Rabies Symptoms in Humans?

Factual Questions
41

[QUOTE=WhyNot]
Ouch. That really sucks. OTOH, since I’m not her doctor, the baby is under medical care, and there’s really nothing else that can be done, I’m going to stick with my “keep my mouth shut and pray” response. Ignorance, despite our motto, sometimes is bliss, and since there’s nothing else that mom can do, I don’t want to give her two years of worry for something that probably won’t happen.
[/QUOTE]

Oh, you wouldn’t catch me dead telling that poor mom she needs to be wigged out for the next two years… it was just an “:eek:” moment for me reading it!

I need to stop reading this thread and freaking myself out about rabies.

42

[QUOTE=vetbridge]
… In my backyard earlier this year I killed several rabid raccoons. ..
[/QUOTE]

This reminds me of an incident about 13 years ago. I was arriving home (street of townhouses) in the middle of the afternoon. I saw a raccoon wandering down the sidewalk, and up and down several houses’ front steps. This looked VERY strange to my untutured eye.

From my cell phone (still safe in the car) I called the county Animal Control (northern VA, Fairfax County) and described this behavior. The person on the other end insisted this was just fine and not at all a symptom that the animal was rabid.

Was the person on the phone fulla baloney? I’ve never before or since seen a raccoon in the wild, there was no reason for it to be wandering around the front steps (no garbage cans), and I always thought they were mostly nocturnal.

43

IIRC, it would be strange to see a raccoon walking around blatantly in daylight. A professor here teaches us that such behavior from a skunk would be enough to worry about rabies. However, it’s possible that this particular raccoon was just very habituated to people.

Mayhap CannyDan will wander back in.

44

[QUOTE=Broomstick]
Actually, last year my husband and I did trap a bat in our apartment. The local authorities said that we did not have to get the rabies vaccine because of the circumstances involved and that we could positively state there had been NO direct contact of any sort between bat and occupants.
[/QUOTE]

Interesting. Sounds like the bats were never tested for rabies, from what I read in that thread. Is that right?

Having never reacted badly to a vaccine, I wouldn’t be inclined to take the risk unless the bat was actually tested and came back negative. But that’s just me.

45

Rabies is a big problem in Thailand. Once symptoms appear, the victim is pretty much a goner. Not much can be done then. I’ve read local accounts of people like one mother whose son contracted it apparently by kicking a street dog as he rode past it on his motorbike. Didn’t think he’d been bitten, but that’s the only time he could think of that he could have gotten it. All they could do was try to keep him comfortable until he died, although “comfortable” regarding rabies deaths is not really possible.

I was bitten by a street dog once during a time when I’d let my vaccine lapse, so I had to go through the whole series of shots. That’s one vaccine you have to keep up on over here.

46

[QUOTE=psychonaut]
Why should I go to an emergency room if I suspect that someone else has rabies?
[/QUOTE]

Because if you’ve been in contact with them, you must get vaccinated as a precaution. Once symptoms appear, you will die. There is no successful treatment once symptoms appear.

47

[QUOTE=chorpler]
Interesting. Sounds like the bats were never tested for rabies, from what I read in that thread. Is that right?
[/QUOTE]

Correct. But as there had been no, I repeat no contact between bat and human that could cause transmission the authorities deemed shots unnecessary. If infective material never touches you then you can’t be infected. Although there have been cases of airborne transmission in caves full of millions of bats this was not the situation. It was a lone bat. It is also a fact that bats roost in the nearby trees and building eaves and have done do for years. You don’t catch rabies merely by being *near *bats (or anything else), there has to be some sort of contact. If you caught merely by being in the vicinity of wild animals we’d all have dropped dead years ago.

Yes, but if you’re in a situation where you could potentially have a lethal reaction to the vaccine that does complicate the issue. A sort of damned-if-you-do-damned-if-you-don’t thing.

48

[QUOTE=Broomstick]
Correct. But as there had been no, I repeat no contact between bat and human that could cause transmission the authorities deemed shots unnecessary. If infective material never touches you then you can’t be infected. Although there have been cases of airborne transmission in caves full of millions of bats this was not the situation. It was a lone bat. It is also a fact that bats roost in the nearby trees and building eaves and have done do for years. You don’t catch rabies merely by being *near *bats (or anything else), there has to be some sort of contact. If you caught merely by being in the vicinity of wild animals we’d all have dropped dead years ago.
[/quote]

All good points, but as some of the stories show, people don’t always know (or at least don’t always remember) if they’ve been bitten / scratched / whatever by a bat (or a street dog, as Siam Sam recounts). Scary.

Yeah, I can certainly understand that. I wasn’t aware that the vaccine could cause such strong reactions.

49

[QUOTE=Pullet]
IIRC, it would be strange to see a raccoon walking around blatantly in daylight. A professor here teaches us that such behavior from a skunk would be enough to worry about rabies. However, it’s possible that this particular raccoon was just very habituated to people.

Mayhap CannyDan will wander back in.
[/QUOTE]

Sure.

Rabies manifests itself in wildlife with a variety of symptoms, ranging from the classic foaming at the mouth aggressiveness (“furious rabies”) to the polar opposite. The later is termed “dumb rabies”. The animal may appear calm, submissive, tractable, as if it was a “tame” individual. That individual may flip from one behavior to the other instantly and without warning.

A raccoon or any other wild animal wandering the streets at an unlikely time is always suspect. It may be an individual habituated to human presence, or it may be displaying an aberant behavior caused by some underlying injury (e.g., hit by car) or disease (rabies, distemper, or others that attack the central nervous system). Exercise caution and call your local animal control agency. They are in the best position to judge since they will be familiar with the current incidence of rabies in the area.

If one works closely with wild mammals, one must be ever vigilant. Rabies can of course be transmitted by a bite or scratch. It can also, though with much lower probability, be transmitted by aerosolized saliva, such as from a cough or sneeze. It may, though again with low probability, be transmitted by direct contact with any bodily fluid such as blood, urine or feces. It may even be transmitted by contact with the animal’s fur, if saliva is present. If camping where rabies is common (especially in the third world) a rabid animal might inspect you and lick your face while you slept in a sleeping bag.

All these (except the direct bite or scratch) are considered to be “casual exposures”. The pre-exposure rabies vaccine used today for humans is considered to provide sufficient protection from casual exposures. But in the event of an actual bite or other direct exposure, the victim must undergo the post-exposure rabies injection series. There’s a pretty good description of this series and some other rabies issues in another current thread called “Pet Wolves”-- but I seem to be too stupid right now to remember how to link to it.

The pre-exposure vaccination series for humans typically comprises three injections spaced some days apart, each consisting of either 1.0cc of vaccine injected subcutaneously or 0.1cc vaccine injected intradermally. Our cost for this series is usually about $60 per injection.

The pre-exposure vaccination in humans challenges the immune system which will create some antibodies. This level (“blood titre”) is measurable, and as stated above will help to decide if a booster shot is required periodically. When challenged, the immune system first designs a “template” of the antibody. (highly simplified version of immunology) It then makes some but not necessarily much of the actual antibody. In rabies, the virus is pretty selective in its choice of tissue to attack, concentrating first in the central nervous system. It may actually remain “unnoticed” by the body’s immune response system, even if some antibodies are present. If the infection proceeds rapidly enough, it may be able to stay ahead and overwhelm the body’s ability to manufacture sufficient new antibodies from the existing template. In which case, you could still die even if you had the pre-exposure vaccination.

So in case of a significant exposure, as from a bite, the post-exposure series is required whether or not the victim has had pre-exposure innoculation. This is no longer the nasty series of stomach injections. Instead it is a series of (a) some amounts of vaccine, intended to challenge the immune system (which again may or may not have “noticed” the virus from the bite) and produce de novo antibodies, plus (b) massive doses of human rabies immune globulin, intended to “soak up” such virus as is present. Cost for this series is commonly in the $2,000 range. And, while not as nasty as the old stomach shots, it isn’t particularly pleasant.

Bats are always a judgement call, for the reasons stated upthread. It does appear possible to transmit the disease from a bat to a human without an actual bite, presumably by aerosolized saliva and/or urine. Certainly in any wild population of bats, only a low percentage of individuals actually have the disease. One bat found in the house makes transmission rather unlikely. However, as also stated upthread, rabies is pretty much 100% fatal (there are incredibly rare exceptions) once symptoms develop. So when it comes to bats, this is a classic “Are you feeling lucky today?” scenario.

The only reliable way to avoid this nasty scenario is to have the animal examined to either confirm or rule out the possibility of rabies. Of course, this requires that the animal be available, and not have run off into the woods after biting you.

NajaNivea my dear, please accept my apology for the unwarranted assumtion about your gender. (You must admit though that neither skinning foxes nor falconry is practiced by as many women as men.) I hope you get your golden eagle. We don’t have them around here; we only have bald eagles. I’ve got 5 of them here right now. Please do be careful with the foxes. And if you are bitten, refrigerate the carcass (do not freeze) and bring it immediately to your local health department for rabies testing.

50

[QUOTE=chorpler]
All good points, but as some of the stories show, people don’t always know (or at least don’t always remember) if they’ve been bitten / scratched / whatever by a bat (or a street dog, as Siam Sam recounts). Scary.
[/quote]

Yes, however, as I stated, we did consult with local authorities on rabies who looked at our particular situation. We did not simply guess but rather consulted with people more knowledgeable than us about the risk of such situations.

It’s NOT the vaccine, it’s ME - I have also had life-threatening reactions to such innocuous things as tomatoes.

51

[QUOTE=CannyDan]
If one works closely with wild mammals, one must be ever vigilant. Rabies can of course be transmitted by a bite or scratch. It can also, though with much lower probability, be transmitted by aerosolized saliva, such as from a cough or sneeze. It may, though again with low probability, be transmitted by direct contact with any bodily fluid such as blood, urine or feces. It may even be transmitted by contact with the animal’s fur, if saliva is present.
[/quote]

From the CDC’s rabies exposure page:
"Under most circumstances, two categories of exposure – bite and nonbite – should be considered.
…
Nonbite exposures from terrestrial animals rarely cause rabies. However, occasional reports of rabies transmission by nonbite exposures suggest that such exposures should be evaluated for possible [postexposure prophylaxis] administration.

The contamination of open wounds, abrasions, mucous membranes, or theoretically, scratches (potentially contaminated with infectious material from a rabid animal) also constitutes a nonbite exposure.

Other contact by itself, such as petting a rabid animal and contact with blood, urine, or feces of a rabid animal, does not constitute an exposure and is not an indication for PEP." (bolding theirs)

…although I have to admit the very idea gives me hives, and you can bet I’d be checking myself for even microscopic abrasions and making a slightly hysterical phone call or two were I in that position. :wink:

No apologies necessary!
The golden is a bit of a wild dream. Were I to pull it off, I’d be–to my knowledge–the only practicing female eagle hawker in the US and one of only three ever licensed. I’ve still got a lot of years of training to do and a ferruginous hawk to get acquainted with before I even begin to think about GE territory, but it would be a neat thing, wouldn’t it?
I sent an email to the CDC and my local health department to ask to whom I should inquire about rabies risks in my area, and whether or not they want routine samples for data collection. I tell ya, I had really never even thought about rabies being a concern, and… now I’m a bit eeked out. I looked up the stats and in my state we’ve only ever had bats test positive in the past several years with the exception of one fox in 2006, so that at least makes me feel marginally better, although there’s so much wild land here the chance of running into critters is lower than on the east coast.
Rabies! Yik.

52

Also, please note that even if you have had the vaccine, you still need to go get MORE vaccines once you have been bitten.

The way it was explained to me was, the pre-bite vaccine is kind of a time-buyer. If you get bitten and you are not vaccinated, you have a certain number of hours/days before the symptoms start to appear, at which point you had better of started treatment already, or else you are screwed. The pre-bite vaccine (I dont know what else to call it, but there is a better term for it) adds a couple of days to that window.
love
yams!!

53

[QUOTE=NajaNivea]
<snip>
Other contact by itself, such as petting a rabid animal and contact with blood, urine, or feces of a rabid animal, does not constitute an exposure and is not an indication for PEP." (bolding theirs)
<snip>
Rabies! Yik.
[/QUOTE]

Your citation is quite correct. Although perhaps I shouldn’t quibble with the CDC, the above sounds perfectly acceptable for a single incident, a once in a lifetime event. However, those of us that experience such on an almost daily basis are a bit less willing to be quite so absolute. That’s the reason we have the pre-exposure vaccination.

/parenthetically
I knew female hawkers were rare-- I didn’t know that so few of you had eagles. Good luck with the frog mouth! And do keep on until you get your golden!
/close parenthesis

54

[QUOTE=yams!!]
Also, please note that even if you have had the vaccine, you still need to go get MORE vaccines once you have been bitten.

The way it was explained to me was, the pre-bite vaccine is kind of a time-buyer. If you get bitten and you are not vaccinated, you have a certain number of hours/days before the symptoms start to appear, at which point you had better of started treatment already, or else you are screwed. The pre-bite vaccine (I dont know what else to call it, but there is a better term for it) adds a couple of days to that window.
love
yams!!
[/QUOTE]

This is correct. However, if you are vaccinated, then you will require only a single booster shot after you are bitten. If you are not vaccinated, you must take the entire series over a period of a few weeks.

That’s how it was explained to me by the Red Cross, who chided me for not having kept up on my vaccination that time I was bitten by one of our street dogs. I had to retake the whole series; now I keep up on that vaccination.

55

When I was in vet school I was shown an old old movie of a man dieing of rabies. There was no sound, thank god, but it looked pretty awful.

I received the vaccine plus booster as a junior vet student. Two years later, as an intern I was exposed to a rabid bull. He presented for urinary tract obstruction because the owner interpreted his bellowing and tail twitching as straining to urinate. About 5 people handled him or were exposed to his secretions. This occured in Minnesota, which has a relatively large number of rabid livestock present, so the index of suspicion was high. As soon as it was clear the bull did not have a urinary obstruction the next most likely diagnosis was rabies and nobody touched him again. The bull went down that night and died the next day.

What was odd was that this was a valuable bull that had been housed in an isolation facility at an AI bull stud, and prior to that had been on the state fair circuit. Nobody could figure out a time that he might have been exposed to a wild animal. It’s possible it occurred months earlier before his show career. I had one of my more surreal conversations with an owner when one of his co-owners called (he was owned by a syndicate) because he had gotten wind of the fact that this bull was in our hospital. I had to tell the owner that said bull had in fact been here, died, and been diagnosed with rabies.

When the positive result came back - two U Minnesota employees (I was one of them) and about 5 students went to student health services to get post-exposure shots. The doctor there told us that herbivores don’t have enough virus in their saliva to be infective and thus we were low risk and it wasn’t worth spending the money to vaccinate us. We told the Dr. that low risk or not, we weren’t going to screw around with rabies. The other employee and I were then given the shot because we had insurance to cover it. But the students had to pay out of pocket for the vaccine because the Dr. deemed it unneccesary.

56

[QUOTE=Mama Zappa]
This reminds me of an incident about 13 years ago. I was arriving home (street of townhouses) in the middle of the afternoon. I saw a raccoon wandering down the sidewalk, and up and down several houses’ front steps. This looked VERY strange to my untutured eye.

From my cell phone (still safe in the car) I called the county Animal Control (northern VA, Fairfax County) and described this behavior. The person on the other end insisted this was just fine and not at all a symptom that the animal was rabid.

Was the person on the phone fulla baloney? I’ve never before or since seen a raccoon in the wild, there was no reason for it to be wandering around the front steps (no garbage cans), and I always thought they were mostly nocturnal.
[/QUOTE]

Any behavior that is unexpected (nocturnal animal out during the day and showing no fear of humans unless habituated to not fear them) would make me worry about rabies. There is also the question of how common it is in your area. In my part of the world, raccoon rabies is very common.

57

[QUOTE=Long Time First Time]
When I was in vet school I was shown an old old movie of a man dieing of rabies. There was no sound, thank god, but it looked pretty awful.
[/QUOTE]

Sounds like the same movie I saw. Black and white movie of an Iranian (IIRC) who had been attacked at a bus stop by a wolf! The camera was apparently on a tripod by his cot, filming random snippets as he progressed. I know veterinarians who claim that it was the most graphically horrid movie they have ever seen.

[QUOTE=NajaNivea]
Her. :wink: My hope, though years down the road, is to eventually fly a golden eagle
[/QUOTE]

Hehe. Before seeing that you are female, I was going to say you really have balls. I guess I still have to say that, though. I have worked with eagles, golden and bald, and they are unbelievably strong. Working as a team, I recall being responsible for restraint of a single foot. Until the animal was anesthetized, I was sweating bullets.

58

[QUOTE=vetbridge]
<snip>

Hehe. Before seeing that you are female, I was going to say you really have balls. I guess I still have to say that, though. I have worked with eagles, golden and bald, and they are unbelievably strong. Working as a team, I recall being responsible for restraint of a single foot. Until the animal was anesthetized, I was sweating bullets.
[/QUOTE]

We have a bald here right now, recovering from a shoulder separation. Our 100 foot flight cage isn’t nearly big enough for sufficient flight conditioning, so most every day we catch her (all 12.5 pounds and 6+ foot wingspan) and transport her to a nearby polo field for creance flight. (The polo field is like a football field, but 6 times as large.) Then bring her back to the flight cage. No anesthesia is involved. Talk about sweating bullets!

In a couple of weeks we expect to reach the point of testing her on live prey, pre-release. That’s even more exciting. So far, on this eagle at least, my staff is not perforate. (That isn’t always the case.)

59

I met a guy in Delaware at a well known bird rehab facility who was torn up pretty badly by an eagle. Be careful!!!

60

[QUOTE=vetbridge]
I met a guy in Delaware at a well known bird rehab facility who was torn up pretty badly by an eagle. Be careful!!!
[/QUOTE]

Thanks-- I am! Been doing this for more than three decades and counting, still have all digits intact. As with most things, due care and proper technique goes a long way.