Woman bit by unvaccinated feral-ish cat. Must wait 10 days for vaccine?
April 2, 2014 7:43 AM   Subscribe

John's unvaccinated, fractious outdoor cat, Wretched Beast, bit Janet when she tired to help John capture the cat so it can go to vet. John and Janet live in Westchester County, New York. John took Janet to the emergency room and has paid her subsequent medical expenses. Janet wants the rabies vaccine. The doctor instructs John to quarantine Wretched Beast for ten days. If at the end of the ten days that cat starts acting rabid then the doctor will administer the rabies vaccine. Janet wants the rabies vaccine NOW. Shouldn't the doctor give the rabies vaccine sooner rather than later? Suppose Wretched Beast doesn't show symptoms for a longer period of time?
posted by anonymous to Health & Fitness (11 answers total) 1 user marked this as a favorite
It's unlikely that the cat has rabies. The vaccine is annoying (four shots, over two weeks, somewhat painful, some side effects) enough so that if an animal is subsequently found to NOT have rabies after vaccinations have started, they are discontinued. Your doctor makes a risk assessment based on a few things including rabies incidence in your local area. Ten days is best practice.
posted by jessamyn at 7:51 AM on April 2, 2014 [20 favorites]

Rabies vaccine is a series of vaccines spaced months apart. It's a serious deal. It's not a tetanus shot.

Chances are Wretched Beast is just wretched, and not rabid. I would trust the doctor's advice.
posted by St. Peepsburg at 7:51 AM on April 2, 2014

I've had rabies shots after exposure to a bat. It was Not That Bad. I had two shots in the ER - the first regular shot and the large immunoglobulin shot, which was miles less uncomfortable than I expected. I had the other two shots at my doctor's office. I would say that my reactions to the shots were in line with my usual reactions to shots.

When our cat bit the bat in question (which subsequently escaped and could not be tested) we were told that the cat - which was vaccinated - should be kept in light quarantine (only contact with household) for six months.

This feral cat advocacy group page seems to suggest that feral cats hardly ever harbor rabies and that there is no real history of cat-to-human rabies transmission.

I understand Janet's feelings, though, based on my own experience with the bat.

Perhaps Janet could get a second opinion?
posted by Frowner at 7:59 AM on April 2, 2014 [1 favorite]

In addition to being painful, the post-rabies treatment regimen can be pretty expensive if you aren't covered by health insurance (it's not clear from the OP whether Janet is so covered). One blogger reports spending >$16k for the treatments. Since the cat is in custody, it can be observed.
posted by mr vino at 8:00 AM on April 2, 2014 [2 favorites]

this is the kind of question where non-doctors like myself have no business offering an opinion, and the doctors here are too professionally cautious to say anything, so you'll have to go with the meatspace doctors.
posted by bruce at 8:01 AM on April 2, 2014 [7 favorites]

I add that if Janet does get rabies prophylaxis, having it at your doctor's office and not the ER lowers your costs a lot.

Re the story linked in mr vino's comment - those costs are bizarre and atypical. I'm not sure if that's a regional problem (like, there was a vaccine shortage or they're somewhere weird where they had to helicopter it in) or if it's an insurance-billing thing where patient costs are different, but that's wildly out of line with my experience.

Here is a link from the CDC for programs to pay for vaccine access for uninsured people.

While obviously the decision to vaccinate is not about price, if you do decide to vaccinate, it would be worth talking to both your hospital and a primary care doctor about how best to manage the vaccine.
posted by Frowner at 8:17 AM on April 2, 2014 [1 favorite]

I was bitten by an unvaccinated dog in 2002 and I was given the same medical advice - quarantine the animal and hold back on human vaccination unless symptoms are shown within 10 days. Rabies is a fast-moving virus in animals and it's unlikely that a cat with untreated rabies will fail to show symptoms after a few days or survive for more than 10 days. I did not get the vaccine and neither me nor the dog had rabies.

This is not medical advice, just a personal anecdote. If Janet doesn't agree with the doctor's recommendation has she gotten a second opinion?
posted by muddgirl at 8:29 AM on April 2, 2014

It's worth remembering that the doctor is an actual M.D., qualified to determine when a given course of treatment should be administered. There are best practices for this situation. The doctor is familiar with them. Unless there's something the doctor doesn't know, or you have reason to believe that this doctor is incompetent, I don't see a reason to demand that the doctor not follow best practices and instead do what would make Janet emotionally feel better. That's not how medicine works.
posted by Sara C. at 9:39 AM on April 2, 2014 [9 favorites]

You can get a second opinion from your county (and/or state) health authorities. You can call or e-mail and tell them you have a rabies exposure question. We had a possible rabies exposure (from a bat, when rabies was active in the local bat colony) and spent a great deal of time on the phone with these fine folks. They will be happy to talk with you. Here is what we learned from our own experience, but you should call and consult them yourself:

It is very difficult to get rabies from a bite from an animal that does not visibly have rabies; the virus is not in the saliva until the virus has reached the brain and the animal is actively acting rabid. It is POSSIBLE (but somewhat unusual) for there to be a very short period of 3-5 days when the virus is in the animal's saliva but the animals is not yet showing signs of rabies. That's the reason for the 10-day quarantine. If the cat hasn't dropped dead in five days, you're fine.

And get your damn cat vaccinated. That's incredibly irresponsible. (Also, the animal should be quarantined and observed by a veterinarian.)
posted by Eyebrows McGee at 10:22 AM on April 2, 2014

To be clear: what did the MD mean by quarantine? Literally, in a state sanctioned or licensed facility with proper reporting forms? Or just "don't let it get out again"?

If the former, perhaps a conversation with the staff can ease Jane's mind.
posted by Lesser Shrew at 11:01 AM on April 2, 2014

Last December, I was bit by a wild cat while trying to rescue it (it was injured). I took it to my city animal shelter and they filed a bite report and their vet looked at it. It turns out the cat was too injured to save and it had to be euthanized. :( I was freaking out because I thought I might have contracted rabies, but the folks at the animal shelter said that rabies is VERY rare and that they would send the cat for testing. I then went to urgent care to have the bite looked at. The doctor reaffirmed that rabies is indeed rare and that all I needed to worry about was infection (since he said cats have extremely filthy mouths). I was put on some pretty heavy antibiotics as a preventative measure. If I had not been up on my tetanus vaccination, I would have needed a shot, but I was, so I didn't. About two weeks later, I received a notice from the city that the cat tested negative for rabies and I was in the clear!

Had the cat that bit me survived, the protocol is to wait 10 days to see if the cat would have started to act rabid, then give the vaccination. They don't just give it willy-nilly. Some people can have a bad reaction (side effects) to the vaccine - that's why they don't just give it out if they don't need it.

I can honestly say that for a few days after I was bitten, I was freaking out too. It's funny how we can get so worked up about something. She is probably fine and she needs to occupy her mind with other things.

Message me if she wants more info.
posted by ATX Peanut at 11:18 AM on April 2, 2014

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