Shots in the Dark: The aftermath of Bruce's defenestration

A couple days after our encounter with Bruce, Beth noticed two little marks — seemingly a bite — on her hand. We were in Wisconsin, visiting Vargo, Lauren, Benton, and Leo and attending Pat and Brittany’s (beautiful) wedding. After landing at SFO Sunday night, we took BART home, packed up a little bag, and went to the emergency room at Alta Bates around 11:30 pm.

Rabies is a pretty scary disease. Left untreated, it almost inevitably leads to death. There are very few survivors post-exposure (A google search yielded four. Ever. Anywhere.). Onset of the disease occurs, on average, one to three months after exposure. The initial symptoms are flu-like: fever, tingling, aches. As the virus spreads, two contrasting forms of disease can manifest — ‘furious’ and ‘paralytic’ rabies. In furious rabies, people exhibit hyperactivity, biting-behavior (sometimes), and fear of water. Paralytic rabies leads to gradual, systemic paralysis.

Why all this gloomy talk of rabies? In the US, bats are the source of most human rabies cases.

We learned at Alta Bates that any contact with a bat should be considered a potential rabies exposure unless it can be proven otherwise. Acquitting the bat is no simple task. It involves capturing the bat, bringing it to a local hospital or animal control location, euthanizing it, and confirming via laboratory assay whether the bat was indeed rabid. I can’t speak for others, but my first thought wasn’t to grab some tupperware and snag the lil’bugger. Far from it.

Barring capture (or acquittal within 48 hours), rabies postexposure prophylaxis (RPEP) is recommended. The regimen varies depending on immunization status. If you’re previously immunized, you get two 1 mL shots of rabies vaccine intramuscularly. One on day 0 — the day of the exposure / the day you report to the hospital — and one at day 3. Beth was immunized; this was her RPEP.

I wasn’t immunized, and I paid for it. Non-immunized individuals must receive human rabies immune globulin (HRIG) at a dose of 20 IU / kg bodyweight, and a 1 mL dose of the vaccine on days 0, 3, 7, and 14. HRIG (basically) provides antibodies to protect against rabies during the period in which the vaccine isn’t yet effective. I received 8 mL of HRIG in three locations - 4 mL in my right arm and 2 of the remaining 4 mL in each of my butt cheeks. The vaccine was given to me in my left arm.

No doubt this is a vast improvement from the old method (you know, the one we grew up hearing about) of ~15 shots in the abdomen (this stopped being common practice in the late 70s). It’s still no walk in the park. The shots themselves, while uncomfortable, were not all that painful (save the 4 mL one). The 1 mL vaccination is painless. But vaccines are vaccines and immune responses are immune responses. I’ve felt far from great this week.

Some lessons and recommendations:

  • Window screens are a good and useful thing.

  • Don’t mess with bats. If there’s one in your home, you are exposed to rabies. There’s not necessarily a need to go to the ER, but you need to see a doctor the same day or the next day.

  • If you have reason to get it (for instance, international travel), the pre-exposure rabies vaccination is worth the cost.

Tolkien’s Boromir summed it up nicely: “Is it not a strange fate that we should suffer so much fear and doubt for so small a thing? So small a thing.”

Tags: bats, berkeley, oakland, rabies, vaccines, wild animals

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