Rabies and the End of the World

The following article has been excerpted from my upcoming book, Armageddon Medicine.

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Rabies . . . few words strike fear in the heart more quickly.  Picture your sweet little girl trotting over to pet the slobbering dog weaving down the street.  Should you rush for your gun or run for your daughter?   Are you a dead man, either way?

At the current time human rabies is uncommon, with only a few annual cases in the U.S.  Most are due to encounters with bats, raccoons, and wild carnivores, although about a fourth of the time the disease is contracted overseas.  For the curious reader, see http://www.cdc.gov/rabies/location/usa/surveillance/human_rabies.html for a listing of all U.S. cases.

But what will happen when pets go unvaccinated, when contact with wildlife increases, when no health department exists to examine a dog’s brain for the presence of rabies virus?  How many of the 15 million patients given post-exposure prophylaxis each year will die?  (See http://www.who.int/rabies/human/situation/en/index.html).

Although someday, somehow, manufacture of rabies vaccine may be re-established after a cataclysmic event, what should we do in the meantime?  If we really believed 2012 marked the end of civilization, should we consider vaccinating not only our pets, but ourselves?

Rabies is uniformly lethal. (Yes, there was that one patient who survived with intensive medical treatment, but will you be the next?)  Since preventive vaccination is available, who should consider it?  Everyone?  Veterinarians and veterinary students are required to receive pre-exposure prophylaxis in the form of a series of three rabies shots over the course of 3-4 weeks.  Vaccination is already recommended for spelunkers (cave explorers) and travelers to rabies-endemic regions when contact with infected animals is a possibility.  [Consider the 2009 case of the Virginia physician who diagnosed his own subsequently fatal case of rabies a few months after returning from India (see http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5938a3.htm).]

The lowest price I could find for the pre-exposure immunization series is $513 for veterinary students, though about $750-800 is charged at travel clinics in Ohio.  (The cost for post-exposure immunization is higher ($2000-7000), but this pricing probably reflects use of both the vaccine and immunoglobulin, and antibody titer testing as well.)  Unless you’ve been exposed to rabies, insurance is unlikely to cover the expense of pre-exposure vaccination.

Your doctor will not recommend rabies vaccination unless you fall into a high-risk group, and will not have the vaccine on hand.  Nevertheless, you can investigate immunization on your own at your local health department.  If you do get the vaccine, testing for immunity every two years is recommended, with a booster dose if necessary.

Exposure to a mad dog or aggressive raccoon is a clear indication for post-exposure rabies vaccine, but a scary fact is that some patients who die of rabies have had no known exposure to a rabid animal.  Any encounter with a bat (the flying mammal variety) is reason to seek rabies vaccination.  Even if you are not bitten per se, a tiny, perhaps invisible, scratch may be lethal.  [Consider the 2009 case of an Indiana man who died in Kentucky of bat rabies despite no known physical contact.  (see http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5913a3.htm)]

I haven’t yet been immunized myself, but it is something to think about.  Does it make sense to protect our indoor pets and not ourselves?  Of course, immunizing our pets is protecting ourselves, as well as those who may happen to be bitten by our precious pups.  Whether to take it a step further is the question you must decide for you and your loved ones.

Copyright © 2011 Cynthia J. Koelker, MD

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About Cynthia J. Koelker, MD

CYNTHIA J KOELKER , MD is a board-certified family physician with over twenty years of clinical experience. A member of American Mensa, Dr. Koelker holds degrees in biology, humanities, medicine, and music from M.I.T., Case Western Reserve University School of Medicine, and the University of Akron. She served in the National Health Service Corps to finance her medical education.
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