I went to veterinary school in the Philippines in the early 80’s. At the time there were more human deaths in the PI than any other countries. We were all vaccinated. There was a study I remember that flushing out human bites wounds prevented rabies transmission from infected animals. Of course I would get post exposure prophylaxis. Just saying we underestimate the value of dilution with infectious disease transmission. Americans seem to feel as if rabies is not a threat to us. How wrong we are.
Thank you Sue for elevating this simple and critical measure we can all take at home to reduce risk. Vigorous washing at the bite is something that can be done immediately before any medical intervention, and it goes a long way.
Hi Matt, hope you’re well. I value the bulletins—keep up the good work!
Agree with Dr Palomo on the value of local wound care, when a bite is recognized! It's the bat exposure without known physical contact recs that I struggle with in terms of public health effectiveness.
According to the abstract of a 2007 report in Clinical Infectious Diseases by De Serres et al., the incidence of human rabies associated with sharing space with bats while sleeping, without known physical contact, was 0.6 cases per billion person-years and there is no evidence that bat-associated rabies incidence has decreased since these ACIP/CDC recs were introduced decades ago. The number needed to treat is astonishingly high, as would be costs, of course.
It's a tough one on an individual level: PEP as a preventive intervention is super-effective and the disease is almost universally fatal, but it's not a compelling use of resources.
Hi Tom. It’s a great question. I know health officers struggle with these calls from ED docs seeking guidance for post exposure vaccination (I know I did.) The local animal epi can help.
In parts of the world where bats really aren’t the reservoir (likely included in the CID study) I agree it’s overkill to assume potential exposure if a bats just in the room overnight. In CA one in ten bats tested are positive. I understand the 2024 death in the Fresno case had a very subtle bite. Also a bat that is spry and trying to get out is different than a sickly one, so there are context clues to factor in.
I went to veterinary school in the Philippines in the early 80’s. At the time there were more human deaths in the PI than any other countries. We were all vaccinated. There was a study I remember that flushing out human bites wounds prevented rabies transmission from infected animals. Of course I would get post exposure prophylaxis. Just saying we underestimate the value of dilution with infectious disease transmission. Americans seem to feel as if rabies is not a threat to us. How wrong we are.
Thank you Sue for elevating this simple and critical measure we can all take at home to reduce risk. Vigorous washing at the bite is something that can be done immediately before any medical intervention, and it goes a long way.
Hi Matt, hope you’re well. I value the bulletins—keep up the good work!
Agree with Dr Palomo on the value of local wound care, when a bite is recognized! It's the bat exposure without known physical contact recs that I struggle with in terms of public health effectiveness.
According to the abstract of a 2007 report in Clinical Infectious Diseases by De Serres et al., the incidence of human rabies associated with sharing space with bats while sleeping, without known physical contact, was 0.6 cases per billion person-years and there is no evidence that bat-associated rabies incidence has decreased since these ACIP/CDC recs were introduced decades ago. The number needed to treat is astonishingly high, as would be costs, of course.
It's a tough one on an individual level: PEP as a preventive intervention is super-effective and the disease is almost universally fatal, but it's not a compelling use of resources.
Appreciate additional thoughts on this…
Take care
Tom Boo
Eastern Sierra
Hi Tom. It’s a great question. I know health officers struggle with these calls from ED docs seeking guidance for post exposure vaccination (I know I did.) The local animal epi can help.
In parts of the world where bats really aren’t the reservoir (likely included in the CID study) I agree it’s overkill to assume potential exposure if a bats just in the room overnight. In CA one in ten bats tested are positive. I understand the 2024 death in the Fresno case had a very subtle bite. Also a bat that is spry and trying to get out is different than a sickly one, so there are context clues to factor in.