Playing Doctor

It was a lovely sunny day at the VBB hospital. The trees were getting some new green as the spring rolled in and there was the slight scent of wet earth that remained from an early morning shower. My day was ticking by, surgery in the morning, followed by afternoon appointments, when suddenly a gaunt figure in a large flowered hat careened into the front lobby.

By large flowered hat, I mean it was a hat with HUGE fuzzy flowers on it, worn by the famous "hat lady" in our little town in recognition of the first official day of spring. This particular lady had hats for all sorts of occasions, all worn as a partial jest and partial personality tic of the wearer.

On this day, the normally sunny countenance of Hat Lady was marred by a look of horror. She was holding an equally flowered handkerchief wound around her wrist. As I walked into the reception area, I could hear her demanding to know the rabies vaccination status of one of our patients. I explained that we were not allowed to release that information to her since she was the owner. However, after looking at the record and seeing that the patient, Teeth, had his last rabies vaccination within the year, I felt pretty comfortable telling her that I didn't think she had anything to worry about with regards to rabies. I advised her to go to the doctor to have the wound looked at and maybe a tetanus shot.

It was at this point that the Hat Lady started yelling that I had to give her a rabies vaccination. I told her that A) I didn't have vaccines for humans and B) I was not licensed to give a vaccine to a human. She kept saying that a rabies vaccine is a rabies vaccine and that she "demanded" that I give her one. When I told her that she would need to talk with her doctor and animal control about that, she got super dooper mad. She threatened to call my boss...I offered to dial the number for her. She threatened to call the board...again, I offered to dial the number for her.

When the police showed up (she had called them about the dog bite), both the officer and I were finally able to get her to calm down. As the dog in question was current on vaccines, he was quarantined for 10 days in the home of his owner and the Hat Lady never required a rabies vaccine (at least not yet).

This brings up some important things: One, a vaccine approved for dogs, cats, goats, cows, horses, etc is not necessarily approved for humans. In fact, I am struggling to think of one off of the top of my head. Two, most vets would rather you call the vet board because they refused to work on you rather than to have a board report for working on you. Hell, the vet at my undergrad even refused to pull a splinter out of the hand of a fellow student because he didn't want to get in trouble for working on a human.

The last thing to let everyone know is that rabies vaccines are important. It is against the law to not have your dogs and cats vaccinated and it is a bad idea to not vaccinate other animals. In the US, there are not large numbers of animals identified as being rabid nor are there large amounts of people dying from rabies. However, in places like China and India, those numbers increase exponentially. We can thank our relatively low rabies incidence to the efforts of the public health departments and veterinarians. That does not mean that we can relax our attitudes towards rabies. We have global travel of animals, including the adoption and importation of animals from places in the middle east, where soldiers are falling for homeless animals and trying to help them. Some of these animals can come to the US with rabies. So, thinking that you can extend the time between rabies vaccines beyond the scope of the vaccine is both illegal and dangerous.

A family in Florida just found this out. Their dog came in contact with a raccoon. The dog had not been vaccinated for rabies within the allotted time. Most rabies vaccines are either considered to be effective for 1 year or for 3 years. This dog had been vaccinated 7 years prior to the incident. Because of the lack of protection from the rabies vaccination and the contact with a raccoon, this dog contracted rabies. Rabies is diagnosed post mortem (after death) via a certain test on the brain cells. Once this dog was diagnosed with rabies, the humans in the household had to be vaccinated and the other family dogs were euthanized. In reality, after the unvaccinated dog came into contact with a raccoon, an animal species known to harbor rabies, the dog should have been euthanized or at the very least quarantined for 6 months or so. Rabies viral particles have to travel up the nerves from the site of the bite/contact into the brain, which can take a long time. Thus an animal can be infected, but not start showing signs or being able to transmit rabies for weeks to months, depending on the site of the bite.

As for the 1 year versus 3 year protocol, I am split on this. For animals that are likely to come into contact with wild life regularly, I would stick with the yearly protocol. I have read a report of a dog that contracted rabies in spite of being within the 3 year interval per his rabies vaccine. For those patients that are less likely to see hot wild life action (like my indoor, couch potato old lady dog), I would go with an extended, 3 year protocol. And just because your cat does not go outside, do not assume it is safe. There are enough people that find random bats in the house...and a bat bite often goes unnoticed, even when they bite a human. So, obey the law....and use some common sense. Some of my colleagues might disagree and they are welcome to do that. However, a classmate of mine told me that they just had a dog diagnosed with rabies in Virginia and there was also a recent report of a horse that was diagnosed with rabies in Tennessee.