Consider rabies likelihood before dispensing drugs
Consider rabies likelihood before dispensing drugs
Few animals actually transmit the disease
It’s a Saturday night and the emergency room calls in a panic because someone has come in after reaching into a garbage can and getting bitten by an opossum. Do you have any rabies vaccine, they want to know. You dutifully send down a vial of rabies immune globulin and a vial of human diploid cell vaccine (HDCV).
You probably just wasted almost $300.
Why? Because opossums almost never transmit rabies. The nocturnal creatures have trouble getting the virus themselves. In fact, opossums are so resistant to rabies, it’s estimated it would take 50,000 times more of the virus to cause an infection in an opossum than in a fox.
Pharmacists need to be on the alert for such wasteful uses of rabies vaccine, because the drug is so expensive. It takes five injections of HDCV to complete a course of treatment for rabies. The final bill? About $1,000.
Beside opossums, other species unlikely to transmit rabies include rabbits, mice, and rats. It would also be next-to-impossible to contract rabies from a pet rodent, such as a gerbil, hamster, or guinea pig. Squirrels aren’t important transmitters of rabies, either, and in general, their bites aren’t considered a problem. But in Connecticut, a current hot zone for the disease, rabid squirrels have been identified. The same goes for groundhogs and woodchucks. While these large rodents don’t normally carry rabies, they have been found rabid in the northeast.
Common rabies carriers
The Northeast is the locus for an epidemic of rabies among raccoons. The epidemic started in Florida some 30 years ago and has been spreading northward ever since. Besides raccoons, skunks, foxes, and in some areas of the country, coyotes, are major carriers of the disease.
But the animal that most commonly transmits rabies to humans is the bat. In fact, two recent deaths from rabies both in New York state involved rabies transmitted by silver-haired bats. The major problem with bat exposures, according to researchers attending an international rabies conference at the Centers for Disease Control and Prevention in Atlanta, is that victims often don’t know they’ve been bitten.
"It’s conceivable you could reach into a wood pile and get bitten [by a bat] and think it’s a scratch," says Charles Trimarchi, MD, of the New York Department of Health. Many bats have such small teeth that they only leave a scratch mark, he says.
While unnecessary use of rabies vaccines is important from the standpoint of cost control, any bite that can’t be traced to a particular animal must be treated with vaccine. As Trimarchi says, rabies is 100% fatal but 100% preventable.
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