“I’m at the emergency room right now—could you please call me back as soon as you get this message?” The woman sounded upset. I’m a public health nurse, and one of my duties is to advise members of the public who have been bitten or scratched by animals domestic and wild. The rest of the message related that the speaker had been bitten by her own cat. Because her cat had not been vaccinated for rabies, the ER doc was trying to convince her she needed to start the rabies vaccine series, but she was unsure. What would I advise?
I called her back right away. When I reached her, she sounded relieved. Did she really have to start the expensive and time-consuming RPEP (rabies post-exposure prophylaxis) process? After asking a few questions, I found out the cat was an indoor cat, had never been exposed to other animals, and had been behaving normally until this episode. I told her that since it was her pet, she could observe it for 10 days, there was no need to start RPEP yet. If the cat started exhibiting signs of rabies, or if it died before the 10 days were up, then we would recommend RPEP.
I asked if her cat had been exhibiting any rabies symptoms like aggressiveness, copious saliva, or being unsteady on its feet. She denied this, explaining that she’d been gone from home for several hours, and when she returned, she heard a strange banging noise in her kitchen. Investigating, she found her cat in the pantry, an empty can stuck on its head. Apparently the cat had gotten into the trash can in the pantry, found a can with a bit of food still in the bottom and had gotten its head stuck while trying to get to the leftovers. When my new friend found it, the terrified cat was moving in all directions, banging its can-head against the wall and other objects, desperately trying to free itself.
My caller friend grabbed the cat to try and help it, and it freaked out to the point that it soiled itself, my friend, and part of the pantry. After a good fifteen minutes wrestling with the cat and the intransigent can, the caller finally managed to liberate her cat, whose head was now covered in can-slime. She grabbed some napkins and attempted to clean the slime and poo off the cat, but she was ineffective as it was still thrashing around. She knew if she let it go, it would race through the house to its favorite hiding spot under the bed, spreading yuck on its way. As a last resort, she dumped the cat in the kitchen sink and turned on the water, whereupon the traumatized cat sank its teeth into her hand. Hence the visit to the ER.
“Sounds like a normal cat-reaction to me, given the circumstances,” I told her. She assured me the cat never went outside and was the only animal in the house. I told her we would consider the cat as quarantined, and would check back with her in 10 days to release it as long as it was healthy and acting normally. I advised her to get the cat vaccinated against rabies and she assured me she would. She then thanked me profusely and hung up, obviously relieved. Ten days later, the cat was released from quarantine. And, I’m sure it has received its first rabies shot by now. Rabies cases can be intense!
If you’re like me—or me two years ago, before I started doing rabies investigations—you know very little about rabies and what constitutes an exposure, and what to do if you have been exposed. Lucky for you, I’m writing this post. You need to know that rabies in humans is very rare in the United States. In fact, because of an aggressive pet-vaccination campaign, canine rabies has been mostly eliminated in the U.S. (Not in many foreign countries, however, so if you’re on a humanitarian mission in the Philippines, give the street dogs a wide berth.) What follows is my down-and-dirty rabies primer to prepare you for possible animal encounters of the semi-violent kind.
PSA Point #1: Rabies is basically 100% fatal. Yes, there have been a few documented cases of people who allegedly survived it, which means the odds of survival are practically zero. (I found one list in a paper out of India that recounted 29 cases of people surviving rabies; 26 of them had been vaccinated pre-or-post exposure). Rabies can be prevented by vaccinating your pets and staying away from wildlife. (I spoke with a woman recently who was accidentally bitten while hand–feeding a family of raccoons in the woods behind her house. DON’T hand-feed wild animals! Period.) Raccoons, ferrets, foxes, and bats are some of the wild mammals that most often test positive for rabies. In my county, we had a feral cat test positive last year, so be careful about approaching strays.
PSA Point #2: RPEP is extremely effective. There is only one known case of someone dying after being exposed to rabies and receiving RPEP, but that was because the victim in question suffered from a rare immunocompromising condition that was only diagnosed on autopsy. People with known compromised immune systems should get five doses of RPEP instead of four.
PSA Point #3: Only mammals get rabies. So if your pet parakeet nips you, you’re in the clear. At least as far as rabies is concerned.
PSA Point #4: RPEP is a series of four regular shots in your arm, plus a few shots of antibodies to protect you until your body starts making its own. No more shots in the stomach with four inch needles. (Not sure if that was really a thing, or if it was just a way for parents to scare their kids away from potentially dangerous animals!)
PSA Point #5: If the exposing animal is a pet cat/dog/bunny/ferret, they are quarantined for 10 days in the home. If the animal is symptomatic for rabies—fever, difficulty swallowing, excessive drooling, staggering, seizures, aggression, paralysis—or it dies within the 10 days, it is tested for rabies. If it comes back positive, then we recommend vaccination ASAP. If the exposing animal is wild, and is available for testing, we wait until the test results come back. If the animal is unavailable for testing or 10 days observation, then RPEP is recommended
PSA Point #6: For the love of Pete, people, stop letting the bats go when you find one in your house! Trap it and call animal control to come get it to be tested. Yes, it looks small and sad and harmless, but three of the five rabies deaths in the U.S. in 2021 were from bat bites—and no, you don’t always know if you’ve been bitten if you were asleep and awaken to a bat in your room. Those suckers’ teeth are teeny tiny and often don’t leave a mark. If you don’t know how long the bat has been in your house, or if you or a family member find a bat in your room when you wake up, or if a person with communication/cognitive difficulties (baby, elderly person) is found in a room with a bat in it, TRAP the bat and save it for testing. Otherwise, vaccination is recommended, sometimes for the entire family, depending upon the circumstances.
PSA Point #7: There is no cure for rabies. The only way to prevent it is to get RPEP after an exposure. Rabies generally takes about three weeks to three months to incubate—sometimes over a year or more—so you’ve got some time to do something about it. Once symptoms set in, though, time’s up. It’s estimated by some that RPEP will last approximately 3 years, maybe as many as 10. However, if you receive RPEP and are ever exposed to rabies again, the CDC recommends getting two more rabies vaccines—just to be doubly-sure you’re protected!
For more information on rabies exposures and treatment, see here, or check your state Health Department’s webpage.
Have you had any experience with rabies exposures? What happened?
Thank you for this informative article! I’ve never read such a comprehensive piece about rabies.