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Comment by aluminum96 | Hacker News Reader

I have always wondered why rabies vaccination is not given standard in childhood.

Rabies is incredibly scary -- you camp outside, a bat nips you in your sleep, and by the time you know anything has happened, it's too late.

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The number of human rabies cases in the US for humans is so incredibly low.

You're more than ten times as likely to die of E. coli.

https://www.cdc.gov/rabies/location/usa/surveillance/human_r...

Who is getting nipped by bats in their sleep while camping? This seems like a very rare problem to have.

> I have always wondered why rabies vaccination is not given standard in childhood.

Because the side effects from the rabies vaccine are far more likely than you getting rabies unknowingly in the US.

We're talking 25 total cases from 2009 to 2018--about 2 per year.

If you start jabbing a couple million children willy-nilly, 1 or 2 of them will die of anaphylaxis or a secondary infection from the needle prick every year on the best of vaccines. And rabies vaccines aren't particularly modern or sophisticated.

I had the rabies shot to travel a few years ago when I knew I’d be spelunking around bats. I think I’ve had just about every travel-related vaccine possible and rabies was by far the worst in terms of side effects.

I also didn’t know until after I was given the vaccine rundown but getting the shot doesn’t protect you like most vaccines do. The way it was explained to me was if you get bit without the shot you have hours to get to a hospital to get the vaccine for the first time but if you’ve had the shot and you get bit you have maybe a day to get to a hospital and get the vaccine again. When you’re in a remote area that extra time is crucial but I hadn’t realized rabies was still such a serious risk of potential infection even after vaccination.

That's not the case with me. I got the shots several days after exposure, and was told that if I was exposed anytime in the next 5 (10?) years I would need one booster shot only.

Our vet told us that there was no reason for concern when the dog caught a visibly sick bat. He was current on his shots, and he said vaccination was exceedingly effective to prevent rabies.

Basically, because we don't want to give kids unnecessary vaccines (contrary to what _some_ people say). We don't give yellow fever vaccines to everyone, only to people in high-risk areas.

Also, post-exposure treatment is almost 100% effective, so the vaccine goes down in priority

>Also, post-exposure treatment is almost 100% effective,

Only if you know about the exposure before symptoms appear. In the parent's example you don't realize you were actually bit by a bat in your sleep.

I suppose it is possible, but is it really likely that you'll get bitten by a bat who draws blood and not wake up to the pain of such a bite? Is it likely you'll even get bitten by a bat at all? I thought you have to really fuck with them and be in like a cave or something to be exposed to that kind of risk. I mean, they hang upside down from high vantage points right? Unless you're sleeping in a tree and also flailing around your hands to try to beat the shit out of a bat in your sleep, I don't think any bat would come near you let alone attempt to bite your skin, let alone when you're just laying down and not moving around much.

Apparently the current risk calculus is that if you know you were sleeping in an enclosed area with bats, the vaccine will be recommended, because they can indeed occasionally bite relatively painlessly. (Source: I had two friends who slept in a barn and discovered the next day that there were bats living in the barn; they were then given the vaccine even though they didn't feel anything.)

It's a weird case of very large numbers being multiplied by very small numbers. Like, you're very unlikely to be bitten by a bat even if you're near one, a given bat is very unlikely to have rabies, if you did somehow get bitten by a rabid bat you're almost certain to die unless you get the vaccine (but the vaccine is almost certain to save you if so), and the vaccine is very expensive (and, in its older formulation, very unpleasant, though much less so more recently). So that's a lot of things that point in all different directions in terms of the decision.

When I was bit by a bat, I didn't feel it and only noticed the bite until I saw the tiniest amount of blood. I was awake too... Not saying it's a common occurrence, but rabies is such a terrible way to go.

Vampire bats specialized in drawing blood from sleeping victims without waking them. It is rare for them to find human targets, but it happens sometimes: https://en.wikipedia.org/wiki/Vampire_bat#Human_health

My understanding is that a bat trapped in a building with humans can get dehydrated, and they try to get moisture from people's mouths when they're sleeping.

Not every one is super informed and insured. Millions of people would wait it out a while before seeking care.

Not commenting on the likelihood of rabies, but bats hang out at around human-height well away from caves all the time (at dusk/night, anyway). Not uncommon at all. Aside from hearing and seeing them flying low fairly often (which one does), it's not unusual for them to hit things like barbed wire fences and get killed, which means they must have been flying at that height.

Sure, I'm not arguing that it's impossible to get bitten by bat, but you'd have to be extremely unlikely to get bitten by one in your sleep, unless you sleep standing up and a bat flies straight into you somehow.

Ordinarily, yeah. Dunno whether bats do the same thing other mammals (including humans) do when they're symptomatic with rabies, though. Might get paranoid and aggressive like the rest of us. Still, agreed that being bitten in one's sleep doesn't seem super likely. Regardless, I'd bet the knowledge that we (effectively) cannot cure rabies once it's symptomatic and that it's (more or less) a slow, horrifying death sentence isn't as widespread as one might hope. I'd expect there's a greater risk of someone being bitten and not knowing they absolutely need to go get treated ASAP, than of someone getting bitten and not realizing it.

No. Wrong. Incorrect on all accounts. A rabid bat absolutely will bite a human, will fly into a home seeking water, will be down at a human level because they no longer fly well, and most bats are so small that the bite won’t be noticed if it happens while sleeping.

The vaccine doesn't last your lifetime, you get a booster when exposed [1], and is super expensive (in US it's ~$1000 [2]).

But about the article, if < 0.05% of dogs have fake rabies certificates out of millions of dogs is this actually a problem? (Not to condone the behavior) Just because your dog doesn't have a rabies vaccine doesn't mean it does has rabies.

[1]: https://en.wikipedia.org/wiki/Rabies_vaccine#After_exposure [2]: https://en.wikipedia.org/wiki/Rabies_vaccine#Cost

It's only expensive in USA because USA human healthcare system is crazy. It's €100 for humans in Europe, and it's cheap enough to give to every domestic dog several times.

It’s maybe $40 for my cat to have a 2 year rabies vaccine. In the US we do a good enough job of animal vaccination that we don’t need to do human rabies vaccination, as another poster down thread said, 2 deaths per year per 350 million, the vaccine itself is more likely to cause death than the disease.

Wouldn't a simpler solution just be to ask people importing dogs to get them a new rabies vaccination?

The main exposure route is people getting rabies from their dog. The dog is bitten by a rabid animal (especially if it's a guardian dog for livestock) and then one or more family members get it from the dog.

So - much more important to get the dog vaccinated.

A lot of the people I hear about who get exposed to rabies in the US is because they are ignorant. I've seen and heard of many people picking up baby animals, like raccoons and later being required to have post-exposure prophylaxis treatment.

The rabies vaccine is the most intimidating/uncomfortable shot I've ever had - it's a huge vial of bright pink/purple fluid!

https://www.reddit.com/r/mildlyinteresting/comments/5qnq82/t...

It also doesn't provide full protection - you still need to get multiple shots if you're ever actually exposed to rabies.

Not sure what you are talking about... I was exposed to rabies 3ish years ago and received the PEP (post-exposure prophylaxis). The most painful shot was the rabies immunoglobulin, merely because it was a fairly large volume, maybe a couple cc's IIRC. That shot is only needed after exposure and is not a vaccine. The vaccine came as several shots spaced apart by days/weeks, and each individual shot was smaller and less painful than the seasonal flu vaccine. In fact, I literally did not feel the nurse give me one of them.

In America [and most other countries that have done a similarly good or better job of suppressing rabies] the wildlife are the ones getting vaccinated against it. Vaccinating the wildlife by baiting them with an oral vaccine is very effective and can eradicate rabies from a region (vaccinating the general public cannot do that, since person-to-person transmission is not really the concern.)

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