There was no treatment there so it was flown in from Germany. We were there with the Army Security Agency, I took care of the MP dogs. This sweet stray dog came walking up to me wagging his tail and I offered it some food and he bit my finger. He also bit one of the Military guys who was stationed there. We got one shot a day for 21 days in the stomach in a circular pattern. The shots bothered him much more than me because he was so muscular and it took the serum longer to go in. Only once did it bother me because they hit a large scar and the serum got stuck in there and it swelled. They have come a long way with treatment since then. Good Luck.

[kestrel91316]

43. They sure have. That treatment protocol disappeared forever

(in the US) over 30 years ago. The Third World took a while to catch up. Sadly, the expense prohibits most Third Worlders from getting PEP, so they still die by the TENS OF THOUSANDS every year around the globe.

Do you see now why I am such a fanatic about this? There is no end to the public education aspect of this.

We will never rid the world of rabies, but we have the means to keep any humans from dying of it. We just need the will.

[raccoon]

77. Why did the shots have to be in the person's stomach? I've always wondered that. nt

[kestrel91316]

81. I'm not sure why they were given in the skin/muscle of the abdomen (the stomach is an internal organ

inside the abdominal cavity, for clarity's sake). I think they figured the arms just wouldn't hold up to the 6 weeks or whatever of daily injections, each of which was horrifically painful.

[Sgent]

44. That seems very high

for what its worth, as long as you stay in network, the cost probably won't vary greatly from place to place assuming the same geographic area and same type of facility.

Try to get it done at an outpatient facility -- your doctor's office can probably provide the follow-up shots, which will save you significantly compared to a hospital.

They can probably give you a "list" price if you dig long enough, but it has no relation to the negotiated price between your provider and insurance company. Those are *usually* similar for similar types of facilities (hospital, surgical center, doctor's office, etc.) within the same geographic area and same insurance company.

For example, I just had some lab work done. The charge was $2,500. The insurance companies negotiated rate was $150 -- the amount I had to pay as I hadn't met my deductible yet.

[JanMichael]

64. In this county...and most counties in NC

you have to start treatment in the ER, and then finish your last 3 or 4 doses at the outpatient clinic. No doctor's offices have the immunoglobulin. We looked into that.

[struggle4progress]

50. Some drug stores offer the vaccination

[kestrel91316]

56. You mean they administer it??? ROFL.

I would NEVER trust a drug store to follow the protocol properly. You need to have a physician AND the health department working together to come up with the correct course of action in each individual case.

If you are referring to them stocking rabies vaccine to sell - they have no business doing that whether it's for animals OR humans. Rabies vaccine in animals is to be administered only by a veterinarian or someone working under their direct supervision. And in humans, well, see the above paragraph.

[struggle4progress]

58. Fair enough. I didn't check carefully: they're probably offering a pre-exposure protocol

for travelers and for persons at occupational risk of exposure. They're not offering the post-exposure protocol, which may also involve immunoglobulin

[kestrel91316]

71. Important difference, lol. But I am THRILLED to see that the

pre-exposure protection is now so easily obtained.

I tried to get a routine booster from my doctor's office several years ago and they were completely flummoxed and finally said they simply couldn't obtain it. I got my titer checked and it was still good so it was moot, but I found it disturbing nonetheless.

[Kali]

100. I can order it on line/by mail and administer (veterinary) with no scrip or supervision

won't qualify for legal tags but it is available.

[kestrel91316]

103. That would be animal rabies vaccine, not human.

I think some states allow it to be purchased by laypersons, but I don't know any that consider the animal vaccinated in the eyes of the law if a layperson does it.

[Kali]

105. yes that is what I said

you wrote "Rabies vaccine in animals is to be administered only by a veterinarian or someone working under their direct supervision."

I knew that I could purchase and administer (and that it was not valid in terms of county legalities but in my situation the animals would never be in public or off the property)

To be clear I have not ever done that, all the pets here got their rabies from a pro, though I did do one dogs other puppy shots.

We get rabid skunks/foxes pretty regularly in this county.

[Generic Other]

51. Oh my.

Hugs to you both. Haven't seen you posting for ages.

I am not sure I could have been calm if I found a bat in my room.

Take care.

[Peaceplace80]

54. I was bitten by a raccoon

Had to get the rabies shot along with many others to avoid getting any diseases that raccoons carry. The rabies shot was given in my arm and I had to go to the hospital once a month for four months. I didn't have any problems at all after getting them.

[David__77]

60. OMG, that some thing happened to my friend next door.

She said she was trying to help an injured raccoon. Those things can be vicious under any circumstances! My neighborhood is overrun with those things, and skunks and possums. Fun stuff...

[FourScore]

59. I know A LOT about this topic, and some of your information is incorrect.

Trust me, I understand how confusing this can be.

Here's the deal:

Rabies infects very few people in the US each year, but it is 100% deadly. Most cases come from dog bites, although very few domestic animals carry rabies today. Wild animals carry it the most, including bats. Only 2% of the entire US bat population have rabies, so 1 in 50. However, if the exposure is in the home, the odds become higher. Allow me to explain.

Bats do not tend to live alone, but rather in packs. Sometimes, one will accidentally fly into a house. For example, often bats feel drafts coming from open windows; they are drawn to the draft and can pass through the thin opening between the screen and the wood of the window sill. A common entry. Or, bats may be residing in your attic, and one waywardly found it's way into the main part of the house. (It is interesting to note that bats can flatten themselves to the width of a QUARTER and can squeeze through extremely thin spaces.) In these cases, the bats are usually healthy. Another scenario, however, is that the animal is sick, in which case it separates itself from the pack, and can wind up in odd, unnatural places like your bedroom. No matter how or why they have arrived in your house, you have one and you do not know if it is healthy or rabid.

Again, let me re-iterate: only 2% of the entire US bat population have rabies - a 1 in 50 chance. However, if the exposure is in the home, the chances are higher than 1 in 50 since SICK BATS ISOLATE themselves and land in odd places -- like your bedroom. Never forget -- even though the odds are higher that the bat is healthy, IF the bat has rabies, and you get bitten, YOU WILL DIE!!! A completely preventable outcome with rabies shots.

You are correct that 80% (actually I thought it was higher than that) of bat bites go undetected. This is because a bat can anesthetize the animal it is biting as it bites -- so a person will feel NOTHING. The bite can happen VERY quickly. At most, it might feel as though the bat brushed up against you, and nothing else. Also, bat bites do not usually leave any marks -- NONE!!! If a person is asleep, and a bat is in the room, it can bite you -- especially if it is rabid. And you will not know that you have been bitten!!! If children are in a room with a bat, remove them IMMEDIATELY to another area of the house without alarming them. Don't forget, the bat can move quickly from room to room. You can try to shut the door to seal it, but it doesn't always work. I have seen bats fly under door cracks, and they can move from room to room VERY rapidly. If you are not careful, you can lose sight of it. Then, you may end up sitting up for hours or all night waiting for it to re-appear. In some cases, it might stay hidden until the next night. They can be impossible to find, or they might be hanging onto a door frame. Sometimes they squeeze behind furniture.

Another important piece of information -- If you find a bat in the home, odds are it has already been there for a day or two. I know this sounds hard to believe, but the data shows this to be true. You can call critter control, IF you have them in your area -- most metropolitan areas have a critter control hotline. If you do not have critter control, and you have a bat in your home, CATCH IT!!! DO NOT LET IT GO!!! DO NOT PUT IT IN A BOX OR COVER IT WITH SOMETHING BECAUSE IT WILL GET OUT!!! I know catching it is creepy, but it can be done. Some people wear jackets and gloves and even motorcycle helmets while trying to make the catch. Some people catch them in mid-air. It is easiest if the bat is asleep and hanging somewhere -- but it's still creepy. Once caught, the bat should be placed in a tightly sealed container (I KNOW this is cruel -- don't forget your life could be on the line!) and then placed into the freezer. A BAT CANNOT BE TESTED FOR RABIES IF IT IS ALIVE!!! Immediately, call your local health department, if you have not done so already (actually you should have done this first -- AFTER you have removed all kids from the premises or from the area where the bat is flying around). All local health departments have a 24-hour call service, they can give you the specific instructions how to freeze the bat and when/where to drop it off the next day. The bat must be dropped off the next day. It will take 24 hours to get test results (unless it is a weekend, in which case it could take up to 48 hours), and rabies shots should be given within a few of days of exposure. The SPCA has also been known to take frozen bats and can arrange their delivery to the health department.

Most bats tested for rabies come back negative and no shots are necessary. Problems arise when the bat gets away. In those cases, there is no way to know if the bat was rabid or if the people exposed were bitten. In some states, it is law that all minors exposed to untested bats (or bats that tested positive for rabies) must get rabies shots. Adults can deny their own shots, but I wouldn't recommend it. THE SHOTS ARE NOT GIVEN IN THE STOMACH!!! The shots are administered in the deltoids and consist of an immune globulin shot and 4 vaccine shots given over 14 days. The amount administered is based on the patient's weight; so a large person may get multiple LARGE immune globulin shots at once. I've seen enormous men blanch at the sight of their shots. The patient will then be observed for adverse reactions and then sent home. The remaining vaccine shots are administered on days 3, 7 and 14. If another possible exposure to rabies happens in later years, only two booster shots over 3 days are required.

The initial series of rabies shots cost THOUSANDS of dollars. Six years ago, a family of five needed shots and the total cost was $13,000.00. In most states, the health department will bill the patient's insurance company. The insurance companies are mandated by law to pay for the shots, unless there is an outstanding patient deductible. In the case of a deductible or if the patient(s) have no insurance, the state will cover all the cost of the immunization. You should inquire in your local health department about their payment liability policy. It is unusual for the health department to demand a person pay for it out of pocket. It is a public health issue and is taken very seriously. It sounds to me like you re dealing too much with the insurance company and hospital. These are not good sources for information. CALL YOUR HEALTH DEPARTMENT!!!!!! They will tell you the law regarding payment. Tell them you want to speak to the person in charge of "bat exposure" and rabies. They might ask questions first to try to screen your call, but there is a person in charge of that.

I think that about covers everything. I hope this helps. Let me know if you have any further questions.

[JanMichael]

63. What did I write that was incorrect?

You rewrote exactly what I did- and apparently missed the part about "we have started treatment." We go back for round two (day three) on Monday.

[FourScore]

75. You seem a little defensive.

I spent over an hour writing that info for you late last night at 2:00Am and I was dead tired. All you care about is what was incorrect about yours?

Okay, after re-reading your post, I think I was simply trying to educate others on DU (as well as you) on how to do it right, because you made some errors with the bat -- like not containing it, not freezing it. It was meant to be educational. That's all.

Honestly, I'm kind of wondering why I spent my time on it...since you know all you need to know...

Geez.

[JanMichael]

84. I seem defensive because you spent an hour

of wasted time reiterating what I wrote....which clearly you did not read. I appreciate your attempt at edification, however, before you start next time, perhaps you should read the OP. I do not mean to come across as sarcastic-- but when I read your post this morning, all I could think was "did this person even bother to read anything I wrote?"

Clearly we handled the bat wrong. Obviously we made mistakes. That is what the whole thread is about-

[FourScore]

118. Sorry if I offended. I was just trying to help. n/t

[JanMichael]

65. We also started with the state wildlife department

then found the rest of our information via the county health department through a phone call. I appreciate your attempt to educate us, but it doesn't sound as if you read much that I wrote.

We started treatment within 36 hours, the dog has been to the vet already, and apparently the cat needs to go in too...even though her rabies is current, and was administered just a few months ago. She will go in Monday.

SC quit paying for the immunoglobulin last year. NC never did. There are only programs such as the Pastuer foundation to help the uninsured, and payment plans through the hospital. The main cost is the immunoglobulin. We live down the street from one of the most famous hospitals in the US.

[kestrel91316]

109. Oh dear. Where to start?

THIS is patently false: "...Rabies infects very few people in the US each year, but it is 100% deadly. Most cases come from dog bites....." I am not sure where you are getting your completely WRONG information, lol, but you need to stop while you are ahead and stop pretending to be knowledgeable. Most human rabies acquired in the US, if not all of it in recent decades, has been from the BAT strain. No one has acquired dog rabies in the US in many years. The cases involving the dog strain were ALL acquired outside the US.

http://www.cdc.gov/rabies/location/usa/surveillance/human_rabies.html


The rest of your post, while largely correct, is a hysterical rant at the OP which is completely unwarranted. He has a very keen grasp of the situation and I am helping to fill in the gaps in his knowledge.

[FourScore]

117. WTF? I was trying to help.

(Deep breath.)

Okay. First of all, I will grant you the sentence I wrote was really badly written. I cut and pasted some of my own writing at 3:00AM, and it came out sort of jumbled -- that was not my intention. Allow me please to clarify -- Worldwide, dogs are the main transmitter of rabies, accounting for around 97% of the cases. In America, they do not account for that many at all. Bats are the primary source, accounting for more than half of the US cases. What I was trying to say in that sentence is that rabies is not as prevalent in the US as elsewhere in the world, but it is 100% deadly. That was the main point.

I am knowledgeable in this area. I'm not pretending. What other mistake do you think I made that warrant such dismissive responses from you like "lol" and "stop while you are ahead and stop pretending to be knowledgeable.." Wow! Pray tell...what was so wrong about my information?

My post was really just trying to be informative to those who don't know anything about bats and rabies and what to do. It was never meant to be a rant, and I'm really baffled where I ranted. The title was not so great when I said the OP was "incorrect" or something like that. But, I wrote it between 2:00-3:00AM. I was REALLY tired. I didn't even proof read it.

Honestly, I thought the OP seemed a little overwhelmed and I was just trying to educate. I think bats and rabies and rabies shots and the cost can be very overwhelming and many people are poorly informed on the matter. I happen to be very educated on this. Just trying to share my knowledge.

Obviously, I stepped into a beehive with this one. So, my apologies to all I offended in this thread. I was truly just trying to help.

[kestrel91316]

119. I think it would have helped to leave the ALL CAPS and multiple

exclamation points at home. It made it look like a hysterical rant.

No harm, no foul. You meant well. Typing while exhausted is always dicey.

[FourScore]

121. They were meant to point out the most important stuff.

It's a long piece and if a person only wanted to scan it, I wanted them to see those points. Not being hysterical.

But you still haven't told me why you were dismissive about my information. Why the "lol" and the "stop pretending" and all the other insults you hurled.

Of course I meant well.

I will agree with you on this -- typing while exhausted is always dicey.

[LeftishBrit]

62. Very best wishes - I hope the treatment isn't too unpleasant, and that the financial aspects are

sorted out without too much difficulty or expense.

Sorry that this has happened to you!

[SwissTony]

66. We have good insurance....the cheapest out of pocket cost...will be around 2 grand

As an Australian living in the Netherlands, I can't get my head around that sentence. Can a sentence be oxymoronic? Good insurance but a min of 2 big ones?

In both Australia and the Netherlands, the payout would be measured in dollars and not thousands of dollars.

I'm glad you and your loved ones got the required treatment.

[JanMichael]

67. correct. Kestrel posted some CDC links

the number of people that have come down with rabies in the US is very small.... hiding the real problem that the health care providers treating those people all had to be treated like we did...

Millions. It's millions for the hospitals and drug companies.

[MNBrewer]

69. One of our local weathermen recently had a similar experience.

http://blogs.citypages.com/blotter/2013/08/sven_sundgaard_talks_about_his_rabies_scare.php

[roseBudd]

70. My raccoon bit me. I didn't surrender him

I got the full course of shots. They aren't in your stomach.

They were only available at the Level One Trauma Center hospital.

Can your primary care physician obtain the shots? Vets get it as prophylaxis every few years

[Marrah_G]

116. One question: why do you have a raccoon?

[kestrel91316]

74. While we're on the subject of rabies.....................

http://www.wormsandgermsblog.com/2013/09/articles/animals/horses-1/rabid-horse-attacks-owner/

"It doesn't matter whether the horse gave you rabies or stomped on you. Dead is dead.

"A Carroll County, Georgia horse owner learned the risk of rabid horses the hard way, but fortunately doesn't appear to have been seriously injured."

~~~~~~~~~~~~~~~~~~~~~~

[Warpy]

78. The treatment isn't prohibitively expensive

and is a damned sight better than dying of rabies even if it were.

It's good you're getting treated. You don't even have to be bitten, a droplet of saliva on a mucus membrane will do it.

I'm not surprised you're not getting a straight answer about cost. You're correct that the bedside caregivers of all levels don't know, only the hospital billers who translate treatment codes into dollars do and they're not available for consultation.

[JanMichael]

83. The treatment is prohibitively expensive

for many people in the US. Without insurance, you are looking at between 10 and 20 grand. I have already talked to folks that said they wouldn't do it. Incredibly sad.

I should have added something to my OP: one of the aides came in and took our check card in the exam room. Before we talked to a PA/ nurse...anything. We could afford it; I can't think of what we would do if we were close to being on the street.

Horrifying and eye opening experience. For damned shots. The PA talked to us for about...45 seconds. I will post her bill as we get it.

[Warpy]

87. It wasn't always that way

I wonder if the local Board of Health would help the uninsured in this.

It's one of those public health issues.

[LisaL]

80. Back when I was a child, I got bit by a dog and had to have rabies shots.

The shots were in the stomach back then.
I just read of a woman who died from rabies after finding a bat in her room. She didn't get vaccinated because she wasn't advised that bats carry rabies.
So it has to be done.

[morningglory]

85. My sister rescued a sick horse. Turns out it had rabies. She went to the doctor and

said she had just lost her job and had no health insurance. Doctor said it is a matter of public health and she was treated for free.

[Marrah_G]

86. I'm glad you were told to go get treated

Unfortunately once you show signs of the illness it is too late.

I'm currently listening to "Rabid: A cultural history of the world's most diabolical virus. " on audiobook.

[dipsydoodle]

88. Do you get many cases of rabies in the US ?

We only get extremely isolated cases in the UK usually picked up abroad. This is largely due to our quarantine laws on dogs.

[kestrel91316]

112. Do we?? And howdy!!!! Take a look:

http://www.cdc.gov/rabies/location/usa/surveillance/wild_animals.html

http://www.cdc.gov/rabies/location/usa/surveillance/domestic_animals.html

I am in SoCal so the only wildlife rabies we have to worry about is bats. We have only seen one case of domestic animal rabies in LA County in the past 50 years or so, I think. It was a cat. There was a rabid puppy imported from SE Asia that came through LA County several years ago but it wasn't diagnosed until it hit Santa Barbara County, so it doesn't qualify as "our" case.

There are HUGE problems with skunk rabies and raccoon rabies back east.

[dipsydoodle]

123. Thanks

I'd never realised. I remember going to stroke a pack of raccoons at about midnight at a dance event near Port Townsend WA in 1995 because I thought they looked cute only to be whisked back by the scruff the neck by a large friend who said "no Richard - we don't do that" laughing as he did so. I guess the risk of rabies may have been the reason. Only skunks we've got here are pet ones and they are few and far between - I was surprised how small they are.

Domestic dogs here have to be certified to come and go with their owners and imports follow the same rules : http://www.petrelocation.com/resources/international-regulations/united-kingdom

Our NHS blurb on the subject in general here : http://www.nhs.uk/news/2012/05may/Pages/london-rabies-case-from-dog-bite-abroad.aspx

[kestrel91316]

124. As a veterinarian I have had the "pleasure" of

getting cats prepped for importation into the UK. Oy. What a hassle!

Australia and our own state of Hawaii are just as bad. But I do understand why all that is necessary. I just hate having to do all the thinking and planning and research because owners are too lazy to do it themselves, lol.

[telclaven]

98. Yes

Feral cats attacked my brother and I in Germany. Wing commander sent an F16 to England to get a (then) experimental vaccine for us. Five shots in the arm, way better than the old way. My understanding is it is what vets have to take these days to maintain immunity. Never had any repercussions.

[kestrel91316]

113. All we need is an occasional single booster.

And there is some debate if you even really need those if you have had a prior documented titer or have been through the PEP.

Somebody like me, who was given the pre-exposure series in vet school AND had the post-exposure series in 1987, is probably immune for life. But we don't know for sure and nobody is willing to take the chance. If I ever get exposed again, I WILL go through the reduced PEP that I qualify for.

[Owl]

99. I had a bat clamp on to my face a few years back. Went through the whole $ shot thing.

RabAvert I believe it was.

[FourScore]

122. Whoa. That's intense.

Are you really an Owl? That might explain why it clamped onto your face. And bats and owls are both nocturnal.

[Deep13]

107. I don't know--but don't you have to be bitten to get rabies?

Did it bite anyone?

[kestrel91316]

114. You can get rabies without a bite AND DIE. I had

aerosol exposure to my face, which is like when spelunkers inhale it in caves - it's a VERY fast way to get rabies and die.

Saliva on a tiny scratch or nick you don't even know you have can do it.

And there have been a number of cases where people have gotten it from human tissue transplants. they really need to be more selective about donors. I thought they prohibited b=people who died of undiagnosed neurological disease from donating organs now, but it still happens so maybe they are misdiagnosing it and they slip through. SCARY.

[Deep13]

125. good to know. nt

[dem in texas]

111. I was bitten by a rabid dog and took 14 painful shots in my stomach

I was in the 4th grade, it was back in 1949. The school had a fire drill and all the kids went out and at the same time a rabid dog came on the grounds. The gym teacher had seen the dog and tried to catch it and she was bitten all over her hands The teachers and janitors were chasing the dog when it went around the corner of the school where my class stood waiting to go back inside. My little friend and I saw the dog coming and reached out to pet it and it bit us both, me on the leg. It bit ten or 12 children and several teachers. This was in Dallas at W.W. Bushman school. The man who lived next door to the school came over with his 22 rifle and he and the janitor cornered the dog and shot it. The body was sent to Austin and confirmed to be rabid. My family was poor with 6 children and my mother's first worry was how were we going to pay for the shots. But we were able to get them at the health department for free (at first we were told we'd have to pay). Every morning for 14 days, I had to go to downtown Dallas and get a shot in the stomach. The shots were very painful and left knots in my stomach that were there for several years.

Think if this happened in this current news crazy age - a rabid dog on the school ground biting children. News helicopters, Swat teams, CNN coverage, it would be news all over the world. In those no one even called the police, just got help from the man next door.

I know that the shots are not painful anymore. Thank goodness.

[kestrel91316]

115. Not only are the shots not painful now,

(well, Day 1 is pure hell but after that it's no biggie), but there is a much reduced schedule, I think only 4 of the vaccine injections after the first immunoglobulin injection. So full compliance is the norm. It is considered virtually 100% effective, too, if given in a timely manner and completed per the protocol.

I've had a single injection of that old vaccine - in my arm. I truly wanted and expected to die that day. Fortunately after that we could get the new vaccine to complete our preventive series in vet school.