Every once in a while there’s a story about a rabid critter that was found and that people “exposed” to it had started receiving PEP. Not only people who had actually been bitten, but exposed. I’m up to speed on the need for rabies treatment before symptoms start, but if you’re not bitten, how close of a contact do you need before a doctor thinks you need to start it anyway?
Not factual, but my husband got treatment after being attacked by a (later diagnosed as rabid) dog; no real “bite” happened, but the dog did claw him, maybe got one tooth puncture in, and did drool on the claw wounds during the attack.
Looks like the CDC has some guidelines - petting the animal doesn’t count, nor does touching their bodily excretions/fluids, unless we’re talking about saliva. Looks like skin abrasions that got saliva on them may constitute an exposure. They also base treatment likelihood on animal type.
PEP after “exposure” of almost any close contact with an animal known to be rabid is pretty darn close to 100% in un-immunized contacts even if the contact was pretty casual and doesn’t meet the formal guidelines (see for example, the CDC article referenced above). It’s pretty common for people to tend to maximize their exposure story “I think some saliva might have gotten on my hand before I rubbed my eye” because we all–on both sides (exposee and treater)–want to make real sure we aren’t taking even a miniscule chance.
Scientifically, rabies transmission requires direct exposure past the normal skin barrier. So that’s things like mucus membrane contact with contaminated fluid or bites or scratches–stuff like that.
In the US, the only human rabies cases reported in recent years are from bats and from people bitten/exposed to foreign rabid animals (literally foreign; i.e. the exposure occurred in a different country).
Rabies is almost always fatal. So what happens is that there is a low threshold to cross when deciding about PEP. Was it a bat that was found by the bed “maybe looking sick” which flew out the window on arousal and is not available for testing? PEP. (Bat coulda sneaked a no-longer-apparent nibble while I was napping.) Was it a raccoon “acting funny and then it scratched me and took off” and there has been rabies reported in wild vectors in the area? PEP.
And so on…
Basically we way over PEP and so it becomes hard to tell if we did any good. You can imagine that it’s pretty anxiety-provoking when I tell a patient “This is probably not a significant exposure. I am pretty sure you won’t die. Let’s hold off on the PEP.”
But most of the time PEP keeps away rabies the way chanting keeps giraffes out of my back yard.
This varies tremendously on the type of PEP. The vaccine is almost assuredly harmless, the human immunoglobulin (used here in the US) is similarly safe, but the horse anti-rabies immunoglobulin (used in less developed nations and much cheaper than the recombinant or human immunoglobulin) can cause problems, particularly with repeated exposures in the form of “serum sickness” where you produce antibodies against the anti-rabies horse antibodies and those complexes land and cause major problems on your kidneys etc.
There have been about a half dozen survivors or so in recorded history, I think the first back in the early 1970s. Oddly, I have been unable to find any kind of follow-up information on their long-term health. You would think there would be some interest in that very exclusive club.
Then there was a girl a few years ago who survived rabies despite receiving no treatments until the symptoms started. She had a long rehab, but seemed to have weathered it reasonably well. The other survivors, IIRC, had already started receiving treatment once the symptoms started.
She was placed in a coma in order to survive. The thinking was that by keeping the brain fairly inactive, it would give the body a chance to make antibodies against the rabies. The full paper is here. And, here’s the follow up.
The half-dozen survivors until the Jeanna Giese case in 2004 were all vaccinated post-exposure, but the vaccine didn’t work properly. They survived, but with major neurological damage, from what I’ve been able to find.
Jeanna Giese was the only non-vaccinated survivor of the disease until this year, apparently thanks to the Milwaukee protocol “coma treatment” that was tried on her. Similar treatments failed at least six times after that, but in late 2008 the treatment was applied successfully to a boy in Brazil.
I’m not sure if Jeanna Giese has any lasting neurological symptoms, but she has a blog and posts Youtube videos; one of them is here. Her speech seems like it might be ever-so-slightly slurred, but that might just be my crappy laptop speakers. She looks amazingly good for the world’s first person to survive rabies unvaccinated.