May 12, 2000 -- Call it the paradox of rabies. It is 100% fatal -- but atthe 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. Thesmall, dog-sized creature snuck up on Nina and a friend as they were walkingbicycles up the street.
"He got her in the back of the calf," Slote says. "He was bitingand 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 thatmorning it attacked a baby and a toddler and finished up the day by duelingwith an elderly man who beat it off with a squeegee. That's when Newton Policetook over and shot it dead.
Disturbing as the rampage was, experts suggest it would be better if allexposures to rabid animals were as obvious. They're not. "In the lastcouple of decades, most of those who have died of rabies in the United Stateswere infected with bat-strain rabies," says Michael McGuill, DVM, publichealth 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 gounnoticed.
Not that people are dropping dead all over the place from rabies. In itslatest report on the disease, the CDC notes that just 22 humans developedrabies since 1990, and 20 of those were from bats. Public health investigatorsonly know that because rabies viruses can be genetically traced to theanimal of origin. In other words, different species of mammals harbor differentstrains 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 calledhuman diploid cell vaccine (HDCV) and it's used in conjunction with rabiesimmunoglobulin (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 protectionfrom 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 ofseven injections over a month's time," says Mille Vitale, RN, rabies nursefor Pinellas County, Fla. "You will have five visits to the doctor, on dayszero, three, seven, 14, and 28 -- and that schedule has to be kept. You will begetting the vaccinations in the upper arm, on alternate arms."
"Most people still think you get them in the stomach -- and youabsolutely don't," says Slote. But you can get the RIG injected in unusualplaces -- depending on where the bites are. "Nina had three places wherethe fox bit or scratched her and she had to have some RIG injected into each ofthose spots."
The HDCV/RIG regimen is a huge advance from what might be called the DarkAges of rabies treatment, Vitale says, when the vaccinations were so numerousthey had to be given in places such as the abdomen -- and even then, didn'talways work.
"It's much easier to treat patients and much easier to recommendtreatment," says Alfred DeMaria, MD, director of communicable diseasecontrol at the Massachusetts Department of Public Health. "Now the risk oftreatment is virtually nil."
Which is not to suggest anyone who comes in contact with a rabid animalnecessarily needs treatment. It really depends on how "contact" isdefined. Public health experts say the greatest danger lies in getting thesaliva of a rabid animal, or its brain or nervous system tissue, into an opencut. That could happen through a bite, of course, or indirectly.
That was the case with Roland Vaillancourt, a paramedic from Greenville,N.H. One day eight years ago he noticed an odd sight: a raccoon wanderingaround a neighborhood in daylight. "So something was wrong," he says."It was acting very unusual -- slow [breathing], unsteady gait. We justdecided to put it down at that point."
He used a bow and arrow, and accidentally cut himself on the arrowhead,which was tainted with the raccoon's nervous system tissue. But Vaillancourtunderwent PEP and didn't have any problem.
Another method of indirect exposure: getting saliva or nervous system tissuesplashed onto a mucous membrane, such as the eye. But experts say it'simportant to note that blood, urine, and droppings from rabid animals cannottransmit the virus.
Cats and dogs were once important rabies transmitters -- but no more. Now,raccoons are king up and down the East Coast. In fact, three years ago, Canadamounted an intensive effort to keep rabid raccoons from spreading into Ontario.Planes flew over the border, dropping thousands of oral rabies vaccine doseshidden inside food bars. It failed.
Ontario's current efforts to control the disease's spread includeestablishment of a five-kilometer "kill" zone at two entry points --where every raccoon seen is exterminated. There is also an outer zone in whichraccoons are trapped and vaccinated. And beginning in June, a shower ofvaccinated bait bars will be airdropped into the area.
A similar effort on Cape Cod, Mass., seems to have done the trick. DeMariasays raccoon rabies there have been virtually eliminated.
McGuill says rabies may rise and fall among animal populations -- in greatpart, because animals die from it -- but at this point it remains a problem."There's no indication it's going away."
That said, DeMaria has some recommendations to avoid an exposure: First,avoid any animal you don't know -- especially one which is behaving unusually.That could mean an overly aggressive creature, but also one that is too docile.A raccoon or fox shouldn't be seeking human contact -- they're normallyafraid.
"Second, reduce the environment and habitat for potentially rabidanimals by reducing food and nesting sources," DeMaria says. "Third,immunize your pets -- cats and dogs."
And if you are bitten, thoroughly wash the wound with soap and water -- thisis an important step, since the virus may be broken down by soap. And alwayssee a doctor.
- Since 1990, only 22 people have died from rabies, usually as the result ofan unnoticed bite from a bat.
- A person contracts rabies by coming into contact with the saliva or braintissue of a rabid animal, but can prevent the disease with a series of sevenshots over a month's time following exposure.
- If you are bitten by an animal, thoroughly wash the wound with soap andwater, then see a physician.