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Thursday July 30, 2015

A Bat in the House, a Rabies Scare

Wednesday February 29, 2012

A Bat in the House, a Rabies Scare

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Charles Rupprecht, Rutgers graduate who directs the rabies program at CDC, offers advice about exposure

Courtesy U.S. Bureau of Land Management
Rabies in this country is exceedingly rare – only one or two cases each year, and though bats are the most common mammals associated with human cases, most aren’t rabid.
Is there anything more horrifying than sitting at your dining room table on a weekend morning and having a bat swoop down over your head? Well, perhaps what next occurred: the whap of my husband’s tennis racket as he smashed the critter onto the wood floor.

Those tense minutes were just the beginning of the bat saga that unfolded in my household in January. By the time it was over, my husband and I would make four trips to the emergency room for post-exposure rabies vaccinations, an inconvenience compared to arranging the shots for my son overseas. Michael, a Rutgers student who had been home at the time of the bat's visit, had just left for Israel when the results came back from the state rabies laboratory.

Rabid, you think. Well, not exactly. My husband’s mighty swing had crushed the bat’s brain, making its tissue impossible to test. Nonetheless, the local health officials advised us to get the vaccinations. Bats, they explained, are the most common source of human rabies in this country and their bites may not be easily noticed or felt, particularly if one is asleep. Hard to fathom, but enough to get us to the emergency room  fast – because rabies is not a disease with which you want to play wait-and-see. The incubation period is typically one to three months, and once its flu-like symptoms set in, rabies is almost always fatal. The virus attacks the nervous system, causing brain inflammation, convulsions, respiratory failure, and then death.

In truth the shots were fairly tame, not like 30 years ago when you got 21 of them in the belly. Now the post-exposure protocol consists of four pokes in the arm within a two-week period. There’s also a slightly more discomfiting intramuscular injection of an anti-rabies immune globulin into the butt the first day of vaccination. But that was the worst of it, along with a $400 deductible out of the whopping $20,000 bill.

Getting the vaccine for my son, however, was another matter, involving the approval of the Israeli Ministry of Health, several days of international phone calls, enlisting an American-Israeli doctor to assist, and finally $1,200 out of pocket for his shots.

At last, with our family safely rabies-proofed, I felt relieved – yet still unsettled. Had all the worry and stress really been necessary? The literature wasn’t clear, and I got different answers from the health professionals I spoke with.

So I set out for THE TRUTH. Googling bats and rabies, a name kept popping up: Charles Rupprecht, chief of the rabies program at the Centers for Disease Control & Prevention, who happened to be a Rutgers graduate. I dialed the number listed on the CDC website, and he answered his phone.

The vaccinations had a $20,000 price tag of which our family paid a small amount. Still, the money had to come from somewhere.
Rupprecht, a veterinarian and a zoologist, turned out to be a friendly academic who could talk about rabies for hours. We spoke for 45 minutes. He grew up in Trenton and graduated from Rutgers in 1977 with a BA in ecology. His fascination with bats goes back to 1980 when he was a field coordinator for a bat project in Panama with the Smithsonian’s Tropical Research Institute. He has headed up the CDC’s rabies program since 1993.

I told him about my recent bat travails, seeking his opinion. “Does the CDC recommend shots for anyone who comes in contact with a bat if you can’t rule out rabies?” I asked.

Rupprecht told me I’d be amazed by how many calls the CDC gets along these lines from practitioners and the public.  “It’s one of the most misunderstood of all our public health recommendations about rabies,” he said. “What needs to be done in every case is a risk assessment. You investigate. You ask the right questions. You act accordingly.”

Rabies in this country is exceedingly rare – one or two cases each year, he said. And though bats are the most common mammals associated with human cases, most aren’t rabid. Even among those submitted for testing – which represents a subset of those that could be captured (and, thus, more likely to be sick) – only about 6 percent have rabies.

 “Do we want anyone to die of rabies? Of course not,” Rupprecht said. “But a majority of people who get post-exposure prophylaxis may not need it. There’s a certain cadre of professionals who fear being wrong regardless of the level of risk, and obviously it is faster to write a prescription than evaluate each incident on a case-by-case basis.”

Of course, when a person is bitten by a rabid bat, the decisions about vaccination are easy; however, he admits, the gray zones can be challenging. 

“People can’t get rabies from just seeing a bat or from touching a bat on its fur; however, if you woke up because a bat landed on you while you were sleeping, most likely you’d know if you were bitten,” he said. “But because bats have small teeth and claws, it’s important to take other factors into account. Was the person in the room with the bat compromised in some way – an extremely deep sleeper, mentally impaired, or intoxicated? The same assessment should be made for an unattended child.”

Rupprecht recommends that people familiarize themselves with the CDC’s rabies website and its section on bats, which offer everything from state and local rabies consultation contacts to how to bat-proof your house.

In the end, Rupprecht did all but say our immunizations were unneeded. But after our conversation, I understood why health practitioners steer clear of assessing the fuzzier areas of exposure. When my husband and I walked into the emergency room (we needed no prescription), not one doctor or nurse questioned our claim to have come in contact with a bat or our decision to spend $20,000 – nor did anyone ask whether the bat had even tested positive. But with the staggering explosion in health care costs and insurance premiums, something’s wrong here.

Safe over sorry seems an easy choice when you’re dealing with an incurable disease like rabies. And given the same scenario, the likelihood is I’d probably get the shots again. But at least I’ve learned this: The next time a bat comes calling, there will be no smash of a tennis racket. I’ll sweetly ask my husband to put on some gloves, trap the critter in a box, and take it to the local health department. You can also ship a bat to the state rabies laboratory alive, with a label on the container indicating that it contains a “LIVE BAT.”

Just one more thing about a bat I really didn't want to know.

Carla Cantor is the managing editor of Rutgers Today.

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