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Could I have acquired rabies from this squirrel?
October 23, 2011 6:05 PM   Subscribe

Is it possible that I could become the first ever documented case of squirrel-to-human rabies transmission? Yesterday at about 11AM Eastern time I was bitten in both thumbs by a half-paralyzed squirrel.

Circumstantial evidence (the squirrel was on a median strip) led me to believe that it had been struck by a car and lost the use of its back legs, either due to spinal cord injury or massive trauma to the legs. There was no visible blood, nor was the squirrel foaming at the mouth. As I approached it it lay completely still until I actually picked it up, at which point it vigorously defended itself with the upper half of its body. Later on animal control was alerted, but failed to find the squirrel where I had left it on the grass between the road and sidewalk, and when I drove back along the same route late in the afternoon I did not see it either.

The ER doctor informed me that squirrels "do not" transmit rabies to humans, and sent me home with an antibiotics prescription. I have since been enlightened that paralysis of the rear legs is a symptom of rabies in various animals. I am aware that doctors often fail to distinguish the unproven from the disproven, and it seems that squirrel-human rabies transmission is solidly in the former category.

My reasoning is that if everyone bitten by a squirrel were to receive the rabies vaccine, then squirrel-human rabies transmission would never be proven. If rabid squirrels are rare, then less thorough use of the vaccine could still obscure cases of squirrel-human rabies transmission. And I found a journal online documenting that at least some people have received the vaccine for squirrel bites.

I would prefer not to achieve fame as the first ever documented case of squirrel-to-human rabies transmission. According to Wikipedia/Sherris Medical Microbiology, "treatment after exposure, known as post-exposure prophylaxis (PEP), is highly successful in preventing the disease if administered promptly, in general within ten days of infection." So I have 9 days to make a case to myself and the medical profession that I should receive a rabies vaccination. Or maybe 2 years!--"The period between infection and the first flu-like symptoms is normally two to twelve weeks, but can be as long as two years. " (Wikipedia/Robbins and Cotran Pathologic Basis of Disease)

The CDC says "Small rodents (such as squirrels, rats, mice, hamsters, guinea pigs, gerbils, and chipmunks, ) and lagomorphs (such as rabbits and hares) are almost never found to be infected with rabies and have not been known to cause rabies among humans in the United States. Bites by these animals are usually not considered a risk of rabies unless the animal was sick or behaving in any unusual manner and rabies is widespread in your area."

Somebody on this thread http://www.thesquirrelboard.com/forums/showthread.php?t=11220 was told "I should watch for flu symptoms over the next month to indicate I got rabies but otherwise don't worry", which sounds like useless advice since PEP is apparently not effective after symptoms emerge.

I am unable to find a description of signs and symptoms of rabies in a squirrel, presumably because of the rarity of identifying a squirrel as rabid: "only 4 rabid squirrels have been reported since 2000, despite a mean of 1,232 squirrels tested each year." (Rabies surveillance in the United States during 2009, Jesse D. Blanton, MPH; Dustyn Palmer, BA; Charles E. Rupprecht, VMD, PhD, Journal of the American Veterinary Medical Association September 15, 2010, Vol. 237, No. 6, Pages 646-657)

Based on descriptions of other animals' behavior when rabid, and/or your knowledge of neurology, could this squirrel have been rabid? I am prone to anxiety, and I would rather not spend the next 2 years worrying that every fever is prodromal rabies.
posted by r0w to Health & Fitness (36 answers total)
 
I've been told that rabies shots hurt like hell, but if you are truly as concerned as you seem from your post, I don't see a reason (except financially speaking) not to get one. The next time you get the flu, are you literally going to believe you are dying from an incurable disease?
posted by DeltaZ113 at 6:17 PM on October 23, 2011 [2 favorites]


FWIW, here's a reference to at least one prior squirrel-to-human rabies transmission, so you would not be making history, even if it is apparently extremely rare.

If I were in your shoes, I'd definitely want some additional professional opinions beyond the ER doctor you happened to see. I'm thinking a local (large) vet hospital, your poison control center, and certainly your GP if you have one (and ideally his or her referral to an infectious disease or other related specialist).

Hope you're able to get the answers and/or treatment that will give you some peace of mind!
posted by argonauta at 6:24 PM on October 23, 2011


It is highly unlikely that you have been infected but it the shots are available to you and will reduce your anxiety then I'd say go for it. I actually know two people who have had the shots in the past two years: they were given in a series over a few weeks and are no longer very painful, just inconvenient, if you have to get off work or whatever. Either get the shots if you can't banish it from your mind or banish it from your mind. Props to you for trying to help.
posted by Morrigan at 6:33 PM on October 23, 2011


argonauta: that is NOT a prior squirrel-to-human rabies transmission, since the victim was treated with rabies vaccine and did not develop the disease. Presumably (the story doesn't say) the squirrel in that case was captured and tested.

rOw: No one here is going to be able to tell you for sure this squirrel was not rabid. However. This is all a matter of probabilities, and as you have already found out, no one — not one person ever — has been known to catch rabies from a squirrel. That alone puts the odds highly against you being infected. Add to this: only 27 people have been infected with rabies in the US since 1990 — only 1 or 2 per year. Plus, as you've found, it is extremely rare in small rodents (much more common in cats and dogs). So the odds are extremely low you're in danger. But they're not zero.

For what it is worth, the old painful, three-week series of painful stomach injections for rabies have been replaced with a much less painful vaccine given in the arm.
posted by beagle at 6:37 PM on October 23, 2011


I think it's tremendously unlikely that your squirrel was rabid. However, please note that rabies is 100% fatal -- all of six people are known to have survived after the initial onset of symptoms. And half of them suffered brain damage. You cannot simply wait for "flu symptoms over the next month" and then do something about it: by then it would be too late. There is an experimental treatment involving artificial coma, but I don't think "wait a month and see if you'd be better off in a coma" is real useful advice.

If you decide you want treatment, you need five rabies shots -- two different shots now, plus additional doses of the vaccine on the 3rd, 7th, and 14th days. As a bonus, this will make treatment for future exposures much easier (people who've previously been vaccinated only need two shots).

Again, you probably weren't exposed to rabies, but given the consequences if you were, I think I'd consider treatment. At the very least, you might want to get a second opinion as soon as possible, preferably from a specialist.
posted by vorfeed at 6:42 PM on October 23, 2011 [1 favorite]


beagle, quite right. Thanks for the correction.
posted by argonauta at 6:45 PM on October 23, 2011


They are not painful anymore.

It's not like we all have been bitten by a squirrel this year and we can all say "Hey look at me I didn't get rabies!" It's really rare to be bitten by a squirrel. (My mom taught me not to touch dead things.) Because this is a rather unique situation we can't really base any answers on lots of data at our disposal. So just get the shots. You will be sent away but insist. You only get one life. Stand up for yourself.

The fact that you can come down with rabies years later is why I would get the shots. Who needs that anxiety??

And never, ever touch a dead thing again. And teach your kids not to.
posted by cda at 6:47 PM on October 23, 2011 [1 favorite]


It's possible. Get the shots. It's the difference between being wrong and being dead.
posted by ellF at 6:58 PM on October 23, 2011 [1 favorite]


I was bitten by a squirrel 20-something years ago when I was 8 years old. The doctor wasn't concerned about rabies and hey look at me, I didn't get rabies.

That being said, were I in your shoes now I would seek the treatment.

See also: this episode of This American Life.
posted by ellenaim at 6:58 PM on October 23, 2011


Five or six years ago, one of my old coworkers received the rabies vaccine after randomly being bitten by a squirrel. (It ran up to her to snatch food from her hand) We all still joke about how ridiculous the situation was, but it's much better to be safe than sorry.
posted by jenny76 at 7:04 PM on October 23, 2011


I am not a veterinarian nor a neurologist but I am prone to anxiety and feel pretty damn sure that I'd be demanding the shots, just in case.
posted by bonobothegreat at 7:30 PM on October 23, 2011


I just had a rabies scare (bat in the house), and you need to talk to the infectious disease specialists at your state department of public health. Or, have your doctor do so. They can help you make a risk assessment. Your county health department should have information on rabies prevalence in your area.
posted by Eyebrows McGee at 7:31 PM on October 23, 2011 [2 favorites]


I had a series of rabies shots earlier this year. Basic jabs in the shoulder, not painful.
posted by TWinbrook8 at 7:32 PM on October 23, 2011


Clearly the risk is tiny, but it is not zero. I would be very surprised if my health insurance (AEtna) would cover the rabies vaccine for a squirrel bite. But maybe the DOH would. The cost for the shots is over $10K. That would be a rather steep price tag for treatment of a single anxiety. Obviously it's a judgment call, which is why I'm soliciting opinions as well as any shred of factual information that could inform my judgment call.

I would like to get a sense of whether the squirrel's behavior was inconsistent with rabies, totally typical of rabies, or indeterminate. Next time I help an injured animal, I will use a stick or a floormat from the car.

I live in the District of Columbia. Not sure how competent the DC Dept of Health is. I know that the Dept of Mental Health sucks, as do many city agencies. They do provide data on rabies prevalence in DC:

http://hrla.doh.dc.gov/hrla/cwp/view,a,1384,q,574122.asp

3 rabid pandas in the 1980s! It's not clear to me if we're a "high rabies prevalence" location from the raccoon numbers.

Okay, this makes the DOH sound competent:
http://www.washingtoncitypaper.com/blogs/citydesk/2010/03/22/d-c-health-department-seeks-man-who-carried-around-rabid-raccoon/

Anyway, I will ask my doctor about my options first.
posted by r0w at 8:00 PM on October 23, 2011


I will add to the anecdata-- one of my friends was nipped on the hand by a squirrel last year while trying to handfeed a random one in a park (she loves/d squirrels) and she did indeed get the rabies shots series.
posted by tangaroo at 8:05 PM on October 23, 2011


ellenaim writes "I was bitten by a squirrel 20-something years ago when I was 8 years old. The doctor wasn't concerned about rabies and hey look at me, I didn't get rabies."

Not to comment on the possibility of getting rabies from a squirrel but there is a 100% selection bias at work here; users who contracted rabies 20 years ago won't be posting to web sites.
posted by Mitheral at 8:22 PM on October 23, 2011 [6 favorites]


Rabies takes 10-86 days to run its course in small animals like squirrels. Florida has had 5 confirmed rabies cases in squirrels in the last 30 years (but they rarely test animals for rabies unless there is cause for concern). One was a flying squirrel that was dead when tested. of the other 4, half showed typical signs of rabies for *ONE* day, while the other half showed no outward signs out all before they died.

I'm sorry, I realize that isn't very helpful. We really have no way of telling by outward signs was or was not rabid.

As for your insurance, as of 9/30/11:

"Aetna considers rabies immune globulin medically necessary for treatment of rabies exposure where the animal has escaped or is known to be rabid at the time of direct exposure or attack*.

Aetna considers rabies immune globulin experimental and investigational for other indications because of insufficient evidence of its safety and effectiveness."

So, again, no human case of rabies from a squirrel bite has ever been reported, and the odds are against it--but I doubt that many people get bitten by apparently-paralyzed squirrels they have picked up off the road, either. You will either have to gamble and keep your money (possibly risking your life) or pay out the nose for those shots.
posted by misha at 8:36 PM on October 23, 2011


My brother got bitten by a bat a year or two ago. It flew away. The doctors gave him a rabies shot. FWIW.
posted by kjell at 8:38 PM on October 23, 2011


Any mammal can carry rabies. Your own research bears out the fact that squirrels can get rabies. The fact that there are no recorded cases of squirrel-to-human rabies transmission is just a statistical quirk.

Any mammal can carry rabies, and transmit it through a bite. That is how rabies works. Your own research also demonstrates that the squirrel's aggressive behavior and partial paralysis is consistent with rabies.

This is not an issue of you being anxious. This is literally the textbook scenario for when you get a rabies shot. The fact that the ER doctor didn't get you the shot is shocking, frankly.

Find another doctor.

Get the shot.

Do it first thing Monday. Time is of the essence.
posted by ErikaB at 9:11 PM on October 23, 2011 [3 favorites]


kjell and ErikaB, rabies transmission from bats is a real concern. Rabies transmission from squirrels is practically unheard of.

And by the way, you are supposed to get some of the initial rabies PEP in the location where you were bitten. There is not a lot of room for injections in your finger. So yes, that one is painful.

I'm an ER doc. I wouldn't give rabies vaccine to someone bitten by a squirrel, because that is not the standard of care. People who have received the rabies vaccine after squirrel bites were not receiving it based on any evidence that squirrel bites should be covered for rabies. As you point out, it's not a cheap series of shots. Everyone wants the cost of healthcare to be controlled, but no one wants the cost controls to apply to them. We don't treat people based on what could happen to one in a million or fewer people, we treat people based on what is reasonable given the odds of contracting a serious illness - believe me, our standards are pretty low, if you're even known to be in the same room as a bat without any confirmed bite, you can get the vaccine. Think about it, squirrels are nasty little critters. They bite people all the time who are foolishly trying to feed them or hold them for a photo op or something. If there were rabies being transmitted, we'd be hearing about it. This is a litigious society, if people were at all likely to get rabies from squirrel bites, we'd be treating it with PEP. But when you find an injured squirrel on the highway, there are other more likely reasons for it to be acting injured than that it has rabies.

You can go to any travel medicine clinic and get the rabies vaccine if you're willing to pay cash for an expensive vaccine. It's not the same as getting the PEP series, but you can get it any time you want it, and if you're the kind of person who will lie awake at night about something like this, you might want it.
posted by treehorn+bunny at 9:14 PM on October 23, 2011 [5 favorites]


From eMedicine's "Rabies" article:

"Bat (avian) rabies appears to be widespread in the 49 continental states, and since 1980, most endemic rabies cases in humans in the United States have been associated with bat strains.[4]

Terrestrial rabies in the United States is most common in raccoons on the eastern coast and in skunks, foxes, coyotes, and dogs on the Texas-Mexico border. Canine rabies and bat rabies are significant problems in Mexico and around the world. (Opossums are rarely infected and are not considered a likely risk for exposure).

The only rodent in the United States that can carry rabies long enough to transmit to humans is the groundhog. Other small rodents (eg, squirrels, chipmunks, rats, mice) and lagomorphs (eg, rabbits, hares) usually die before being able to transmit rabies virus to humans, and human disease has never been transmitted by these mammals."
posted by treehorn+bunny at 9:17 PM on October 23, 2011 [1 favorite]


Clearly the risk is tiny, but it is not zero.

Are you trying to do a rational assessment or an emotional one? Because if you're doing a risk assessment you need to take into account that you're more likely to be killed in a car accident driving to the doctor for your shots than to get rabies from a squirrel.
posted by Justinian at 3:13 AM on October 24, 2011 [1 favorite]


This is not an issue of you being anxious. This is literally the textbook scenario for when you get a rabies shot. The fact that the ER doctor didn't get you the shot is shocking, frankly. [...] Find another doctor. [...] Get the shot. [...] Do it first thing Monday. Time is of the essence.

This is bad information and fear mongering.
posted by Justinian at 3:16 AM on October 24, 2011


The cost for the shots is over $10K.

Contact a tropical medicine doctor in the EU country of your choice. Rabies shots will cost at most a few hundred euro. Even with the cost of plane tickets and accomodation you'll spend a lot less than $10,000.
posted by roolya_boolya at 3:19 AM on October 24, 2011


This is bad information and fear mongering.

We have no conclusive information as to whether this squirrel had rabies. However, it was a mammal bite from an animal that was exhibiting symptoms consistent with an animal who had contracted rabies; while it is statistically unlikely to have been rabid, the chance that it in fact was is non-zero.

Since rabies is fatal in nearly all cases, we're comparing a non-zero chance of rabies-related death vs. a zero chance of rabies-related death. Other factors (whether animal exposure in general is more likely to be lethal than staying inside, whether driving to the doctor could result in an auto accident, etc.) are not within the scope of the question. At least, I don't think they are, upon re-reading it.

Were there an actual factual error here -- i.e., if someone were able to say, "squirrels cannot transmit rabies, here's why" -- the responses would be different. Otherwise, the debate is properly framed in terms of treatment vs. risk. That's not "bad information", even if you might be less risk-adverse.
posted by ellF at 6:11 AM on October 24, 2011


I'd make an appointment with your main doctor, not an ER doc, and tell them you were bitten by an animal you suspect was rabid. Either you'll get a second opinion confirming what the ER doctor says, which will be a comfort to you, or you'll get the rabies shots, which would also be a comfort to you.

In re: pain and expense. My stepbrother, his friend, and I had rabies shots when we were young after feeding a pony that went rabid shortly after. No bites on any of us, so the chances of transmission were exceedingly low, but it was covered by insurance. I don't know for sure but I *strongly suspect* the shots did not cost 10,000 if insurance paid under those circumstances. Also, they didn't hurt any more than a vaccination, and are not, as movies would claim, in the stomach. Two in the ass and one in the arm, then a few more in the arm over the few weeks following.
posted by tchemgrrl at 6:14 AM on October 24, 2011


Why do you think the squirrel was rabid? It sounds like it was paralyzed due to an injury. And it defended itself because it thought you were a predator as animals are wont to do.

I can understand your anxiety though. On my 18th birthday I was bitten by a tiny dog while jogging. It wasn't a big deal to me because it wasn't a wild dog until my doctor and animal control started putting all these thoughts into my head. An animal control person even walked around my neighborhood for two days in a row trying to find the dog and its owner (I didn't get her info at the time). They weren't found, and I would occasionally check online for any reported rabies cases. Eventually I got over the anxiety, and stopped thinking about it.
posted by yodangson at 7:01 AM on October 24, 2011


Your city, county and/or state has a public health office. it's their job to know about rabies; call them. Good luck.
posted by theora55 at 7:24 AM on October 24, 2011


What theora55 said - the squirrel's location and behavior is very consistent with being hit by a car, the likelihood of it having rabies is extremely small, but contact your local public health department, they will have someone who is specifically in charge of rabies-related issues, they will tell you what to do. If the main number doesn't help, contact animal control or a local vet, they will know who you need to talk to at public health (I work at a vet clinic and we regularly receive calls from, and make calls to, the "rabies guy" at the health department). Here rabies is handled is at the county level.
posted by biscotti at 8:00 AM on October 24, 2011


Just to add another perspective, you should remember that the vaccine itself has risks. You could have an allergic reaction to it, or get a serious infection at the injection site, for example. (Or as Justinian mentions, you could be in a car crash on the way to get the shot.) Of course the chance of any of these things happening is vanishingly small, but then again so is the chance of getting rabies from a squirrel bite in the first place.
posted by TedW at 8:00 AM on October 24, 2011 [1 favorite]


How about checking the rabies stats for neighboring counties & calling up their DOHs? As a former DC resident, I can sympathize with the challenges of DC administration. Fairfax or Montgomery County might be more able to give a clearer rabies picture as they are a blend of city & slightly more rural (and larger on the whole).

More data points are better.
posted by countrymod at 8:11 AM on October 24, 2011 [1 favorite]


Ugh, this is when I hate healthcare in the U.S. I got bitten by a puppy (very recently adopted, former stray) in India. Cost of five (painless, by the way) rabies shots: less the $100.

I'm going on memory here, but IIRC I did not get the gamma-globulin shot (the most expensive part of the series) because the puppy was not considered a *likely* rabies candidate, and also because of the nature of the bite. Check out the WHO guidelines--unless you were bleeding, rabies vaccination is recommended but no immunoglobin.

If I were you, I would call next NOT the hospital but the Animal Control in your area to speak to them of your concerns. In many counties they will administer rabies shots.

Also, I understand intellectually where the, "He got hit by a car! Don't worry about it!" crowd is coming from. But...as I said, I got nipped by a pet puppy who had the slimmest chance in the world of rabies. But since that chance was there -- since his origins were unknown, and he hadn't been with his owners longer than ten days -- I ultimately decided I couldn't take the very slim risk. After all, that .0001% chance of contracting rabies? If it occurred, there was no question of the ultimate outcome. Rabies never ends well.
posted by artemisia at 9:08 AM on October 24, 2011


P.S. I should add here that there's a vigorous debate about the efficacy of skipping the immunoglobulin and using a timed schedule of 5 vaccinations instead. Studies have shown that the results are not 100% on the side of survival. Had I not felt pretty confident the puppy was healthy, I think I would have gone all over north India in search of some immunoglobulin.
posted by artemisia at 9:13 AM on October 24, 2011


Can you go back and see if the squirrel is still there? If it was that injured, it may have died right there, or close by. Then you could take it to be tested for rabies.
posted by Vaike at 12:17 PM on October 24, 2011


Other factors (whether animal exposure in general is more likely to be lethal than staying inside, whether driving to the doctor could result in an auto accident, etc.) are not within the scope of the question. At least, I don't think they are, upon re-reading it.

I disagree; you'd have to use the most pedantic and literal reading of the question to believe otherwise. If the question were simply "can a squirrel carry rabies" full stop the question could be exactly that long. One sentence. No context. The entire point of the context for the question is that the OP wants help evaluating level of risk and cost. The level of risk involved in not getting vaccinated vs getting vaccinated is at the heart of the question.

Saying that it was shocking the ER doc didn't administer the vaccine, that "time was of the essence" and that this is a textbook case for administration of the vaccine is obviously wrong information; heck there was an ER doc in this very thread stating that it isn't the standard of case in a case like this. That's the definition of wrong. Saying something is standard when it is not standard.

The fact is that costs must be weighed against benefits. The vaccine has very real costs. Perhaps the OP in conjunction with his doctor will decide the costs outweigh the benefits in terms of anxiety. But that's a decision to be made with the advice of a doctor not by ignoring the advice of a doctor, which is what a lot of this thread is suggesting. By all means the OP should get a second opinion from his or her own personal physician. But that is getting another opinion not walking in and demanding the shots.
posted by Justinian at 1:25 PM on October 24, 2011 [2 favorites]


Thanks, Misha, for penetrating the AEtna website and retrieving the relevant nugget of info:

"Aetna considers rabies immune globulin medically necessary for treatment of rabies exposure where the animal has escaped or is known to be rabid at the time of direct exposure or attack."

So, actually, I'm covered--the animal escaped and was not able to be tested.

Thank you also for finding the information that most squirrels who die of rabies don't act noticeably rabid beforehand.

Artemisia, oh, I was bleeding all right. All over my hands, onto my socks, on the car door, on the gearshift. The skin was broken in at least 5 places, although I think one of them was a scratch from a claw. One tooth went right through my thumbnail. The worst wound was pulsing gently with each heartbeat.

I did call animal control, in order to see if they had found the squirrel. They are supposed to be following up with me "soon". We shall see if that includes any medical advice. In DC animal control is contracted out to the local Humane Society.

Justinian and TedW, besides the simple risk of death, there's also the risk of the horrific pain and suffering of dying of rabies. Being hit by a car would usually not be nearly as bad of a way to die.

While it does seem likely that the squirrel's injuries were due to being hit by a car, there is also the possibility that rabies-related paralysis made it unable to run out of the path of the car.

Another consideration is alleviating my husband's anxiety as well as my own.

I will now email my doctor.
posted by r0w at 10:22 PM on October 25, 2011


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