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Comment by madeuptempacct | Hacker News Reader

Rabies is one of the scariest diseases to me, because most aren't vaccinated, it's virtually 100% lethal, and most of the time, doctors will tell you that you don't need to be vaccinated "just in case", because the incidence is so rare.

If you can, bring in the animal that bit you; you don't want to go through the shots unless they are necessary, but you also don't want to die.

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Also, by the time you show any symptoms, you’re as good as dead. So you have to anticipate whether the animal that bit you might have had rabies or not. Many people are reluctant to seek treatment when they feel fine, especially given the cost of healthcare in the U.S.

Yeah, its pretty weird. I had never really ran into bats until late this summer when I was sitting on the couch around 10:30PM and one flew through our living room. I caught it in a plastic container and let it go.

Looking down the rabbit hole on the internet was absolutely terrifying. I talked to my doctor and our daughters pediatrician but there is really no standard on what you should do because it varies so much by location. We went to the ER and chose not to get the PEP since we were about 99% certain I caught it right after it entered our house and my wife and daughter were in other rooms with doors closed.

It still makes me feel uneasy when thinking about it or reading stories like this.

I was dumbfounded by the attitude of some of the medical personnel I had to deal with when I was once randomly bitten by a stray dog. After I demanded to be vaccinated at the emergency room they finally gave in but their attitude was "the dog lives in the city, it doesn't interact with wildlife so you're most likely fine". I told them 'most likely' doesn't make the cut for me when we're talking about a disease with a mortality rate at 100%.

Did they go to medical school? That's medical malpractice if I ever saw any.

That's honestly quite terrifying. In Germany there was a supply chain problem for rabies vaccine a while back and even though they seem to have managed it kinda scared me.

It's amazing how, to doctors, what were once once meaningful life and death scenarios just become more work or less work scenarios over time. They are desensitized.

It might help to demand in writing that there is no risk. Of course, they would never do that, so likely would just give the shots. Ensure they know that all your friends, lawyers and insurance company will be advised of the doctors decision to not inoculate.

> If you can, bring in the animal that bit you

Don’t they still need to kill the animal and send it’s head to the lab? At least when I was a kid you still needed the shots because it took a week to get the animal’s results back.

I was told you could avoid shots by bringing the animal in, but I am not in the field, so I don't know if that's generally true.

Yes, and if is alive is easier to look for symptoms. People bitten by any species of microbat receive three shots.

There is a lot of difference between risk depending on the bat species, so it helps a lot if can be classified by a specialist.

> if is alive is easier to look for symptoms

As I understand it, removing and examining the brain can yield a definitive diagnosis in cases where time is of the essence. In cases where it's not immediately obvious that the animal is rabid, it can take a week or two of observation to look for more overt symptoms.

That's how my parents ended up adopting a stray dog, who later became just about their favorite pet ever. By the time they'd watched him for a couple weeks, he wasn't going anywhere. :)

Yeah pre-Milwaukee protocol it was an undeniably legitimate case for euthanasia in confirmed cases being irreversible and painful. I believe that Gandhi of all people noted the situationality of ethics - normally killing a child is a horrifying crime but if they are suffering from rabies and it is too late horrifically killing them was long the best option.

Even with advances it is a bit of a longshot but it is still better than the alternatives. There is an irony in medicine that it becomes ethical to be more reckless when odds are longer. It makes sense of course but there is some dark comedy that trying something drastic and seeing if it sticks being the moral thing.

And that's one of the main benefits of the Milwaukee protocol, even if it likely doesn't work, induced coma is still the best place to be once you show rabies symptoms.

Rabies also returned to Europe in the big scam's period. With several recent cases in Greece since 2012. The country was clean of rabies in the previous 20 years.

The expansion of the golden jackal as new centroeuropean animal promoted for the deliberate extinction of the gray wolf by man, could also increase this probability. Jackals are much more prone to bite and interact with dogs and cats without killing it.

big scam period?

> Rabies also returned to Europe in the big scam's period.

Can you be more specific? Are you talking about the early 2010s?

Rabies never went out of Europe. In C&E Europe it exists since I remember, and you get shots every time anything bites you.

You are right, I should have say European Union, not Europe.

The areas of Spain in the European continent are declared free from the presence of rabies virus, but rare cases can occur. We had a case in 2013 from a female dog that got the virus after a travel to Morocco.

Poland is in EU since 2004, you would still be wrong :)

Also AFAIK Germany isn't free of rabies, either.

Sounds like Germany is free of it, officially, except for bats. Caution is advised...

http://www.faz.net/aktuell/wissen/medizin-ernaehrung/tollwut...

Interesting. Is rabies endemic in Poland?

Yes, wild red foxes and bats are the main infected populations. It's not very common, and the last human victim was in 2002 apparently, but it's there and you have to follow the rules if something bites you.

Hum, I see: a young man dead in 2002 in Podkarpackie (unknown origin) and also a woman dead in 2000 in Warmian-Masurian after being bitten by her cat.

>you don't want to go through the shots unless they are necessary

The shots aren't that bad these days. It's just a series of relatively large intramuscular injections.

As someone with a severe fear of needles, that is pretty much my personal nightmare. It is my personal nightmare because I assume they also do blood test.

I may still choose to go through with it, but I am not entirely sure.

getting a course of rabies vaccines cured me of my dislike of needles, YMMV

No blood test.

No, the vaccination shots are relatively small. Very small painless shots, not as bad as a flu vaccine at Walmart/Walgreens. HOWEVER, the first shot of the PEP series, the immunoglobulin shot, is a large painful shot... But the subsequent vaccination is a piece of cake. Source: received PEP a few years ago.

Since the vaccine is pretty harmless and saves you from certain death if you got infected. It's a very very good idea to get a rabies shot after any close contact with any mammal with unknown vaccination status.

Our son was on a school trip in some fairly remote parts of Tanzania and as they were cycling and running they recommended fairly strongly to get a rabies vaccination - glad we did!

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