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Comment by khazhoux | Hacker News Reader

I went on a wikipedia + YouTube walk on human rabies last month, and it is truly terrifying.

> The period between infection and the first symptoms (incubation period) is typically 1–3 months in humans. This period may be as short as four days or longer than six years, depending on the location and severity of the wound and the amount of virus introduced. Initial symptoms of rabies are often nonspecific such as fever and headache. Death usually occurs 2 to 10 days after first symptoms. Survival is almost unknown once symptoms have presented, even with intensive care.

https://en.wikipedia.org/wiki/Rabies

Look up YouTube videos of patients if you want to be sad.

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Cue the random comment that made me terrified of rabies: https://www.reddit.com/r/aww/comments/81rr6f/he_fed_the_cute...

Luckily odds of actually getting it seem pretty low overall given the CDC increase referencing 3 deaths as an increase. But still, one of those terrifying ways to go.

On a positive note, the act of being alive is also a ticking time bomb that inevitably leads to death as well, so there is that!

As mentioned in the previous comment,its less because the odds are low and more becuase the US treats basically every animal bite as a rabies case. It takes a very extreme containment method to achieve low deaths

Addressed in the parent post:

>> Only x number of people have died in the U.S. in the past x years. Rabies is really rare.

> Yes, deaths from rabies are rare in the United States, in the neighborhood of 2-3 per year. This does not mean rabies is rare. The reason that mortality is so rare in the U.S. is due to a very aggressive treatment protocol of all bite cases in the United States: If you are bitten, and you cannot identify the animal that bit you, or the animal were to die shortly after biting you, you will get post exposure treatment. That is the protocol.

> Post exposure is very effective (almost 100%) if done before you become symptomatic. It involves a series of immunoglobulin shots - many of which are at the site of the bite - as well as the vaccine given over the span of a month. (Fun fact - if you're vaccinated for rabies, you may be able to be an immunoglobulin donor!)

> In countries without good treatment protocols rabies is rampant. India alone sees 20,000 deaths from rabies PER YEAR.

Sounds like multiple reasons not to worry and keep doing what you want doing if you live in USA

Unfun fact: the rabies immune globulin shots are by far the most painful shot I've ever experienced and being the size that I am, I received what I think was 7 of them in quick succession.

I also got the 4-shot vaccine series, which felt like any other vaccine (basically painless), but the RIG was like having liquid fire injected into my Forrest Gump region.

Huh. I had immunoglobulin shots ("It's just like maple syrup!" the nurse told me) in my butt back in college, and I don't remember it hurting at all. It was just an odd sensation of so much heavy fluid being injected so slowly.

Mostly, I remember it being funny every time I went back and presented my bare butt to the nurse.

I got bit on my finger tip by a feral cat and had to get the first dose injection in the fingertip. It was not pleasant. The rest of them were in the butt which was not great but nothing compared to the fingertip. The cat did die and my parents were able to send it in and luckily the tests for the cat came back negative after a couple of days and I did not have to get all the doses.

I had immunoglobulin + rabies vax in my arms and butt and it was just a standard vaccination kind of discomfort. I don't remember thinking "omg pain" at all.

Weird. I had the immunoglobulin shots, two in the legs, two in buttocks. Despite the syringes being larger than ones I usually see for vaccine it was nothing too memorable. The intramuscular shots (J&J for covid and Tdap honestly hurt more). The ~$17k bill the hospital sent me was the most painful part of the rabies post-exposure process to deal with, not any of the shots.

Why can't we just get the vaccine before exposure? I'm sure there's a good reason just curious

People who work with bats or are otherwise at risk of coming in contact with rabies are actually getting the vaccination like they get others (note: in Germany).

I bet you could make a lot of money advertizing an elective rabies vaccine to people searching for rabies on YouTube. They might not ultimately need it, but if they're willing to pony up some money for peace of mind, why not?

If it only affects 2-3 people per year in the US, then is it worth it?

Might it not be better to reduce rabies in wildlife, or spend the money on other kinds of vaccinations?

It effects ~50,000 people per year (in the US). It fails a couple.

I guess there is a lot to account for when you start talking about preventative vaccination instead of post exposure vaccination.

The rabies vaccine needs fairly frequent renewal (more than once a year). People likely to contract it (vets, pest control, zookeepers, etc) get them. Others get post exposure treatment that is very effective.

This isn't accurate. It may need frequent renewal, which is why most professionals get titers regularly to test for immunity.

Most vets I know have only ever had one or two doses per decade.

You can, especially if traveling to a region where it’s endemic and common. I got the series at a Kaiser travel clinic just by asking when I was planning out a long international trip. You still need post-exposure shots, though fewer (and maybe no immune globulin, if I remember correctly).

There is an mRNA prophylactic version in clinical trials:

https://clinicaltrials.gov/ct2/show/NCT03713086

To what end then is it useful to drum up public fear of rabies in bats, if what actually leads to deaths seems to be economical problems? People only react stupidly to fear mongering. If you want a delightful read, the Merlin Tuttle Bat Conservancy has collected stories about how Fauchi's baseless, "idk, probably bats" reasoning has led to the extermination of entire populations. https://www.merlintuttle.org/

If you truly must live your life in fear of dying, look no further than heart disease and car accidents.

If you truly must live your life in fear of dying, look no further than heart disease and car accidents.

Those are not as scary because there are plenty of survivors, in various states of health. Rabies is notable for being a very binary and decisive disease with little advance warning or treatment.

I think, some creatures are just trouble for our species. Mosquitoes are the deadliest for us, but it seems that bats, with high instances of rabies, and things like covid, are right up there too.

It is sadly funny that we manage to extinct the useful, and mostly beneficial creatures around us, but our "enemies" just exist rampantly and laugh.

Those shots are not cheap either. We found a bat had been in our bedroom at night when we visited my in laws and I saw it fly over us several times.

They didn’t catch it so we didn’t know if the bat had rabies. We hadn’t been bitten, but you can get the virus dropped in your eyes or nose and it is basically 100% fatal.

With those odds, you go through the 3 shot protocol. It was basically $1k per shot for each of us. We have solid insurance but they were not covered because they are so rare.

Surely covering rare events is the whole point of insurance!

(I know US medical insurance is different)

Americans have been fucking themselves for so long that they don't even care if it makes sense anymore.

That sounds ridiculously cheap. I got bitten by the squirrel and went to the emergency room only to be told that they don’t do rabies shots after squirrel bites. The price I paid for 15 min visit? - $3,500.

less scary than prion diseases like mad cow... imagine eating a burger ten years ago and dying from it. there was a notable case recently where a woman in a lab accidentally pricked her finger a long time ago and died from it. I believe it was in france. thankfully it is fairly rare.

Imagine developing untreatable cancer and dying next year. Much more likely than either prion disease or rabies. You can't go through life afraid of "what if" we are all dead in the end anyway.

Chill, friend. He didn’t say he lives in mortal fear of burgers. Just how weird it would be for that tasty burger to kill you a decade later.

Prions are doubly terrifying because it's not a typical disease. From what I understand it's proteins folding in a different way that come into (the prions can be dead or alive) and the healthy proteins will take on the new form. It's scary because typical sterilization (high heat) for surgery does not work guarantee it and the heat required is not currently practical.

The shakes from that cannibals get are prions. I also though I saw a link to a subset of alzehimer cases but can't find it.

Prions are basically immortal.

https://www.foodsafetynews.com/2015/06/researchers-make-surp...

"...in 1985 when the Colorado Division of Wildlife tried to eliminate CWD from a research facility by treating the soil with chlorine, removing the treated soil, and applying an additional chlorine treatment before letting the facility remain vacant for more than a year, they were unsuccessful in eliminating CWD from the facility."

There seems to be some kind of species barrier making it difficult for deer prions to infect humans, because people are certainly being exposed to it frequently, especially in areas like the midwest where CWD is rampant. But we're in deep trouble if that ever changes. Imagine people dying of CJD because deer peed in a field somewhere decades ago, the prions bound to the soil, then bound to a seed planted in the soil, then you ate whatever crop happened to be grown there. It'd be inescapable.

The tree could have fallen on you. Or any other thing that once in a while, very rarely, kills people.

I get the point and it is not all that bad writing. But, people don't die of rabbies all that often.

The sole caveat to this is the Milwaukee Protocol, which leaves most patients dead anyway, and the survivors mentally disabled, and is seldom done - see below

I was curious, and thought that would be something gruesome involving power tools, so I looked it up and it's apparently an induced coma with heavy doses of antiviral drugs, which has a very low success rate.

As far as I'm aware, exactly one person has survived that treatment, and she never fully recovered. A low success rate indeed.

When I was a kid, I was pretty sure that rabies, quicksand and poisonous snakes were the big things to look out for.

We had a bat in the house years ago. In my 3am stupor I tried to let it out until Dr. Spouse berated me and said we must catch it. Darn thing disappeared. Animal control came and couldn't find it. That's when I started reading about rabies. Freaked me out. Up until that point I had the attitude that if something felt off, just go to a doctor. Nope. Omae wa mo shindeiru.

We had booked 2 adults and 2 diaper-age kids for PEP shots when I took the day off and turned the house upside down trying to find the bat. Eventually I found the dumb thing stuck to a glue trap for mice. No rabies.

But yeah, people were looking at me like I was bonkers for scheduling the shots. "Did it bite you?" No idea! But I'm not going to take my chances on being the second person ever to come out not quite dead from a drug-induced coma after symptoms set in.

Nice work. You don’t take a gamble when the odds are 100%, especially for your kids. Booking the shots was the right call.

My father in law knew better and still let the bat escape. Cost us $10k in shots for 3 of us.

Well at least you are dead within a few days but as an insomnia sufferer FFI (Fatal Familial Insomnia) really scares the shit out of me - you die due to being unable to sleep - not even propofol helps.

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