What's the _real_ deal on rabies shots?

I’ve never gotten them nor have I ever met anyone who did. But they’ve been a standard ‘horror’ story for as long as I can remember. I’ve heard variously:

[ul][li]Its 20 shots[/li][li]Its 14 shots (1/day for 2 weeks)[/li][li]An improved version cuts it down to just 4 shots[/li][li]The needles are 4 inches long[/li][li]They need to be injected into muscle/stomach (?)[/li][/ul]
So are any/all of these true? Anyone here ever actually go thru it? I’m sure its not pleasant, but is it as bad as its made out to be?

[url=http://www.cdc.gov/mmwr/preview/mmwrhtml/00056176.htm]Post-exposure rabies immunization

Not bad, it’s just a regular IM shot. The immunoglobulin is a huge amount, so it’s a little stressful, and after the 3rd or so shot some pain/swelling of the muscle where the shot was given can occur. Other than that, just like getting a flu shot.

I should just point out that IIRC the RIG is about the consistency of honey and a large amount of fluid so it can be pretty ugly. RIG is apparently distributed at 150 IU/ml, so for an average 70 kg man getting 20 IU/kg = 1400 IU, so about 9 ml.

Second, rabies is bascially 100% fatal (the highest case-fatality rate of any disease). In fact, in a disease that kills between 30,000-70,000 per year and has been known for thousands of years, only one person not previously vaccinated has survived a rabies infection. So you should seek medical attention for any kind of bite. The recommendations differ by species (I’m looking this up on UpToDate, a medical encyclopedia, I’m no expert…) so not all bites will need the shots, but the disease is scary enough to choke down any needle phobia.

The vaccine course that is given is used to prevent the infection from taking hold after a bite (post–exposure prophylaxis). Basically, the rabies virus enters a nerve and then starts to work its way up to the central nervous system. The prophylaxis prevents this process, and there has been no failures of the regimen reported.

I’ve had post-exposure rabies shots.

It was a series of 5 shots in my shoulder. The material was a thick, purple “goop” that, as was pointed out, looked like it had the consistency of honey. It left a little lump in my shoulder and I felt kind of wiped out after getting them, but it wasn’t a terrible experience.

Getting to the hospital, expecting to get the shots with the big hypodermic needled, right in the stomach, THAT was a horrible experience.

I know someone who just a week ago started the post-prophylaxis series because she was bitten by an animal whose rabies status was unknown. She said:

“Tonight I had to have a tetanus shot in the arm, 3 rabies shots in the butt and one rabies shot directly into each of the 4 tooth holes in my arm. Not a fun evening. And I have 4 more shots to look forward to beginning Friday and every Friday thereafter for 4 weeks. All this and antibiotics for a week.”

And this was someone who had already had the pre-prophylaxis series.

Don’t fool around with rabies. If they told me I had to have shots directly into my eyeballs, I’d do it. Rabies is not the disease you want to die of. I believe QtM has a story about a patient he saw in the last stages of rabies. Not pleasant.