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A Bad Time for Rabies

The news that there's a temporary shortage of human rabies vaccine sends a shiver down my spine.

The shortage, caused by production problems at Sanofi Pasteur and Novartis, the nation's only two licensed suppliers of rabies vaccine, means the existing stock is all we've got until July, when Novartis is expected to be able to put more vaccine on the market. Sanofi Pasteur is in the process of building a new factory, so it won't make more rabies vaccine until mid-to-late 2009.

The current supply is to be administered only to people who have been exposed to rabies. The wildlife-control workers, lab workers, and even veterinarians who typically receive pre-exposure, preventive vaccinations aren't allowed to get those shots until supplies are restored.

This is probably not cause for panic: chances are we'll make it through the summer just fine, rabies-wise. Richard Franka, a microbiologist with the U.S. Centers for Disease Control and Prevention (CDC) says that, based on the past five years' use of rabies vaccine, the existing stock should see us through.

But I'll make a confession here: rabies scares the heck out of me.

Here's why: A few years ago my then-little boy got bit by a dog. The bite barely broke his skin -- but any time an animal bite breaks the skin at all, the specter of rabies arises. It was the beginning of a terrifying ordeal during which we learned that, because the dog's shots weren't up to date, we had to wait out a 10-day period during which the dog was quarantined and watched for signs of rabies. If the dog had rabies, my son would have needed an immediate dose of rabies immune globulin -- which is not currently in short supply -- plus a series of five shots of vaccine over the course of a month to prevent him from developing the deadly disease. After much anguish, we decided to order the costly immune globulin to have on hand if he needed it. Because the insurance company wasn't convinced that was necessary, the money -- several hundred dollars -- came out of our pocket. It was a pittance to pay given the peace of mind it afforded us, of course, but still.

When word came that the dog was healthy and, therefore, so was our son, our pediatrician's office asked if we would sell them half the vaccine we'd bought, because a baby in their care had just had her face badly bitten by a dog. (She was so young, she only needed half the amount my son would have needed.) We were happy that, because we had ordered the stuff just in case, it was there right away when that baby needed it. But the whole episode left us deeply shaken.

Rabies in humans is very rare -- there are only one or two cases a year in the U.S. -- but it's almost always fatal. Encounters with rabid animals have been steadily on the rise in recent years (as this article explains) as land development has forced critters that once lived and died in the woods out into areas occupied by humans.

To avoid rabies, the CDC recommends that you make sure your pets have their rabies shots and that you stay away from wild animals -- and, in fact, any unfamiliar animal. Last year a bunch of people at a softball tournament handled a stray kitten that turned out to have rabies.

I'll let you know when the vaccine supply is restored. Until then, hands off the stray cats, okay?

By Jennifer LaRue Huget  |  June 9, 2008; 7:00 AM ET
Categories:  Family Health  
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I seem to recall reading in the _Post_ -- or perhaps I saw it elsewhere -- that in the District, the main source of rabies exposure is indeed feral kittens.

In Northern Virginia, I seem to recall that it's foxes, and if you get a bit farther out from the city, it's skunk.

In suburban Maryland, I seem to recall that the main source of exposure is bats. It's certainly how I found myself in the emergency room at Montgomery General Hospital seeking treatment. In broad daylight, a bat flew out of nowhere, right into my ear, and then repeatedly tried to come at me again until I drove it away.

It would be really interesting if the _Post_ would have someone research the recorded number of exposures treated. Although rabies in humans is rare, I suspect that this is because there is an almost 100-percent rate of successful prophylaxis. It may be that there is actually a fairly high rate of possible exposures.

If that is the case, any shortage of globulin and immunizations is potentially disastrous.

There has been exactly one successful recovery, in all recorded history, from symptomatic rabies. Yet it is one of the most preventable of all deadly viruses.

Posted by: Thomas Hardman | June 9, 2008 6:49 PM | Report abuse

You should have told WHY rabies is so horrible: it takes over the fear centers of the brain, causes terrifying halluncinations, then waits in the saliva for the victim to bite someone.

In Rabies: The Facts, Kaplan et. al. describe several typical cases, including one of a 23 year-old Englishwoman:

"On June 17, 1981 she was bitten on the ankle by a dog in New Delhi. On August 18, about two months later, she experienced the first prodromal symptoms. She became anxious and depressed, and it became impossible for her to drink more than small sips of liquid. While sleeping, she frequently sat up in bed suddenly, terrified. On August 19, she became confused, hallucinated, and was incontinent of urine. On August 20, she was unable to eat or drink and was taken to the hospital where she hallucinated and screamed in terror. Misdiagnosed as a psychiatric case, she was injected with a tranquilizer and sent home, however she repeatedly woke up screaming in fear and became so wild and agitated that her husband felt he could not deal with her by himself and took her to her mother's house. She remained terrified, hallucinating and screaming in horror throughout the night. She had no water for almost three days. She fell into a coma the next morning, and died on August 23."

Posted by: Faye Kane | June 9, 2008 7:12 PM | Report abuse

To me, the real horror of human rabies is the certain fatality of it, once symptoms have started. Even the one known survivor to make a "full recovery" suffered damage comparable to a traumatic head injury. Only years of constant therapy have restored normalcy.

In recent years, a set of transplant recipients succumbed to rabies they got from their organ donor.

Aside from the horror I feel for the unsuspecting victims, I get a creeping sense of weirdness when I think about the misdiagnosis of the donor's cause of death.

The donor was thought to have suffered a massive stroke while smoking crack cocaine, and due to the desperate need for his organs, they were harvested and transplanted immediately. But if it's possible that someone could die of rabies and have that fact be undiscovered, I have to wonder how many others died with rabies, with the cause of death written off as traffic fatalities (walked into traffic, or lost control of vehicle) or other deadly "accidents" caused by confusion, delerium, or spasm.

We'll never know until there's a law requiring universal testing of all decedents.

Considering the lethality, and the preventability, it's surprising that more people aren't immunized against it.

Posted by: Thomas Hardman | June 10, 2008 9:40 AM | Report abuse

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