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Follow These Rabies Rules for Safety

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WebMD Health News

May 12, 2000 -- Call it the paradox of rabies. It is 100% fatal -- but at the same time, 100% preventable. The key is prompt and effective treatment.

That paradox was certainly on the mind of Karen Slote, of Newton, Mass., last month, after her 10-year-old daughter was attacked by a rabid fox. The small, dog-sized creature snuck up on Nina and a friend as they were walking bicycles up the street.

"He got her in the back of the calf," Slote says. "He was biting and scratching at her legs. She fell down. I ran out -- I didn't have a plan -- and luckily the fox just stopped and backed off a little."

The Slote house was actually the third stop for the crazed fox. Earlier that morning it attacked a baby and a toddler and finished up the day by dueling with an elderly man who beat it off with a squeegee. That's when Newton Police took over and shot it dead.

Disturbing as the rampage was, experts suggest it would be better if all exposures to rabid animals were as obvious. They're not. "In the last couple of decades, most of those who have died of rabies in the United States were infected with bat-strain rabies," says Michael McGuill, DVM, public health veterinarian with the Massachusetts Department of Public Health. "Only one had a known bite."

McGuill says it may be that bat bites are so insignificant that they go unnoticed.

Not that people are dropping dead all over the place from rabies. In its latest report on the disease, the CDC notes that just 22 humans developed rabies since 1990, and 20 of those were from bats. Public health investigators only know that because rabies viruses can be genetically traced to the animal of origin. In other words, different species of mammals harbor different strains of rabies. The rampaging fox in Newton got rabies from a rabid raccoon, McGuill says, but there is also a "fox rabies" virus.

Fortunately, one vaccination type covers all strains of rabies. It's called human diploid cell vaccine (HDCV) and it's used in conjunction with rabies immunoglobulin (RIG). The former provides what's known as "active" immunity -- but it takes around a month to kick in. To cover that time period, RIG is injected right after the bite. It provides almost immediate protection from the virus -- which slowly travels up nerves to the spinal cord and brain. Together they are known as post-exposure prophylaxis (PEP).

The treatment is easy -- and relatively painless. "It's a series of seven injections over a month's time," says Mille Vitale, RN, rabies nurse for Pinellas County, Fla. "You will have five visits to the doctor, on days zero, three, seven, 14, and 28 -- and that schedule has to be kept. You will be getting the vaccinations in the upper arm, on alternate arms."

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