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Guardian
06-09-2011, 10:06 AM
If a person is bitten by an animal with rabies, they get a rabies shot, yes?

If they've had one before, and are unfortunate enough to be bitten by another animal suspected of having rabies, do they need another shot or did the previous one cover it?

ETA: I'm thinking about 5 years in between the two incidents, let's say.

I have a new question in Reply #9

New new question in post #19

StoryG27
06-09-2011, 10:11 AM
This (http://www.medicinenet.com/rabies/page5.htm) might help answer your question.

Guardian
06-09-2011, 10:15 AM
Ah, that was unexpected! Thanks for the link, I think that cleared it up for me. :D

StoryG27
06-09-2011, 10:16 AM
Glad I could help.
:D

areteus
06-09-2011, 12:11 PM
Not looked at the link, but I am guessing it is something about giving passive artificial immunity via a serum of anti-rabies antibodies?

lastlittlebird
06-09-2011, 02:58 PM
Thought I would add my two cents (even though the question has been answered). When I was in Peace Corps we were warned that even though we were being vaccinated, all that did was slow down the virus to give us time to get to the hospital and get the treatment.
Which was apparently terrifyingly painful, consisting of multiple shots to the stomach (I don't know if that's just because we were probably not going to be getting the most modern of treatments).
We were also told, if at all possible, to bring the head of whatever bit us along to the hospital so they could test the brain for rabies.
I am so glad I didn't get bitten by any mammals while I was over there.

areteus
06-09-2011, 04:33 PM
Rabies acts so rapidly that you cannot usually mount a defence against it before it kills you. This is why you use passive serums on initial infection - to give you enough of an immunity to keep you alive until your body concocts its own cellular and humoural defenses.

My students were quite upset to find out that the immunoglobulins needed to make this serum is likely to have come from rabies infected rabbits (or goats, or sheep, or horses, or mice...)

BTW, I assume everyone here is aware of the difference between Artificial Active immunity (vaccination), Artificial Passive (injection of antibodies to antigens expressed by that pathogen), Natural Active (development of immunity from natural exposure to the pathogen) and Natural Passive (passing of antibodies from mother to child through placenta and breast milk)?

When talking about a 'rabies shot' you do need to make sure you are aware of what you are talking about - a vaccine or an antiobody containing serum. They are different things - one gives you long term protection by activating your own immune system in advance of the infection (active) and the other gives you short term protection by boosting your own natural antibody levels (passive).

Purple Rose
06-09-2011, 07:28 PM
I live on an island where rabies has killed more than a hundred villagers in the past year, maybe two. The mayor calls it an epidemic but it really isn't. I had my rabies shot (in the arm, painless, active type, long term effect) which involves three shots staggered over four or five weeks (don't remember exactly).

Over here, we are all constantly reminded that if we are bitten by a rabid dog, we have to go straight to hospital. Those of us who have been vaccinated will still require an intensive/high dosage treatment with rabies medication (like littlebird said). I suppose this means I have a much higher chance of surviving the bite. Villagers without vaccinations have mostly survived because they were treated almost immediately after being bitten. Those who waited more than a few hours usually died.

Guardian
06-12-2011, 07:54 AM
NEW QUESTION:

So with another character, she is going to get infected with a disease that's very similar to rabies, so that people assume she's been infected by it. She's never been vaccinated before, so she gets to go through the lovely multiple-painful-shots treatment.

The town is small and isolated, but they have a local doctor, or the choice of medivac. Assuming he's stocked for rabies, she wouldn't have to get medivac'd, right? In fact it'd probably be more risky to waste time medivacing, right? Or would it have to be that the local doctor immediately treat her while medivac comes, and she has to go to an actual hospital? If so, how long would they make her stay before allowing her to go home?

In fact, I remember being bitten by my cat who had gone feral, and they made me stay in the hospital overnight, but I'm not sure if it was one night or more. They had me on an IV and I don't remember shots, because they must have figured out my cat didn't have rabies. After all, if it did, I'd be dead. Or I don't remember getting shots. I'll have to ask my parents.

Purple Rose
06-12-2011, 08:14 AM
I don't think it's that simple. You might first want to check what would happen if she got a rabies shot for an infection that would react negatively with rabies medication. It could kill her, or cause a violent reaction that could do more harm than good. Why do people assume she's been infected? Was she bitten? How long before showing symptoms?

I think your medivac vs local doctor question should come after your background information is clear. Depending on the situation, medivac may in fact be better.

Guardian
06-12-2011, 08:28 AM
I don't think it's that simple. You might first want to check what would happen if she got a rabies shot for an infection that would react negatively with rabies medication. It could kill her, or cause a violent reaction that could do more harm than good.

The infection is of my own creation, but it presents itself with symptoms very much like rabies (coincidentally, but how lucky for me). If you're saying the rabies shot will react negatively to the rabies medicine... that sounds like that should never happen. That'd be dumb. If you're saying the disease might react to the rabies medicine? It won't. Since it's very similar to rabies, her symptoms will calm down for a while but actually still persist and eventually mutate so that the shots won't help. I need to have her home for her downfall.



Why do people assume she's been infected? Was she bitten? How long before showing symptoms?

I think your medivac vs local doctor question should come after your background information is clear. Depending on the situation, medivac may in fact be better.


Um, because the symptoms are just like rabies, and they've had rabid animals before. They are in the middle of the wild nowhere. She will have a cut on her hand, perhaps showing signs of infection. Her symptoms will appear within hours - itching, or prickling sensation at the wound, fever and headache that anyone in the area would take as warning signs for rabies.

My question still needs to be answered.

Purple Rose
06-12-2011, 09:06 AM
If you're saying the rabies shot will react negatively to the rabies medicine... that sounds like that should never happen. That'd be dumb.

That's not what I said. This is what I said:

if she got a rabies shot for an infection that would react negatively with rabies medication.

By the way, if you are asking for help, you should take what is offered with some grace and humility. Referring to people's offer of help as "dumb" is not going to encourage anyone.

Guardian
06-12-2011, 09:12 AM
I didn't call your statement dumb, I was merely trying to interpret it, because it was confusing to me. I didn't know whether the rabies shot was reacting with the rabies medication, which WOULD be dumb on the doctor's part, or if the infection would react with the rabies medication, which doesn't make sense to me either because I'm not a doctor.

You asked me to explain my background, which I did though I felt that I should have been able to skip that part and get to the treatment scenario. I mean, if she's showing signs it's an emergency. I wasn't trying to be rude, I was just confused.

Sarah Madara
06-12-2011, 09:14 AM
NEW QUESTION:

So with another character, she is going to get infected with a disease that's very similar to rabies, so that people assume she's been infected by it. She's never been vaccinated before, so she gets to go through the lovely multiple-painful-shots treatment.

The town is small and isolated, but they have a local doctor, or the choice of medivac. Assuming he's stocked for rabies, she wouldn't have to get medivac'd, right? In fact it'd probably be more risky to waste time medivacing, right? Or would it have to be that the local doctor immediately treat her while medivac comes, and she has to go to an actual hospital? If so, how long would they make her stay before allowing her to go home?

In fact, I remember being bitten by my cat who had gone feral, and they made me stay in the hospital overnight, but I'm not sure if it was one night or more. They had me on an IV and I don't remember shots, because they must have figured out my cat didn't have rabies. After all, if it did, I'd be dead. Or I don't remember getting shots. I'll have to ask my parents.

If I understand rabies correctly, the whole battle is preventing the illness from taking hold. If the doctor is stocked with the correct serum, I can't see any advantage to waiting. I don't know whether a medivac to a better hospital offers any advantages if the doctor has the treatment for the CDC protocol on hand - unless they monitor viral load or something like that? Essentially, though, the prophylactic treatment either works or it doesn't, and time is of the essence. Once a person develops a symptomatic illness, it is almost invariably fatal.

Also, I don't think the stomach shots are done anymore. At least according to this website: http://rabies.emedtv.com/rabies/rabies-treatment.html

Were you severely injured as a kid? I'm surprised at the overnight stay, but they may have worried about infection. You would have gotten a tetanus booster if it had been more than 5 years since your last vaccination. Some shots can be administered via IV, though I don't know about rabies specifically. You may have gotten intravenous antibiotics if the doctor was worried about infection.

Guardian
06-12-2011, 09:24 AM
If I understand rabies correctly, the whole battle is preventing the illness from taking hold. If the doctor is stocked with the correct serum, I can't see any advantage to waiting. I don't know whether a medivac to a better hospital offers any advantages if the doctor has the treatment for the CDC protocol on hand - unless they monitor viral load or something like that? Essentially, though, the prophylactic treatment either works or it doesn't, and time is of the essence. Once a person develops a symptomatic illness, it is almost invariably fatal.

Also, I don't think the stomach shots are done anymore. At least according to this website: http://rabies.emedtv.com/rabies/rabies-treatment.html

Were you severely injured as a kid? I'm surprised at the overnight stay, but they may have worried about infection. You would have gotten a tetanus booster if it had been more than 5 years since your last vaccination. Some shots can be administered via IV, though I don't know about rabies specifically. You may have gotten intravenous antibiotics if the doctor was worried about infection.


I was thinking that the doctor would be the better choice. Maybe more than I realized, because now after looking a little closer I realize that the symptoms I originally had in mind would mean that she was going to DIE. They could try treating her, but more logically they'd probably end up on death watch.

I think a key to making this work would be having her symptoms seem to go away, along with her insistance that she feels fine. If the more logical thing would be that she goes away to a hospital for a few weeks, then I'd have to think of some ways to make that not happen (i.e. emergency symptoms, and then treatment seeming to work, so they think that it's a miraculous recovery, only to have her die a few days later at most).

ETA: Oh, and um, my cat bit my arm when I was little and it was pretty deep. I still have 4 scars from it. I remember they took care of my wound and spent a lot of time on the phone while I cried, and my dad killed the cat. They probably did have me on antibotics even if the cat wasn't rabid. But remembering the way the cat acted, I'd think he was, so I should ask about what happened.

JayMan
06-12-2011, 07:31 PM
I've actually done a ton of research on rabies for my current WIP, so I've learned a few things. Hope this helps.


Essentially, though, the prophylactic treatment either works or it doesn't, and time is of the essence. Once a person develops a symptomatic illness, it is almost invariably fatal.

Also, I don't think the stomach shots are done anymore. At least according to this website: http://rabies.emedtv.com/rabies/rabies-treatment.html

This.

Guardian, rabies shots are administered if a bite from an animal with rabies is suspected. If symptoms have begun to show, it's too late--the shots are no good at that point. The whole point of rabies vaccine and rabies treatment is to prevent symptoms from appearing in the first place.

By the way, here's the schedule and doses of what's given to both previously vaccinated and unvaccinated persons:
http://www.health.state.mn.us/divs/idepc/diseases/rabies/risk/postexposure.html#regimen



Rabies has an incubation period of 2-3 months (http://www.webmd.com/a-to-z-guides/rabies-symptoms), but in extreme cases it can be anywhere from a few days to several years.

The thing about rabies is that it travels through a person's nerves. For example, the virus will generally take longer to reach the brain and central nervous system from a bite to the foot versus a bite to the neck.

Regardless, if I understand your story and predicament correctly, you don't have a dilemma at all.

Unvaccinated character gets bitten. As per the link above, she receives a tetanus booster (if her tetanus vaccine was given more than 5 years prior), human rabies immune globulin aka HRIG (essentially an antibody serum that's administered near the bite to begin fighting the virus immediately) and four doses of the rabies vaccine (the last three are given 3, 7 and 14 days after the first dose. They are injected in the shoulder for adults and older children, and the thigh for younger children).

If the local doctor is well-stocked, there's no need to go to the hospital, and I'm not sure why Medevac would enter the picture. Even if necessary, couldn't she just drive to the hospital?

In summation:
The best and most logical way for this to play out, in my opinion, is the following: Unvaccinated character gets bitten by an animal that's suspected to have rabies. Character moseys on down to the local doctor, says, "Hey Doc, I've been bitten. Can I get some rabies shots?"

Local doctor says, "Sure!"

Doctor administers a tetanus booster, HRIG near the wound site, and one dose of rabies vaccine, then says, "There's three doses of rabies vaccine left. Come back to me in 3, 7 and 14 days and you'll be right as rain."

Character says, "Thanks!" and goes on her merry way.

Two to three months later (or sooner/later if your story demands it), she develops symptoms anyway. At first, she thinks it's just the cold or the flu--fever, headache, tiredness (see http://rabies.emedtv.com/rabies/rabies-symptoms.html). She sees the doctor and the doctor says, "Gee! I told you you should've gotten your flu shot. Oh well. Go home, take some aspirin, drink plenty of fluids, and get lots of rest."

A few days later, she's got classic rabies symptoms. Doctor says, "That's weird..." and suggests maybe she should go to the hospital to get tested (see http://www.cdc.gov/rabies/specific_groups/doctors/ante_mortem.html) but by then, it's too late. She dies a couple days later.




As a side note, based on your first question, rabies vaccine is generally good for 2-3 years (http://en.wikipedia.org/wiki/Rabies_vaccine), but even then, if someone who's been previously vaccinated is bitten, they have to get two doses of the rabies vaccine (the second dose is given 3 days after the first). Previously vaccinated persons, if their titers are good, are not given HRIG.

areteus
06-12-2011, 08:10 PM
Mainly not given HRIG because they have no need for it - if vaccine has worked correctly, they should already have plenty of thier own antibodies floating around ready to battle the infection... waste of very expensive antibody serum otherwise.

Guardian
06-13-2011, 01:37 AM
Hmm, okay. That was very informative. So if shots are no good once the full-blown symptoms start to show, then I need to know some different info.

Guardian
06-13-2011, 04:07 PM
New scenario:

Girl shows up displaying the severe rabies symptoms. They'd probably chalk it up to influenza at first. Hydrophobia seems to be distinctive of rabies, so that would lead to diagnosis or at least suspicion. Would they test her to confirm? If the test came back negative, how would a doctor proceed? i.e. what medication if anything might they give her? Keep her for observation? Let her go home and tell her to come back later if things persist or get worse?

WriteKnight
06-14-2011, 03:34 AM
http://news.yahoo.com/s/yblog_localsfbg/20110613/ts_yblog_localsfbg/norcal-8-year-old-becomes-rare-rabies-survivor?bouchon=807,ca

Little girl survives rabies. Great story.

Guardian
06-14-2011, 03:40 AM
Thanks, that helps to give me a clue of what it can look like, and how a medical team responds.

Purple Rose
06-14-2011, 10:07 AM
New scenario:

Girl shows up displaying the severe rabies symptoms. They'd probably chalk it up to influenza at first. Hydrophobia seems to be distinctive of rabies, so that would lead to diagnosis or at least suspicion. Would they test her to confirm? If the test came back negative, how would a doctor proceed? i.e. what medication if anything might they give her? Keep her for observation? Let her go home and tell her to come back later if things persist or get worse?

Hi Guardian, nice thing about fiction or paranormal is the ability to be imaginative :-)

I had to see a doctor this morning and learnt that she worked in the main hospital in Bali until setting up her own practice in january this year. All the answers above are good and correct but given that I live in one of only a few countries in the world with an "epidemic" (I really don't see it though!), I asked her some questions. Hope this helps:

- If she shows severe rabies syptoms, then yes, they would test for rabies but this usually happens only if the patient confirms being bitten by a dog within the past 2 years. The test is very expensive and there is no cure anyway. By the time symptoms are presented, the patient is nearly dead and in every known case here, has died.

- If the test is negative, they'll do the usual, other tests, other treatments.

- If the patient goes to a doctor or hospital within a day of being bitten by a dog, he or she will be immunized with heavy doses of rabies vaccination. If the dog was rabid, then the patient will have been immuzied and should not get rabies. If the dog was not rabid, then the patient just received preventive care.

As for what a doctor would do if the test is negative, it depends on the symptoms themselves. I'm not a doctor but I would think the doctor would do other tests if the symptoms are severe, as you say. Hallucinations, difficulty swallowing and partial paralysis are all good reasons to keep a patient in hospital.

Guardian
06-14-2011, 10:16 AM
Thanks so much Purple! Talk about going the extra mile. :)

So I think that leaves it up to me now. Hopefully I don't have any more questions

Purple Rose
06-14-2011, 11:25 AM
You're welcome! Yes, it's all up to you now. At least you know you can ask the questions and get some answers.