OK I have a friend who seems to be obsessing on the idea that he may have contracted rabies from a garbage can. Raccoons had apparently been frolicking in said can sometime (one day to one week) before he cut himself on it. He called his doctor’s office and the secretary apparently told him “we don’t do rabies shots in those cases.” But that just left him thinking that just because they don’t do shots doesn’t mean he doesn’t need shots.
Now I’ve researched as much as I could on the CDC’s website for ammunition to prove to him that he doesn’t have rabies. But all I can really come up with is proof that he probably doesn’t have rabies. This largely centered around the fact that very few people get rabies in the first place and if they do they usually get it through bites. And by the way if the raccoon had rabies and did slobber all over the can, the virus probably didn’t survive too long afterwards. That is if it wasn’t very damp.
Still, nothing that I read totally ruled out the possibility of getting rabies the way he proposed.
Any way anyone can think of to provide more reassurance than “you’re probably ok”?
So, you have specific symptoms to watch out for with the above and if he does have rabies he is in deep shit. If treatment is started early then chances to defeat it seem pretty good (info here ). If rabies progresses a bit it seems death is unavoidable.
Considering only one or two people a year die in the US from rabies it is less likely a cause of death than being struck by lightning. Clearly rabies is serious but worrying about it must be balanced with reality.
That said TALK TO A DOCTOR. I am not a doctor and medical advice here is not a good basis to make decisions off of. Rabies is a serious disease and is lethal. Do not take it lightly.
The most pessimistic information I can find is from here:
If he came into contact with the body of a dead raccoon, or if a raccoon had, a few hours before, slobbered or bled on the area of the can he cut himself on and it hadn’t dried, I would say that it would be very reasonable for him to be worried.
Rabies is a very serious, deadly disease. I would be extremely surprised if a competent medical professional declined to give someone treatment for rabies when it was requested unless the actual chance of infection was very, very low.
I’m just wondering why a cut by a rusty garbage can makes him think “rabies!” and not, say, the near-infinitely more likely result of “tetanus.” Further thought leads me to think he may have already covered that base, however.
Agreed. However, infectious rabies virus has been recovered from old carcasses in extreme cold conditions (think permafrost). Virus has been recovered from the oral cavity of an owl that was feeding on the carcass of a rabid skunk. Also, spelunkers have contracted rabies in caves where the bat population was so high that there was a “saliva mist” in the air. Corneal absorption is to blame in these cases.
People with a high concern for exposure (like veterinarians or people working with live virus in a lab) can receive pre exposure vaccination. I have spoken with people who have cheated their health insurer by claiming exposure. They go to their PCP with a wound and say it was from a raccoon. They then get post exposure treatment, which is covered by most plans and is very similar to pre exposure vaccination.
In veterinary school I saw an old B&W movie showing a rabies death. A man in Iran was bitten by a rabid wolf. He was in a hospital on a cot and a camera on a tripod was used to film a few minutes every hour or so as he died. It was the most hideous thing I’ve ever seen.
From www.batcon.org The Bat Conservation International site
[QUOTE=Two cases of aerosol transmission were reported in the 1950’s in Texas caves that support very unusual environments. However, no similar cases have occurred since, despite the fact that many thousands of people explore bat caves each year. No such transmission has occurred outside or in buildings.[/QUOTE]
Two cases, five decades ago, in some unusual caves in Texas.
Back To The OP
Malpractice insurance is hellishly expensive in Pennsylvania. While it’s cheaper in most other states, it and the threat of malpractice suits have to be a concern. If that practices policy was to turn away such cases without any tests whatsoever, either they are massively incompetent or a panel of doctors and lawyers have determined the chance of people actually contracting rabies in through a dumpster cuts is so statiscally insignificant that they don’t have to worry about it.
In addition, there are cases where people died from rabies and no known exposure existed. Epidemiologist Larry Glickman has written some papers that suggest aerosolized bat saliva is to blame for a few of these. I am not saying that spelunkers drop dead daily from rabies, but I also think your stats are lacking.
The teenage girl in Wisconsin who actually developed rabies last year contracted it by being bitten by a bat. She failed to seek post-exposure vaccination. She survived due to an experimental treatment in which her doctors induced a coma before the usually fatal infection took firm hold of her nervous system. She is believed to be the first person ever to survive a rabies infection without vaccination.
Having read the link, I don’t see where they conclude the man contracted rabies through aerosolized saliva. I don’t see any facts which would make that the likely conclusion. OTOH, we have a bat landing on the man’s chest. Isn’t it far more probably he was bitten and infected then?
If no known exposure exists, how can you logically conclude it was aerosolized bat saliva?
I’d like to read them.
The point in question is not whether bats can become infected with rabies and transmit the virus to humans. The issue is whether infection through contact with aerosolized bat saliva has occurred outside of two cases in Texas in the fifties.
Hey, DocCathode, if that seems snarky, I apologize. I was typing quickly in between other things (like work;)). Having had a few exposures to rabies, and having had reason to deal with local goverment officials who think rabies is over dramatized, I sometimes am a bit jumpy.
BTW, from the CDC:
and
And on preview:
I have Larry Glickman’s papers in my office somewhere and will try to find them. Again, sorry if my previous post was “snarky” or “bitchy” or whatever.
Again, neither myself nor BCI are saying that people don’t get rabies through bat bites. Bats can become infected with rabies. Before they go on to foamy death, they may transmit the virus to humans or other animals.
What I, and the BCI site are saying, is that outside of two cases in some specific caves, infection through contact with bat saliva in the air does not happen.
Nor are we saying that breathing the air in a bat roost is necessarily safe. It is possible to contract a respiratory infection due to a fungus that thrives in guano. (It ain’t fatal, ranking IMHO with pinkeye, ear infections and the flu).
Granted. However, in my defense, with a (usually) fatal disease I think it is best to err on the side of caution. It has been documented that aeroloziation of the virus can occur. It has been shown that application of virus to the cornea can lead to infection. I believe (no cite at hand) that a corneal transplant recipient contracted some disease (possibly rabies, I have CRS…sorry)
Definitively? How do you prove the source? IANACoroner and do not honestly know. If there is a corpse with no bite wounds and no history of contact with a rabid animal? Personally, the two cases decades ago are enough to make me iffy about caving. And I have had pre exposure prophylaxis.
Except for flying foxes, the bat is a tiny animal. Those would be some tiny bite marks.
But, if I understand what you’re saying, you’re arguing that not only can the air in a damp cave filled with bats transmit rabies, but that aerosol transmission can occur simply by being in the same room with an infected bat or even just having one in the house.
I am aware that cavers are at higher risk and take preventative measures. However, I maintain that this is simply because the risk of being bitten by an infected animal is higher. Veterinarians are also at higher risk, and I don’t think aerosol transmission is the cause there either.
Re Tetanus
Last time I asked a doctor about this, I was told that tetanus is only a concern with a deep wound. Scratching yourself on a dumpster doesn’t warrant a tetanus shot, but stepping on an old nail does.
I’d like to briefly hijack the thread to state that last summer, a very confused bat flew around me a few times in Ikea. I wanted to go capture it and put it outside, but I realized that would be a huge rabies risk. If anyone’s familiar with the Penny Arcade strip with the tiny bat, though, I did sing that song at it!
I love bats, bats are the best, bats, bats, bats, yaaaay bats!
I cannot find the cite right now, but two US laboratory workers died from aerosolized rabies virus. And i would not discount the risk from aeorosolized virus to a veterinarian. I do not get bitten frequently. In a case of suspected rabies, I will make damn sure I do not get bitten. It is not unusual, however to get saliva thrown onto myself from an aggressive, uncooperative animal.
Why do veterinarians not die from aerosolized rabies virus? Maybe it isn’t an important route as you suspect. Maybe pre exposure prophylaxis works.
Actually, the more I read the more I can see your point of view. However, even those in the field of rabies transmission to humans do not agree.
Very interesting paper. I haven’t read the whole thing, but I’ve got it bookmarked. I’m visiting a friend with a PhD in molecular biology tonight. I’ll try to guide his attention away from trifles like his move to another state next month, or the fact that he and his wife just learned that they’re pregnant and have him help me with methodology, statistical validity, and some of the big words.
However, after clicking on a footnote I find some very interesting things.
#1
I’d like to read those reports. So, it may be aerosol transmission or it could just be a guy who really should know better handling wild and potentially rabid animals and then rubbing an area likely to have open scratches.
#2
So it may be aerosol transmission, or it could have been a bite or contamination through an open wound.
The description of Frio cave is also enlightening. This is not just a cave with a lot of bats in it. It is a cavern filled with as many bats as can possibly fit in the space. If infection by aerosolized bat saliva did occur, it was no doubt helped by the fact that 20 to 30 million bats were in the cave.
We do have two definite cases of aerosol transmission though. The first is a veterinarian who pureeing rabid goat brains in a blender. So, if you ever enter a bat roost and see them using a Mixmaster, Osterizer, or Cuisinart, you should leave the area. More practically, the case involved aerosolized brain tissue rather than saliva that had aerosolized due to the respiration of rabid animals.
The second case involved an industrial accident
I’m curious as to just how concentrated the suspension was. I suspect it contained a significantly higher concentration of the virus than is found in the saliva of an infected animal. Again, while this demonstrates aerosol transmission is possible it does not demonstrate that it is possible under naturally occuring circumstances.