Tag: rabies

A Rabies Case in Utah

Unlike most other vaccine-preventable diseases, we have gotten rabies under good control by vaccinating and protecting our pets and some wild animals.

Never touch a bat that you find on the ground during the day, as it might have rabies.
Never touch a bat that you find on the ground during the day, as it might have rabies. Photo by Radu Privantu (CC BY 2.0)

Add in post-exposure prophylaxis with the rabies vaccine and human rabies immune globulin and you understand why human rabies cases are so rare.

A Rabies Case in Utah

For all of this to work though, folks need to vaccinate and protect their pets and they need to know to get post-exposure prophylaxis when they encounter an animal that might have rabies.

Unfortunately, this doesn’t always work, which is why human rabies cases are rare, but not unheard of.

Did you hear about the case of rabies in Utah in 2018?

A 55 year old man died, getting exposed to bats, one which must have been rabid, that were roosting in his home.

“The patient’s family reported that, beginning in August, a large number of bats had occupied their attic and frequently were found in the living area of the home, particularly in the master bedroom. On multiple occasions, the patient had removed bats from the home with his bare hands, and on one occasion, the patient awoke to find a bat near his head. In September, a dead bat was found on the floor of the bedroom. Despite the substantial bat contact, no bites were noted.”

Morbidity and Mortality Weekly Report, Volume 69, Issue Number 5 Human Rabies — Utah, 2018

Don’t you have to be bitten to get rabies?

“On October 17 and 18, 2018, a man aged 55 years who lived in Utah sought chiropractic treatment in Idaho for neck and arm pain thought to be caused by a recent work-related injury. On October 19, he was evaluated in the emergency department of hospital A for continued neck pain, nuchal muscle spasms, burning sensation in his right arm, and numbness in the palm of his right hand.”

Morbidity and Mortality Weekly Report, Volume 69, Issue Number 5 Human Rabies — Utah, 2018

A bite from a rabid animal is the typical way that you get exposed to rabies.

People usually get rabies from the bite of a rabid animal. It is also possible, but rare, for people to get rabies from non-bite exposures, which can include scratches, abrasions, or open wounds that are exposed to saliva or other potentially infectious material from a rabid animal.

How is rabies transmitted?

Surprisingly, bites from bats can go unrecognized, especially if the person was sleeping at the time.

“In instances in which a bat is found indoors and there is no history of bat-human contact, the likely effectiveness of postexposure prophylaxis must be balanced against the low risk such exposures appear to present. Postexposure prophylaxis can be considered for persons who were in the same room as a bat and who might be unaware that a bite or direct contact had occurred (e.g., a sleeping person awakens to find a bat in the room or an adult witnesses a bat in the room with a previously unattended child, mentally disabled person, or intoxicated person) and rabies cannot be ruled out by testing the bat. “

Rabies in Bats

In this case, even though the man had extensive exposure to bats, he didn’t know that he was at risk for rabies, so didn’t mentioned the bats or rabies when he first got sick.

“When specifically questioned about the patient’s exposure to wild animals, family members reported extensive contact with bats that had occupied the patient’s home in the weeks before illness onset.”

Morbidity and Mortality Weekly Report, Volume 69, Issue Number 5 Human Rabies — Utah, 2018

Tragically, he had been in the hospital for 14 days and in a coma for 9 days before they recognized that he likely had rabies.

“CDC confirmed the presence of rabies virus antigen and RNA in postmortem brain stem tissue and cerebellum specimens by DFA and real-time RT-PCR, respectively. Antigenic typing with monoclonal antibodies to the rabies virus nucleo- protein, and phylogenetic sequence analysis indicated that the virus identified in the patient’s specimens was consistent with that of a rabies virus variant associated with Mexican free-tailed bats (Tadarida brasiliensis). “

Morbidity and Mortality Weekly Report, Volume 69, Issue Number 5 Human Rabies — Utah, 2018

He died the next day.

“The delayed diagnosis of rabies in the patient in this report prevented him from receiving any early treatment for rabies and also resulted in potential rabies exposures for 279 persons in multiple settings during the patient’s infectious period.”

Morbidity and Mortality Weekly Report, Volume 69, Issue Number 5 Human Rabies — Utah, 2018

Hopefully his death will be publicized so that everyone knows to avoid contact with bats and to consider post-exposure prophylaxis (rabies vaccine and human rabies immune globulin) if they do have direct contact with a bat, keeping in mind that other wild animals that can have rabies include raccoons, skunks, and foxes.

Health care providers should also consider rabies early in their differential diagnosis when faced with an unexplained illness, although rabies is typically fatal once symptoms begin.

“The first symptoms of rabies may be very similar to those of the flu including general weakness or discomfort, fever, or headache. These symptoms may last for days. There may be also discomfort or a prickling or itching sensation at the site of the bite, progressing within days to acute symptoms of cerebral dysfunction, anxiety, confusion, and agitation. As the disease progresses, the person may experience delirium, abnormal behavior, hallucinations, hydrophobia (fear of water), and insomnia.”

What are the signs and symptoms of rabies?

If nothing else, this should demonstrates how important it is to learn how to remove (exclusion) and keep bats out of your home.

More on Rabies

Risks and Benefits of Vaccines – Anti-Vax Edition

Anti-vax folks like to say that they are doing their research, even collecting that research into handy binders. And they like to think that they are looking at both the risks and benefits of vaccines when they make their decision to skip or delay their child’s vaccines.

When anti-vax folks look at the risks and benefits of vaccines, they see lots of risks and few benefits.
When anti-vax folks look at the risks and benefits of vaccines, they see lots of risks and few benefits.

Like their research, their method of considering the risks and benefits of vaccines is very flawed

Risks and Benefits of Vaccines – Anti-Vax Edition

What’s the first thing you notice when you look at Ashley Everly‘s chart?

She doesn’t have a column for when a child Should Be Vaccinated!

Although there are no optional vaccines, there are some situations in which getting vaccinated and protected is truly essential, including:

  • a child bitten by a dog, coyote, or bat with rabies
  • a completely unvaccinated teen who gets a deep puncture wound while playing in a field
  • a baby born to a mother with hepatitis B
  • an unvaccinated older teen living in a dorm on a college campus where there is an ongoing outbreak of meningococcemia
  • a preschooler with a cochlear implant
  • an unvaccinated 1st grader who’s sibling is starting chemotherapy for leukemia
  • unvaccinated kids traveling out of the country to parts of the world where vaccine-preventable diseases are still endemic
  • a child with asplenia

Does she really think that the benefits of the rabies vaccine don’t outweigh the risks? Does she understand what happens if you get rabies, even if your child has access to nutritious food, clean drinking water, and emergency medical care?

Who Should Not Be Vaccinated?

What else is wrong with Ashley Everly‘s risk and benefit chart?

Most of the things on her list of who should not be vaccinated are not true contraindications.

Of course, the one about having a “previous vaccine injury or serious reaction” would likely be a reason to not get that vaccine again, as long as the injury or reaction was really caused by the vaccine.

Are there situations in which the potential benefit of vaccination might not outweigh the vaccines risks?

“Events or conditions listed as precautions should be reviewed carefully. Benefits of and risks for administering a specific vaccine to a person under these circumstances should be considered. If the risk from the vaccine is believed to outweigh the benefit, the vaccine should not be administered. If the benefit of vaccination is believed to outweigh the risk, the vaccine should be administered. Whether and when to administer DTaP to children with proven or suspected underlying neurologic disorders should be decided on a case-by-case basis.”

ACIP Contraindications and Precautions

Those situations are called precautions.

Fortunately, most are temporary, such as having a “moderate or severe acute illness with or without fever.”

These precautions do not include having a family history of cancer or autoimmune disease.

When Vaccination May Be Unnecessary

Are there any situations in which vaccination may be unnecessary?

There are a few, including:

  • when a disease is eradicated
  • when you aren’t at risk to get a disease and there is little risk that there will be an outbreak in your community or a return if folks stop vaccinating – that’s why we don’t routinely vaccinate against yellow fever, cholera, and typhoid fever, etc. in the United States
  • when you get sick and develop natural immunity

Vaccination is still necessary if a child’s mother is breastfeeding (which doesn’t protect against most vaccine-preventable diseases), has natural immunity to wild type infections (passive immunity quickly wears off), and even if the child has access to nutritious food and clean drinking water.

Nearly two months in the ICU vs getting a tetanus shot… How do the risks and benefits stack up now?

And yes, getting vaccinated and protected is even necessary if a child has access to emergency medical care.

What to Know About the Risks and Benefits of Vaccines

While you should certainly consider the risks and benefits of getting vaccinated, understand that vaccines are safe, with few risks, and very necessary.

More on the Risks and Benefits of Vaccines

Are They Spraying the Rabies Vaccine Into the Air?

Folks have gotten used to hearing about some strange ideas from anti-vaccine folks.

Are 'they' really going to spray rabies vaccines into the air?
Why were folks so quick to believe anti-vaccine propaganda?

Have you heard that some folks are worried that ‘they’ are spraying rabies vaccines into the air?

Are They Spraying the Rabies Vaccine Into the Air?

Hopefully you already understand that no one is spraying vaccines into the air.

Just think about all of the work that has gone into getting us a nasal spray flu vaccine, which must be kept refrigerated… Do you really think that we could make an effective vaccine that could simply be sprayed into the air?

The oral rabies vaccine (ORV) baits baits are coated with fishmeal and distributed in one-inch square cubes or two-inch plastic sachets.


The oral rabies vaccine (ORV) baits baits are coated with fishmeal and distributed in one-inch square cubes or two-inch plastic sachets. Bait photo by John Forbes, USDA-APHIS-Wildlife Services.

And if we could spray vaccines onto people, why would we spray the rabies vaccine? Why not spray flu or measles vaccines instead?

“Oral rabies vaccine (ORV) baits will be distributed in northeastern Maine beginning on or about August 3 through August 7 as part of ongoing, cooperative rabies control efforts aimed at reducing the incidence of raccoon rabies.”

USDA Distributes Oral Rabies Vaccine for Wildlife in Northeast Maine

While we can’t spray rabies vaccines on people, what we can do is distribute oral rabies vaccines, by air and ground, to combat raccoon rabies.

“The vaccine packets will be distributed by airplanes in rural, wooded areas. Personnel from Wildlife Services will distribute vaccine baits from vehicles in the more populated areas.”

USDA Distributes Oral Rabies Vaccine for Wildlife in Northeast Maine

Combined with getting our pets vaccinated and the use of rabies post-exposure prophylaxis, combating rabies in wild animals helps us all avoid rabies.

And combating anti-vaccine misinformation and propaganda will help ensure that more kids get vaccinated and protected.

More on Spraying the Rabies Vaccine

Alternative Names for Vaccine Preventable Diseases

You know all of the names – measles, mumps, rubella, diphtheria, whooping cough, etc.

But do you know why they used to call 10-day measles?

And which disease causes a 100-day cough?

Alternative Names for Vaccine Preventable Diseases

Back in the day, when these diseases were more common, they used much more descriptive terms and nicknames, in addition to their official names.

Why was measles known as 10-day measles?

Because there was also a 3-day measles!

MeaslesRubella
10-day measles3-day measles
red measlesGerman measles
rubeola

Unfortunately, 10-day measles made you feel miserable for 10 days!

Although a vaccine was available, it took a little more time to get measles under better control.

Can you guess which disease was known to cause a 100-day cough?

That’s right, it’s whooping cough or pertussis.

“I honestly felt like it was never going to go away. The doctor told me it was 100 day cough, so I was counting the days while Googling to see if there was anything that could help. I tried everything, you name it, I tried it, and nothing worked. It came to 120 days and I couldn’t understand why it wasn’t gone. I then researched and found that babies take longer to get over whooping cough.”

Fern’s Story – Whooping Cough

Fortunately, the cough doesn’t typically last that long if you are vaccinated and still get pertussis.

What do they call rabies?

Mad dog disease.

But that’s an easy one.

Which disease was known as “the Strangling Angel?”

“The breathing became much more difficult, with a kind of rattling stertor, as if the patient was actually strangling, the voice being exceeding hoarse and hollow, exactly resembling that from venereal ulcers in the fauces. This noise, in speaking and breathing, was so peculiar, that any person in the least conversant with the disease might easily know it by this odd noise; from whence, indeed, the Spanish physicians gave it the name of garrotillo, expressing the noise such make as are strangling with a rope.”

Edward Headlam Greenhow on Diphtheria

How about “The Crippler?”

Fight Polio Poster
Polio, also known as infantile paralysis, was known as “The Crippler.”

The “Speckled Monster?”

Even mild smallpox, as depicted on this WHO Smallpox Recognition Card, included flu like symptoms, a few weeks of pustules, and then waiting for the lesions to scab over...
Even mild smallpox, as depicted on this WHO Smallpox Recognition Card, included flu like symptoms, a few weeks of pustules, and then waiting for the lesions to scab over…

We forget these names, because we don’t see these diseases anymore.

“…for those trained in pediatrics in the 1970s, Hib (Haemophilus influenzae type b) was a horror.”

Walter Orenstein

Do you remember that measles was called a “harmless killer?”

Be sure to think about how these now vaccine-preventable diseases got their nicknames before you think about skipping or delaying your child’s vaccines.

More on Alternative Names for Vaccine Preventable Diseases