California teacher dies from suspected rabid bat bite | Hacker News Reader

California teacher dies from suspected rabid bat bite

ktla.com

119 pointsBender187 comments

I don't have anything meaningful to add other than how bizarre to see this on HN. Laura Splotch, who was interviewed in the article, is a good friend, neighbor, and former coworker. Weird how things intersect sometimes.

I remember when I briefly lived in WV, we had a bat in our house and after knocking it down with a pillow, I needed to remove it, and i was WAY too much of a scaredy-cat to remotely touch it bare-handed. I came up with an elaborate procedure with an upside down bowl, took it outside and ran away as soon as I freed it.

Glad to see my hilariously overweight instincts validated.

The problem here wasn't getting bit, it was not getting vaccinated. It took a month for symptoms to appear (which is typical) and at that point it's too late.

Growing up, it wasn't too uncommon for a bat to get stuck in the house. Mostly you can just open a door and it will find its way out. If not, it will get tired and you can bring it outside while it's asleep. If you get bit, you need to get vaccinated.

I occasionally have birds fly into my garage and need help getting out. They will fixate on the large window and need some help finding their way out

But, yeah, bats who echolocate don’t really need help, do they?

Sad that the woman’s good faith efforts to peacefully move the animal was far more dangerous than she could have known

> the woman’s good faith efforts to peacefully move the animal was far more dangerous than she could have known

The bat and the bite weren’t dangerous, her decision not to seek medical attention after being bitten by a bat was.

The bite was in fact pretty clearly dangerous.

At some point the reduction of what is to "blame" becomes ridiculous.

Getting stabbed wasn't dangerous. The blood loss was. The blood loss wasn't dangerous, cerebral hypoxia was.

To be fair, we do not know whether she actively decided not to get vaccinated for rabies after her encounter. She may have been ignorant of the need to do so.

Fair enough, I changed the language to avoid that misreading.

I threw a towel to it and moved it outside. It got pretty stuck to the towel so I left it in the garden.

My first instinct would be to shoot it with birdshot. But that would be stupid, as now there will be no way to know if the bat is sick.

If this happens, do not free the bat after trapping it! Instead contact your relevant disease control authority so that the bat can be tested for rabies. Otherwise doctors will have to assume you've been infected and treat you regardless of whether you need it or not. A bite or scratch is not necessarily visible.

The above comment doesn't state this explicitly, but bat bites can go unfelt (e.g., if you're sleeping, for instance) so the recommendation if a bat is found inside the house is to keep the bat for rabies testing and see a doctor.

I’ll never understand why the recommendation is for people with no training or experience in handling wild animals whatsoever is to expect them to catch a potentially rabid bat instead of just vaccinating them. Even if someone manages to catch the bat and it tests negative for rabies, then what? What if the test isn’t 100% accurate? Would you trust it? Considering how awful and deadly the virus is, I would not care what the test result is, I’d want the vaccine. I got it about 10 years ago, it was a series of 3 shots and was no big deal. We give rabies shots to dogs and cats constantly, why do humans have to jump through hoops to get it?

Whether or not to trap the bat requires some common sense specific to the situation, perhaps you can effectively trap it by closing a door for instance. However if like GP you've already trapped the bat then you should definitely not release it.

The post-exposure treatment for rabies involves immunoglobulin[0], which is not always easily available especially in the kinds of places where rabies is most endemic. The vaccine alone, post-exposure, may not be sufficient.

An ounce of prevention is worth a pound a cure, get vaccinated beforehand.

[0] https://en.wikipedia.org/wiki/Rabies_immunoglobulin

I've tried multiple times when I was in California to get vaccinated for rabies. Not a single doctor would consider it despite my telling them I handle bats and other critters all the time. Their excuse was that it can have really bad side effects to which I said, "well so can having rabies". A couple of the ER doctors didn't even know what rabies does so we sat there and read the CDC website for 40 minutes. I went there because I had muscle stiffness and lacked a range of motion but that had been going on longer than the incubation period so we just agreed I didn't have rabies, also ibuprofen helped which would not help for rabies.

I rescued a pup that was really scared when California was on fire. I also had a few infected bats that were highly aggressive. I know that is not a good test as it can take a while. It would have been nice to get vaccinated but I was just lucky.

Chat with veternarians? I've heard they often are vaccinated, because they're at higher risk, and they may know the right words to say to get the vaccine?

That's a great idea. Maybe they know of private entities that can do it outside of a hospital.

Maybe they just give themselves the dog vaccine, adjusted for their body weight?

I’m sorry, but an ER doctor that doesn’t know what Rabies does?!!!?

Two of them. I was also surprised given the large number of brown bats that were diagnosed as infected where I lived. It took us reading the CDC website for 40 minutes because most of the documentation talked about the "what" and not the "why". After some digging we found it. This was around 2008 in northern California.

Travel vaccine clinics are the easiest route to go for a preventative rabies vaccine.

That's surprising to hear a story about under-treatment in the US. In the UK rabies vaccination is easily available from pharmacies, for a fee.

The nurse practitioner I saw recommended me to get the vaccine since I was travelling to a place where rabies is endemic.

> instead of just vaccinating them.

Cost. And the low likelihood of the bat actually carrying the virus.

> But while it is essential for survival, the first treatment alone can cost more than $15,000 in D.C., leaving patients with unexpected bills and medical debt.

https://wamu.org/story/22/04/14/dc-rabies-treatment-cost/

It's American healthcare, cost is as deadly as staying alive

Presumably this is why someone just shot the CEO of UnitedHealthcare

It's sad but this is what the whole 'eat the rich' thing looks like in action. I don't know if it's my cynical nature or age, but I get a sense that generalized feeling of hope/optimism is at all time low (ok, ~century or so low) and these acts will likely increase

Thats crazy. It would be cheaper to fly abroad to receive the treatment (except that the regime lasts 30 days). I had a regime in a foreign country a few years ago, total cost of injections was around $100 USD.

The same is true for many non-urgent medical procedures: you're probably better off booking a flight to Europe or really any place, rather than doing it in America. Even out-of-pocket, it's frequently cheaper to fly somewhere else and do the treatment there than to do it in your own town in the US.

For anyone making it this far: if you need to catch a wild animal in your home, throw a blanket on it, then throw another blanket on that, and one more if you need to.

Best to use thick quilts that block light. Moving blankets are perfect.

For whatever reason almost all animals will freeze when they are entrapped but not in pain and blankets rarely will injure.

I have done this one rabbits, lizards, mice, and birds.

I think there's no way to test the bat for rabies without them breaking open its head. That was why they had to kill that guy's squirrel recently after it bit the person who worked for the government.

After a potential exposure myself the state’s protocol was to capture and monitor the animal. If it displayed symptoms or died, it was assumed positive for my vaccination purposes and would then be tested to confirm.

If it didn’t display any symptoms or die, immunization would be held off. Apparently this depends on the animal you were exposed to and rabies incidence rates in the vector in the geographic area.

In my case, the animal died 2 days later and caused quite a headache.

They recommend getting immunoglobulin within 24 hours. Waiting 5 days seems to add risk the vaccine won’t be effective?

That was my previous understanding too, but this was the protocol of a large healthcare system.

Their logic was that only symptomatic animals can spread rabies, and once symptomatic they tend to die within a week and display obvious symptoms even earlier.

I guess the risk of delaying 5 days is extremely low, or perhaps nonexistent. At least with immediately recognized contact?

They did not have to kill the squirrel [1]. First, rabies is extremely rare in squirrels and there are no documented cases of squirrel to human rabies transmission in the US ever.

Second, if a squirrel (or raccoon) does have rabies it will show symptoms within 10 days and die not too long after. The guy had the squirrel for seven years and had the raccoon for much longer than 10 days.

[1] https://nypost.com/2024/12/01/us-news/rabies-expert-says-nys...

> if a squirrel (or raccoon) does have rabies it will show symptoms within 10 days and die not too long after.

tThat sounds like a relatively rapid way of testing if someone has rabies to me. have em bite a squirrel and in 7 days, you know if you need the shots!

I know you’re joking but to be clear, if they have symptoms they wouldn’t need a shot, it’s too late.

That squirrels death was just like the death of the gorilla in the Cincinnati zoo or of that lion on that it merged multiple realities together and profoundly changed our history. Harris won the election in the reality where that squirrel is still alive.

I still find it interesting that, at all times, a squirrel ran behind her in her first public appearance after the election, her concession speech.

I (tongue in cheek) unironically believe in real life SCP objects for "reality distortion fields". We have too much bloody evidence of this!

Mandela Effect. NO ONE HAS ANY GOOD EXPLANATION FOR THE CORNUCOPIA NOT BEING ON THE FRUIT OF THE LOOM LOGO! I'm from that reality, but the one where Nelson lived.

Sometimes broad rules like rabies safety protocols around wild animal bites aren't optimal. But you don't want everyone improvising what to do when it could get people killed in other cases. The rule needs to be legible and not need a lawyer to decipher for every case. The kind of bad response wouldn't have happened if the law on keeping wild animals as pets hadn't been broken first setting things off into a rare corner case.

Regardless of what you do after you catch it, this is a wonderful way to catch an animal in your home.

If saliva transfers from a rabid animal onto the blanket, is machine-washing it sufficient to prevent later exposure? or do you just have to throw the blanket away afterwards?

> instead of just vaccinating them.

Vaccines are for pre exposure. Google suggests the total cost of this service is between $1,500 and $3,000.

Medical treatment is for post exposure. Google also suggests the total cost of this service is around $15,000 as it typically includes an ER visit.

> What if the test isn’t 100% accurate?

They take the animal and dissect their brain so that it is as accurate as it possibly can be.

> We give rabies shots to dogs and cats constantly, why do humans have to jump through hoops to get it?

Different legal standards for the quality of product and different market sizes. Your dog and cat is taking a bigger risk with the product than we expect you to. Your vaccine is inactivated virus and offers stronger protection. The animal vaccine can be a modified living virus or a recombinant vaccine and offers weaker protection. Your dog and cat is probably legally required to have one and you are not.

> I got it about 10 years ago

It's not a permanent vaccine, is it?

I suspect ones medical provider or an urgent care center could do the same thing. My Dr has fit me in same day for something quick before and an urgent care might be only a $100 copay for the visit.

Also most people's deductable isn't 15k

Also its basically impossible to Google medical prices in America because actual negotiated prices are normally a fraction of the cash price.

> or an urgent care center could do the same thing.

It's a lifesaving treatment. People usually don't bother themselves with frugality in either price or expertise at this point; although, I'm glad you can have this high confidence in your General Practitioner and his schedule.

> Also most people's deductable isn't 15k

The question is "why don't we just vaccinate people?" So while you're saying is true you're actually validating my point. The cost difference is not noticeable to most people and the cost of just the pre exposure vaccine is pretty high to begin with.

> its basically impossible to Google medical prices in America

No, it's entirely possible, because customers discuss these things openly and you can find those discussions. You can't establish an exact price that has any predictive power but you can establish a common range. It's not as if this is some mystery that only the Gnostics can tame.

> total cost of this service is between $1,500 and $3,000.

As a non-us person, I can't understand how medical bill works in the state.

Surely this is some marked up price for insurance?

In Hong Kong, this is HK$215 ( ~US$30) per shot. You can get everything you need under US$200

> Surely this is some marked up price for insurance?

Maybe. But they’ll absolutely try to get you to pay the full price. They might also demand payment up front. In either case you might be able to pay less if you negotiate, but maybe not.

If you’re insured you’ll pay between $0 and the full price of the discounted insurance rate (which this may already be close to—it depends where the numbers come from) depending on the insurance plan you have and how exactly it’s already been used. If you’ve already spent a lot of money “out-of-pocket” this year, you may have hit a limit that triggers 100% from insurance until the year’s up, usually a calendar year (try not to split a pregnancy over two calendar years…)

Then there’s whether the hospital’s in-network for your insurance, and maybe separately whether the doctors are and whether any testing facilities used are—that is, whether the insurance will pay for service from these providers (which may sure look to you like just one provider-entity, but might not be) at all. Sometimes almost nothing is in-network once you’re more than a couple hundred miles from home (and plenty within that radius might not be either), depends on the plan.

[edit] oh and if you ask anyone involved what you are going to have to pay, they’ll treat you like a moron. If you persist, they’ll send you on a wild goose chase of paperwork and billing codes and talking to more people who act like you’re a moron for thinking that was a reasonable question. You probably won’t ever figure it out, just have to wait for the bill. And then the inexplicable second bill. Then three more bills scattered over the rest of the year, two for entities you can’t identify without some phone calls, usually without even specifying on the bill WTF they’re asking you to pay for.

$30K for post exposure is even more crazy. Idk about Hong Kong, but in saner parts of Europe it's either free or like $15-$30 for the whole course.

The prices make no sense and nobody is quite sure why it's so fucked

But someone somewhere must be making a killing. Probably the middlemen

In the US, the pre-exposure course is now often just two doses, although three is possible (and used to be more common). The per-dose price at most pharmacies in the US is $400-500.

You'll generally need either a referral or a travel clinic consultation to get one (unless you work in a job where it's deemed essential to get the rabies pre-exposure course). In more reasonable states, you can do something like the Costco Travel Vaccine consultation service (which runs ~$40) and, if you indicate you are traveling to remote areas in certain countries, get a recommendation for the rabies vaccine course.

In some cases, insurance will cover the rabies pre-exposure course. But that is generally rare.

So, in general, best case if you just want to voluntarily receive the vaccine in the US? Around $800 if you live in a state that is reasonable and use an inexpensive travel consultation service (like Costco's offering). And, if you want the full three dose series? That will generally set you back around $1200 minimum.

So, for a lot of people in the US, the cost will be under the $1500-3000 range that was noted. However, it's still expensive, even in the best case in the US!

I think live attenuated vaccines produce a stronger and more durable immune response than inactivated vaccines.

I believe rabies is one vaccine that is effective after exposure.

https://en.wikipedia.org/wiki/Rabies_vaccine#After_exposure

>> I got it about 10 years ago

> It's not a permanent vaccine, is it?

From Wikipedia [0]:

> Following administration of a booster dose, one study found 97% of immunocompetent individuals demonstrated protective levels of neutralizing antibodies after ten years

[0] https://en.wikipedia.org/wiki/Rabies_vaccine#Additional_dose...

> Vaccines are for pre exposure.

That is correct for most vaccines. However, it's different for rabies. The vaccine is also effective post exposure (as long as it is given soon enough). Human rabies immune globulin (HRIG) is also part of the post exposure treatment, but the vaccine is critical here too.

Also of note: if one has received a course of rabies vaccinations as part of a pre-exposure treatment (high risk jobs, certain types of travel, etc), then the post exposure treatment consists of only a few extra doses of the vaccine (and not HRIG).

I travel to relatively remote places, and hike in those places, so I decided to pay for a course of the rabies vaccine a few years ago (the three dose course). If I do ever end up with a feral dog bite, for example, that makes treatment much easier - the vaccine is much more available globally than HRIG, and the timeframe is more relaxed if you've had the pre-exposure jabs. Granted, that immunity eventually wanes, so I'll occasionally need a booster to maintain enough protection.

with rabies, if you're infected with the virus, it doesn't become unstoppable deadly until it hits your central nervous system. At that point it's pretty much too late unless a near medical miracle of good luck saves you. before that, the virus spreads towards your CNS at a rate (If I remember right) of about a centimeter per day, and during all that time, you can still save yourself through prophylactic vaccination and (if you were never vaccinated before exposure) with a dose of immunoglobulin, which can be pricey anywhere.

As for why it's so insanely expensive in the U.S, not a fucking clue except to pass the responsibility on to the country's insanely byzantine medical billing and services systems.

In the country I live in (Mexico), the rabies vaccine (not immunoglobulin) costs about $50 per dose in a high-end private clinic and a dose of immunoglobulin about $200. There are also about 350 public health centers nation-wide that offer it for free if you're lucky enough to be close to one.

Do you know if those Mexican prices are available foreigners? I've thought about getting a rabies vaccine just for peace of mind as I often travel to weird places in weird ways.

If you visit Mexico, they certainly are. I'm not sure if they might be higher close to the U.S border (a common tendency for many products and services in Mexico, I suspect because of higher demand from American visitors) but anyone visiting any private clinic wherever in the country can simply pay for services at the same price charged to any local. These prices are often posted on CLINIC websites or publicity material, so it's usually easy to know if they're honestly being applied.

As for the quality of doctors and the authenticity of medicine in reputable private clinics, in my experience problems are exceptionally rare, Though language barrier might be an issue in some cases.

Not promoting anything specific here either, just describing personal experience from years of living here (and sometimes having needed medical services or medicines)

Yeah this is the problem. And there is NO way to bypass the system and just get the vaccine if you want it. The only place that will give it to you is the ER. Thus forcing a 15k payment or a very large deductible payment. But yet, you can go to your vet and get it for your dog for 20 bucks. The u.s. system is totally jacked.

Because it's not enough, you still need to do post-exposure shots (or else you still have a not exactly known but reasonably high risk of death). The main benefit of pre-exposure vaccination is that if somehow you have no access to the vaccine the day of exposure, you might still have a (small?) chance of survival. This benefit is nearly zero if you live within a driving distance from a hospital.

So why go through the trouble and pay $1-2k (plus more for boosters every 2-3 years) if you still need to go to the hospital after you get bitten?

I think the (not explicitly stated) question is “why would a pervasively given rabies vaccine for humans cost $1-2k per dose?”

I suspect it wouldn’t cost anywhere near that, as it doesn’t cost anywhere near that in India.

>I suspect it wouldn’t cost anywhere near that, as it doesn’t cost anywhere near that in India.

It absolutely can cost that much in America. I see you're not familiar with just how expensive medical treatments in America are.

> I suspect it wouldn’t cost anywhere near that, as it doesn’t cost anywhere near that in India.

I have bad news.

It would cost $1k-$2k per dose because in the US you can just make up a price, and profit is God.

In public healthcare, it will cost you $3 per dose in India.

> (or else you still have a not exactly known but reasonably high risk of death)

Survival in dogs with post-vaccine high-titer challenge is very, very high 5 years after vaccination-- >80%.

> The main benefit of pre-exposure vaccination is that if somehow you have no access to the vaccine the day of exposure, you might still have a (small?) chance of survival.

"Small" chance of survival seems pessimistic as a way to describe this.

The main advantage of vaccination is that if you have an undetected bite or exposure, you are still probably okay. This is something that someone who routinely handles bats or other wildlife that may carry rabies might want.

A secondary advantage is you need half as many post-exposure treatments after a known bite, which are both expensive and painful (immunoglobulin injections all around are not so fun).

Also, "day of" seems like hyperbole: it is routine to wait 10 days for test results of probably-healthy animals before starting post-exposure treatment.

>We give rabies shots to dogs and cats constantly, why do humans have to jump through hoops to get it?

Because even vaccinations are not universally without risk of complication. See my last cat I had to put to sleep due to complications resulting from an injection site sarcoma as a result of just such a "trivial and routine" vaccination. So, while your flippant attitude toward the matter is noted, it is not appreciated. These things are not without risk in all cases. Bring the damn bat for testing.

Testing for rabies can only be done post mortem.

That seems to be a minor requirement. /s

Only mostly.

I’m a Veterinarian. Second this.

The flip side of this is that in my County, the DOH specifically says they will not test bats for rabies unless there is a medical record of a bite.

They recommend going to the ER if there is ever a bat in the room while you have been sleeping because the bites can be undetectable. Any contact at all and it could have nipped you without you realizing. You were right to be wary.

This happened to our friend's family. They all had to get shots and in the US, doctor's rarely carry the vaccine, so each time a shot is needed, they had to go to the ER, which took hours.

It's a ridiculous combination of needing to go to the ER but something that can be scheduled (especially beyond the initial shot).

Damn, there was a bat hiding out in my room for ages when I was a kid. Glad to say I never got rabies.

I can’t tell you how many times I’ve had bats in the house - hundreds. If it won’t leave of its own volition, all you need is a towel - just lob it into the little blighter’s flight path, and then lob the towel, bat and all out of the window. The bat will be fine, the towel will want laundering, and you will be fine.

The only times I’ve had to handle bats have been where they’ve smacked into something and stunned themselves, and one of the cats is eyeing up a convenient snack - like any other wild critter, leather gloves are a good idea if you have them, but you can barehand it if you do a normal restraint hold, which is trivially easy - they can’t bend their necks downwards so just gently gripping their torso and hind limbs keeps both of you safe - like this: https://www.goerie.com/gcdn/presto/2022/04/20/NETN/8ec5edbc-...

Time to review this post on Reddit:

https://old.reddit.com/r/copypasta/comments/7qwtd5/rabies_is...

That was terrifying. Very well written.

Eek! The only time I've been bitten by a rodent was close to where this happened - sleeping overnight on the floor at a Merced punk venue my band played at, I was awoken by something nibbling on my hand. Not good, it was a rat.

That's punk.

When I got bit by a squirrel and contacted the CDC for a second opinion after my doctor wouldn’t prescribe the shots, they told me that there’s no record of rabies transmission between rodents and humans. They can’t really survive an attack from another rabid animal and would die soon after they became infectious anyway. That applies to anything smaller than a skunk or raccoon, which have thicker hides.

Bats are special because of their unique biology which creates a viral reservoir (IIRC the virus originated in bats). Rabies persists in their bodies without making them sick and they transmit it to each other within their colonies.

Do not ever touch bats. Never ever. If you do touch a bat, go to the ER and tell them you touched a bat.

I mean, in Europe, bats carry rabies - something like 1% of them - but there have been a grand total of three rabies cases in the last 50 years from bat bites across the entire continent.

As to mice and rats - the chance of getting rabies from them is negligible, anywhere - they usually end up incapacitated and dead through predation extremely rapidly.

I’ve been bitten by all of the above. No treatment beyond dousing the wounds with peroxide.

The closest a mouse ever came to killing me was when it pushed a rock out of a wall in the hovel in which I lived, which smashed the headboard of the bed a few inches from my skull.

I feel like this is all something that has been pushed by the American insurance industry. Again - 43 deaths in 50 years. Negligible.

If you really cared about risk management, you would never, ever get in a motor vehicle, and you would have insurance for putting on your pants in the morning.

Like so many things, rational risk management is overtaken by fear and emotion.

At the time I write this comment, the thread has been up for 9 hours and has 130 comments. I can't claim to have read them all, but in my scan of the entire page, yours is the only one I could find focusing on the actual facts instead of the fear-mongering.

I'm disappointed in this community. I suppose it's not fair to expect a lot of deep zoology background here, but damn.

More information on a balancing perspective can be found here: https://www.merlintuttle.org/rabies-in-perspective/

Very good article. While I normally am terrified of rabies, this helps me reduced that fear, and not worry because a bat flew by overhead.

I know in the US we only get 2-3 cases per year, and the OP case is the first in 3 years I think? All of our cases are known to be direct contact with bats/animals and the people should've known to get help.

We had a bat in our bedroom here in France a couple of years ago. We weren't quite sure what to do so checked online and the diametrically opposed advice was hilarious. US sources read like this thread, whereas the French ones were like leave your windows open to allow them to fly out and a bunch of links to why bats are amazing and protected animals.

I guess the incidence rate is a bit higher in the US but yeah interesting risk management.

On a lot of stuff, the US and EU advice are radically different. EU doctors would jail American doctors for the way we circumcise children with no requirement for it.

What a weird take on risk management, I hope you aren’t responsible for managing anyone’s risk besides your own.

You’re advocating against the reason that rabies deaths are so few in your locality and dismissing the monumental amount of effort that went into making it so rare.

There are ~60,000 rabies deaths annually, most from places without access to prophylactic vaccination, and there is little to no public initiatives to control carrier populations or educate the public about the risks.

I’m arguing that risk should be managed based on logic and rationale, not emotion and fear.

To call the entirety of Europe “my locality” is, uh, very American of you.

And yes - rabies deaths from primate and dog bites are more common in undeveloped countries - but 60,000 p.a. is still a vanishingly small number compared to, say, malaria (600,000), TB (1,400,000), hep (1,100,000), diarrhoea (1,500,000), flu (650,000), schistosomiasis (200,000), and cars (1,300,000). I suppose the latter two aren’t scary, because you haven’t heard of one of them, and you use the other every day. There are bigger fish to fry.

Fortunately, dogs (and cats) are universally vaccinated against rabies in Europe, and we have no primates.

Last Christmas, we got a tree from a local farm in the mountains. We had the tree trimmed and decorated before we discovered a sleeping (hibernating?) bat on the inside.

We got it moved outside, but it took about 24 hours before I realized that I should call County Health. By that point, the bat was gone, and county health suggested I receive rabies treatment, but call my doctor. The bat could have bit or scratched without us realizing it.

The doctor concurred. Rabies treatment must be done at the ER. They strongly recommended everyone in the house receive treatment if we could not 100% rule out physical contact. (We couldn't.)

Me, my wife, my kids, EACH receiving the immunoglobulin and four rounds of vaccines at the ER. We ran the first ER out of the treatment so the kids had to go somewhere else. Also, those are big needles.

The treatment ended up billing insurance over $100,000. (Almost all of that is the immunoglobulin.) We also had to return to both ERs, three times each, with the last time being on Christmas morning.

There is research that says immunoglobulin is _likely_ not necessary if you have no visible bites, but it's current health policy in the USA, and no doctor wants to be the first to undertreat.

Most expensive Christmas tree ever.

I had the same treatment in South Korea a few years ago, including immunoglobulin. It cost about $4,000 or so

US absurdities aside, I find it ridiculous that people need to pay for something that will save their life.

Really? That's your only criteria for thinking it's absurd? People need food to live, water too, and also clothing. Is it absolutely insane that all of these cost money?

I'm not defending the insane billing system of the U.S, because it truly is designed to be or at least accidentally off the wall with absurdities, but it's not ridiculous to charge people reasonably for many complex, expensive things that also require hiring specialist assistance. Somewhere down the line, somebody in any case needs to pay for it via money and time.

I think is the unreasonable ammounts that people end up paying in US that make it crazy to understand for non US.

For me as an European, i see anything related to healthcare as core to our society. You mention food, if i dont like an apple from a vendor i can just have another fruit that is cheaper this season. I wouldn't have that choice to change meds for my current ilnesses.

Yeah sure someone has to pay for it, but do meds need a 10000x markup compared to the 2x markup on food? US is such an advanced country in terms of science and tech that is scary to think people still die due to not being able to pay their cancer treatment.

As Aneurin Bevan said:

"Illness is neither an indulgence for which people have to pay, nor an offence for which they should be penalised, but a misfortune the cost of which should be shared by the community."

How does this make sense when some people intentionally do things that cause illness?

And it’s not just Americans either, for example some Japanese like to intentionally eat fugu, meat from super poisonous puffer fish prepared in a very specific way.

Surely there’s no expectation for society to pay millions to treat someone who ate the 99.99th percentile fugu slice…

Loads of people do things that might result in a visit to hospital - my wife was hospitalised after a climbing accident (with a mountain rescue team and separate helicopter based team), I've been treated for cycling accidents and because one of our cats bit me...

You can either accept the vast bureaucracy of evaluating risk and paying for each bit of treatment or the much simpler and cheaper option of paying for it in taxes and giving everyone the same level of basic care and not worrying too much about the fugu eaters...

You didn’t mention the third option?

No vast bureaucracy and no payment expectation.

But more realistically since the vast bureaucracy already exists… and isn’t going away in the foreseeable future, then it makes sense to utilize it.

I don’t mind sharing the bill in procuring medicine if it means i won’t have to pay when it ends up being my turn.

A person’s capacity to live shouldn’t be a function of how much money they make.

It’s such a core and fundamental principle that I can’t reconcile it.

You may disagree with me, and you are free to, but this is merely an opinion.

The word “reasonably” does a lot of work in your comment. I can accept 20 eur for a rabies shot, not 4k.

The main issue is that if you get bit you definitely need a rabies vaccine to live. Medicine it not the same as food or clothing. It is inelastic in nature. If I'm hungry I can eat a steak or an apple. When it comes to medicine we rarely have that opportunity.

Even in South Korea it doesn’t exactly sound cheap - I really wonder what makes a 150 year old, mass produced vaccine so expensive. Haven’t we figured out how to produce it cheaply.

I assume the bulk of the cost is the immunoglobulin, but no idea

> The treatment ended up billing insurance over $100,000.

Yep, that definitely confirms you're in the US. ;)

Omg that's an expensive Christmas. Glad to hear everyone was alright, but that cost is insane.

Hopefully your insurance covered a lot of that $100,000. That's astronomical.

How much did your insurance cover and how much did you have to pay out of pocket?

> Most expensive Christmas tree ever

Would have been even more expensive if the USA had UK laws- in the UK disturbing bats is an offence.

Also, unless you really think you need it (just finding a bat is not enough), you don't want to take rabies vaccine. But IANAMD.

I've walked through swarms of bats without a care in the world. You came within ten feet of a sleeping bat and put your family through a medical grinder. Different strokes.

Weird flex in the comments on an article about someone who interacted with a bat, didn't get treated, then died.

I'm sorry for you and your family. This is a catastrophic thinker's literal nightmare.

Rabies is approximately 100% fatal [1]. The moment you start showing symptoms it's already too late.

If you get bitten by a wild animal, tell your doctor and get a rabies vaccine. It's as stupidly effective at preventing rabies as the rabies virus is at kiling you [2].

[1] https://www.who.int/en/news-room/fact-sheets/detail/rabies

[2] https://en.wikipedia.org/wiki/Rabies_vaccine#Before_exposure

> If you get bitten…

Nit: If you get exposed to the infected animal’s saliva. [1] This does not need to be a bite.

> People can get rabies if they have contact with the saliva or neural tissue of an infected animal… [2]

[1] “Canadian child dies from rabies after bat found in bedroom” https://www.bbc.com/news/articles/cvgxjnldqvdo

[2] Center for Disease Control “Rabies VIS” https://www.cdc.gov/vaccines/hcp/vis/vis-statements/rabies.h...

I agree with what you're saying, and you're absolutely correct, but purely in the interest of pedantry, there has been at least one case of a person surviving after showing symptoms [1].

Still, the odds are so close to 100% lethal after symptoms that you can very honestly round up to 100%.

[1] https://en.wikipedia.org/wiki/Rabies#After_onset

> there has been at least one case of a person surviving after showing symptoms

There appear to be some people with the ability to create antibodies to the rabies virus. Together with the Milwaukee protocol, which may keep the brain from frying itself (or do nothing, we don't know), we have the ability to turn it from a death sentence to--in a hair of cases--just a severely debilitating disease.

And that case was (relatively) recent! https://childrenswi.org/at-every-turn/stories/jeanna-giese-r...

> If you get bitten by a wild animal

Or even if you "only" get scratched

What's interesting is that in many cases, you will not be given a vaccine. A skunk bite will do the trick, but if you were bitten by a squirrel, you probably won't be getting any. You can probably read your state's guidelines online. My state has a surprisingly narrow list of animals that entitle you to a shot.

The theory behind it is that some mammals are somewhat less likely to be carriers, but it's not a comforting thought, right? You have a somewhat lower chance of certain death than if you were bitten by a bat, so we will deny you a pretty safe vaccine.

> can probably read your state's guidelines online. My state has a surprisingly narrow list of animals that entitle you to a shot.

What state is this in? If I want a prophylactic rabies shot, I can just ask my doctor to schedule one.

You can definitely get the rabies vaccine especially if traveling on what not. May not be covered by insurance.

What they do limit is the immunoglobulin shot — that is very hard to manufacture (I think it’s developed from horses antibodies or something) and is used in large quantities based on patient weight. That’s why the gatekeep.

You can get the full course for under $100 OTC in Thailand. Even with travel it will be considerably less expensive than in the USA (think around $7k, although maybe slightly less without the immunoglobin) unless your insurance is exceptional.

> than in the USA (think around $7k

Try $300 to 400 without insurance [1]. It's free with most insurance, including Medicaid and Medicare Part D.

[1] https://www.goodrx.com/rabavert

You need 5 to 7 doses to be safe.

yeah the cost of the rabies vaccine is insane, especially given that it was one of the first vaccines discovered

In my state (Washington) there is no record of rabies in terrestrial wild mammals. It's only been found in bats and domestic animals.

Here's a document of animals tested for rabies from 1988 to 2023 [1], and only 4 cases were not in bats. 2 in cats, 1 in a horse, and 1 in a llama.

Nevertheless there are always people freaking out on NextDoor when they see a raccoon.

[1] https://doh.wa.gov/sites/default/files/2024-05/AnimalsTested...

The problem with squirrels and other wild rodents is plague. Yeah, that plague: The Black Death. It's not spread by bites but merely close contact.

It's treatable with antibiotics if caught early, but still a few people a year die from it in the US. Usually in the Rocky Mountain states.

https://en.m.wikipedia.org/wiki/Plague_(disease)

>The theory behind it is that some mammals are somewhat less likely to be carriers

When I was reading up on this several years ago, it's because smaller animals are highly unlikely to survive an attack by another rabid animal and are therefore less likely to carry rabies (and be alive). Larger animals are more likely to survive an attack and carry rabies.

Well there is also a chance that you contracted the virus without noticing an animal at all.

Not to mention any number of other conditions that may lead to sudden death.

Risk is an inevitable part of being alive, all we can do is minimize it. Once it's minimized to noise levels it's not really rational to do anything else.

I've been rabies vaccinated for 32 years. I get my titer checked every 2 years. I finally got a booster a few weeks ago. I do work with wild animals including bats.

Whenever I read a story like this, I wonder if more people should be vaccinated for rabies. When I spoke to the Oregon state veterinarian a few years ago he told me about a terrible case of rabies infection that happened with a child. The general scenario is - domestic cat catches rabid bat - cat becomes rabid - child in the household is bitten. As mentioned, by the time symptoms are detected it is too late. The doctor also told me a man who got bit by a rabid dog in Mexico and died in Oregon. It took some sleuthing to figure out how/when the infection occurred since the Mexico trip had been months before.

Rabies is a terrible way to die.

The documented number of people who have survived a full blown rabies infection can be counted on one hand. I only know of 1 person, there may be others.

Under 20 for sure, Milwaukee Protocol is the usual approach

I read just recently that they no longer even recommend the Milwaukee Protocol, as it's not been shown to have any significant effect.

Back in the 1980s, a Marine at Quantico made the mistake of picking up a sick raccoon--one heard a lot about rabid raccoons in the area then, but I guess he hadn't. He developed rabies, and survived.

> He developed rabies, and survived

Certainly not. I'd have said almost certainly had this been a civilian. But the fact that it was an on-duty Marine gives this a 0% chance of not being reported.

Furthermore, there is a high chance that a Marine in active service would have already received the rabies vaccine as prophylaxis: https://health.mil/Military-Health-Topics/Health-Readiness/I...

> there is a high chance that a Marine in active service would have already received the rabies vaccine as prophylaxis

Then they wouldn't have developed rabies. There was no Marine who got rabies at Quantico from a raccoon in the 80s who recovered.

You still need to get the vaccine after getting bitten, pre-exposure prophylaxis just reduces the amount that you need afterwards.

https://www.who.int/news-room/fact-sheets/detail/rabies

Here is what a search of The Washington Post yields: https://www.washingtonpost.com/archive/local/1983/03/18/susp...

But, also: "None of the tests for rabies and a host of other viral infections has proved positive".

- "We know that we had a neurological disease that was probably caused by a virus," Bernard said, adding that the lack of a positive lab test made it "highly unlikely" that the Marine had rabies."

- "Throughout his illness, he had a disease compatible with rabies," he said. "We don't know what it is so we can't say what it isn't until we know what it is."

https://www.washingtonpost.com/archive/local/1983/06/02/susp...

Marines are often not from the area where they are stationed. If he was from somewhere in the Western US he may not have thought of raccoons as a rabies risk.

Rabies is not established in the raccoon populations of California, Oregon, or Washington so the only rabid raccoons you might find are ones that recently got it from a bat or (in California) a skunk.

In California that works out to around 4 rabid raccoons found every 20 years or so. In Oregon no rabid raccoons have been documented in at least 50 years. In Washington no rabid raccoons have ever been documented.

Citation most definitely needed for this one.

Curiously there are around 6 cases reported in India in the recent years, with varying degree of confidence in the diagnosis. With 20000 confirmed death per year in India, this could mean that survival rate is in fact 0.01% and not 0.00%, it just looks the same unless you have a huge sample.

Another interesting question is: how many people get infected, then recover, but never develop the symptoms? Do they exist? Could it even be common? On that question, the chances of developing symptoms after a confirmed rabid bite are estimated to be between 15% and 60%. What exactly happens to other 40%? Does the virus fails to get hold and multiply? Or on the contrary it's not stealthy enough and triggers the immune response that defeats it? Or it starts to spread and then stops for some other reason? And whatever happens, what exactly determines it: truly random chance, or genes of the infected person or variant of the virus or type of the bite?

Currently we identify rabies with the terminal stage of the disease and the only reliable test is posthumous, so no wonder it's 100% deadly. While it's indeed extremely deadly it's still a curious question of how much exactly this "extremely" means: 60% or 99.99% or 100%.

Probably this will never be studied, because the humane way is to conduct none of that research and just vaccinate every suspected person within reach. Plus where possible try to eradicate infection reservoirs like the did in the Alps in 1970s. These 20000 people in India could've lived, it's a shame really.

Really good point about whether there are cases where the immune system catches it early or the virus can't survive for another reason.

> Another interesting question is: how many people get infected, then recover, but never develop the symptoms? Do they exist?

It appears so [1]: “New research has shown that humans may be able to survive Rabies without vaccination or treatment after all. A study done in Peru (were Vampire Bats, a known Rabies carrier, are common) lead by Amy Gilbert of the U.S. Centers for Disease Control and Prevention found that 7 out of the 63 people evaluated tested positive for rabies antibodies. Of those seven people only one had previously taken the Rabies vaccine. This meant that the other six had produced antibodies on their own after being exposed to the virus and had survived.”

[1] https://www.nature.com/scitable/blog/viruses101/is_rabies_re...

Go ahead and read up on what a death due to rabies is like. After that, you'll definitely never neglect to treat a wild animal bite seriously. It's the stuff nightmares are made of.

TL;DR it slowly, and mostly asymptomatically, eats its way up your nerves until it reaches your brain and starts eating that. That's when you start developing significant signs and symptoms, by which point, maybe weeks after exposure and without evident illness in the meantime, you're already dead. There's a treatment protocol—it's grueling and if you live, you'll suffer some amount of permanent disability. And, statistically, you won't live. You're dead.

The course after that is a few weeks of effectively rapid-onset severe dementia. Animals don't get violent and unpredictable because the virus is simply angry-making—they get that way because they stop recognizing once-familiar things and can't remember how they got where they are, and so are constantly fucking terrified, plus their throats are closing up so they can't eat or drink (assuming they could remember to, or how to) and are experiencing dehydration and starvation. That's your near future by the time there are signs of the disease. You're about to dehydrate to death over a period of low-tens of days while becoming increasingly confused and frightened by your situation and by your own loved ones.

It's absolutely horrifying.

You need to treat any animal bite seriously.

I had to convince a coworker to go to the ER to have a cat bite looked at, and she ended up spending a couple of days in the ICU with the doctor being clear that delaying treatment another few days would have been fatal.

https://xkcd.com/1775/

This one covers several things but is basically motivated by spreading the bad news about the seriousness of cat bites, as made clear by the alt text.

That alt text doesn't seem to be about rabies, is it something else? Would have been nice to know that and yes the red flags also, haha.

yeah cat bites are bad. Cats tend to not bite though without giving warning fortunately

Knowing that stuff like this happens really makes you appreciate how humanity managed to survive this long. If thrown into the preindustrial past, I would miss temperature control, refrigeration, and the Internet MUCH less than vaccines, antibiotics, and OTC pain relievers.

Ditto for Tetanus. I always half-heartedly got my Tetanus vaccine when it came time because why not? After learning what happens, I started marking the day on my calendar ten years in advance.

Interestingly, the thoughts on boosters have shifted a lot and the recommendation to receive every ten years may soon be dropped, since the vaccine is considered to have a longer effect than originally thought.

Since Clostridium tetani is anaerobic and in fact can't survive in the presence of oxygen, a lot of the things people suspect could give it to them likely can't. Unless you cut yourself while digging it's pretty unlikely you've been exposed to tetani.

And not to downplay your fears too much, but untreated tetanus is ~7% fatal versus 99.9% with rabies.

For the general population. For those who work on poultry farms they're going to continue recommending regular boosters. Chicken droppings can be a source of the bacteria.

Remember that the tetanus vaccine is often combined with a vaccine for diphtheria and whooping cough. You might not need a tetanus vaccine, but you might need the other two. As always, ask your doctor if it doubt.

Clostridium endospores can survive just fine in the presence of oxygen.

Oxygen is literally toxic to anaerobes in the clostridia class. Which means their endospores are likely to be where the bacteria is.

Like botulism or bacterial gangrene, tetani can survive for short periods (as can humans sans oxygen) but is unlikely to be found in sufficient quantities to cause concern.

Unless a not-too-gruesome death is somehow not concerning to you, knowing that rabies = certain death should be enough, And at least where I grew up, rabies = certain death is taught to kids in first grade, maybe even kindergarten.

I live in Washington and bats occasionally wander into our cabin. As others have pointed out, there is a difference between pre-exposure (Vaccination) and post-exposure protocols.

The rabies vaccine is given pre-exposure and can be obtained at travel clinics. It's generally only given to people travelling to high-incidence areas or sometimes to those working with wild animals. I believe this is because it's only effective for a year or two. Although, there was one documented non-fatal incidence of human rabies in an individual who had been vaccinated years prior if memory serves.

The rabies post-exposure protocol is much less pleasant. It includes Immunoglobulin against the virus as soon as possible post-exposure. This needs multiple injections just to make up the volume. It's much more expensive and a little unusual, so ER visit. A child-sized dose was 4 simultaneous injections into buttocks and arms. It's followed by vaccination+booster at travel clinic, a couple of weeks apart.

If you are able to preserve the bat without touching it, local authorities can examine it. They will need to decapitate it and examine the brain tissue, so the brain needs to be intact and not frozen to get good tissue. ie. Don't put it in the freezer.

Having said that, bats are super-adorable and I've been able to move them with heavy gloves by placing a tupperware over them, sealing with a piece of paper, and relocating them outside before anybody gets close to them. We just had one borderline experience (no confirmed contact) where we felt it was better to be safe than sorry. Post-exposure protocol is criticial if there was contact with the bat because the stakes are so high.

When I was a kid and needed rabies vaccine for a dog bite (the owner snatched the dog that bit me and took off before anyone had a chance to query her whether the dog was vaccinated) - it was 30 or so shots into my stomach, given over multiple days - and causing a lot of soreness and pain in between. I wonder if it’s still like this, because damn.

>it was 30 or so shots into my stomach, given over multiple days - and causing a lot of soreness and pain in between. I wonder if it’s still like this, because damn

it's not like this anymore; it's just four shots in the upper arm (like any other common vaccine) over two weeks.

With the fairly broad scope of publicity campaigns and pop-sci information about how bats are notorious hosts of rabies, it's surprising that this woman didn't go get checked out right after releasing the bat. I'd assume she'd have noticed being bitten since she was awake and carrying it before releasing it, and that would have been a huge red flag for visiting a doctor, but even if she wasn't sure about a bite, like I said, the publicity around bats and the danger of rabies is huge. Even little kids often know about the connection between the two.

Strange. She had nearly a month to save herself and simply nope.

Something that never made sense to me: Why don't we just vaccinate everyone for rabies?

We have treatment regimens post exposure, and these are available worldwide:

https://www.nyc.gov/assets/doh/downloads/pdf/vet/what-to-exp...

The amount of people getting rabies doesn't warrant the vaccine. It's not widely transmitted person to person. I guess we could vaccinate all the animals. Then we get the same antibiotic resistance questions other diseases have.

because it's not life long protection and the threat level isn't that high. compare it to the Chickenpox vaccine regime, which needs to be taken once for life long protection. that makes sense to give to everybody. rabies protection only lasts a few years. the chances you'll get exposed to rabies naturally are relatively low, compared to chicken pox. (low doesn't mean zero, and if you're a rural inhabitant, it'll be higher). finally, these things aren't free, so that gets factored into things as well.

I thought that too, but we only have a limited supply of it, its not without its own risks, and we get 2-3 cases per year of it - mostly due to vaccinating those exposed, and the 2-3 that happen, such as this case, should've known but didn't.

I've been through the rabies protocol after a bite from random homeless dog I tried to help.

In the US with insurance it's about $5K out of pocket, and 3 or 4 (can't remember exactly) visits to the ER. the first visit they inject some gelatinous stuff all over the site of the bite site plus the vaccine. And no, they don't inject in your abdominal area anymore. The case will be referred to the city and if possible, the animal will be tested for it. I'm not sure if they have to kill the animal to test. They'll let you know if it was positive though.

It's extremely rare to get rabies, but also it's extremely lethal.

Do people still eat bats on TikTok?

Sorry to sidetrack but is this a local newspaper? I found it odd to see international news so update in this newspaper.

Any wild animal bite needs to be taken seriously. A rabies vaccine series isn't pleasant but it beats the alternative.

The vaccine is much better than it used to be.

The alternative is almost certain death for the readers that don't know.

I received a pre-exposure prophylaxis series and it was really no different than any other vaccine series I’ve had.

Post-exposure is the uncomfortable one as you're getting the immune globulin where the bite was.

But definitely better than the days when you were getting the rest of the series in the abdomen.

Do you work with animals? I'm curious why you or your doctor felt this was necessary.

Not OP but it used to be recommended when travelling to certain parts of the world where it's common to have wild animals live in urban areas.

New York?

I was going to be traveling to some countries with significant issues with rabies. I did end up getting the post-exposure series after a suspected bite, although that may have been an overreaction on my part. Second round was also not memorably painful.

The modern vaccine isn’t that bad. I went through it in 2012 after a bat weirdly decided to mess with my scalp at an outdoor concert. Treatment was a series of four shots (in the arm, not the stomach) over a few weeks of drop in visits to an LA hospital. NBD, way better than worrying about impending death.

The bigger deal can be finding who has the vaccine and is prepared to administer it.

My father got it after an injured looking/unusually behaving cat scratched him up. Cat ran away - so it was impossible to test for rabies. 4 shoulder injections - no drama, no noticeable side effects other than maybe sore shoulder.

Test for rabies can only be done by dissecting the brain by the way.

False, but it's the cheap way.

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

"The diagnosis can also be made from saliva, urine, and cerebrospinal fluid samples, but this is not as sensitive or reliable as brain samples."

I remember reading that these tests only worked like 40% of the time in cases that later proved to be positive posthumously.

Tests for viruses usually either measure the immune response (which rabies doesn't trigger) or try to catch the virus RNA/DNA in a sample, but that requires the virus to be present in that specific sample. Rabies is extremely stealthy, it's not necessarily present in either urine or saliva, so these tests effectively are either "positive" or "unknown". Even if you take sample of nerve tissue you may not hit the infected piece because it spreads very slowly and non-uniformly.

Even if there's no rabies it's a vector for other infections.

Not just "wild" animals but domesticated, too.

I got nipped by a friends dog when playing a bit too rough. Had to go get a "dogmentin" (https://www.drugs.com/augmentin.html) shot as you are pretty much guaranteed a nasty infection.

This terrifies me

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