Dog bite, broken skin?
July 8, 2022 6:47 PM   Subscribe

How worried do I need to be about this dog bite?

Over the 4th of July weekend I was hiking in a state park and encountered some people with a really reactive dog that lunged and bit me on the leg. I was super freaked out and scared and the dog's owners seemed very unconcerned. I basically hiked in the other direction quickly until I calmed down and took a look at my leg (I'm really pissed at myself for this, I know I should have stopped and gotten info from the owners). The bite was over my leggings, which were pretty thick and didn't tear them or even leave a mark. When I first looked at my leg I didn't think any skin was broken. Later when I was able to look more closely there was 1 small area where the very top layer of skin was broken, it was super shallow. I would barely even call it a scrape and was not anywhere near deep enough to bleed.  That area now has a little  bit of a scab (and a spectacular bruise)

I didn't even think about being concerned about rabies until today when a friend brought it up. Is this something I should be worried about?  What counts as broken skin? If you asked me if the skin was broken, I would say no, but can be really anxious about this kind of stuff and am freaking out a bit right now.

I can call my doctors office in the morning,  if needed. I tried going to urgent care earlier today where they were spectacularly unhelpful and basically wanted to give me antibiotics and a tetanus shot.  I had a tetanus shot a few years ago and I'm not at all concerned about infection.
posted by Sabby to Health & Fitness (15 answers total)
 
Best answer: Call your doctor's office because that will reduce your anxiety and we aren't your doctor, but if you didn't bleed I seriously doubt that there was enough of an epidermis break to be worried about. And I say that as a person who got rabies prophylaxis after a stray cat bite (that required stitches) even though the urgent care doc literally rolled his eyes when I said I wanted it. So I get the anxiety.
posted by cooker girl at 7:20 PM on July 8, 2022 [6 favorites]


Given that it was a pet dog out with its owners and not a stray AND it didn’t break your skin, I think your risk is really low. But if it would make you feel better, maybe get the shots? I’m an anxious type about this kind of thing and I think I might ask for it just in case.
posted by nouvelle-personne at 8:01 PM on July 8, 2022 [2 favorites]


It doesn't sound like the skin broke open so much from the dog if your leggings are ok.

FWIW, my vet said rabies shots aren't always covered by insurance and can cost 10,000 to 12,000$. US specific of course
posted by aetg at 8:29 PM on July 8, 2022


Best answer: I had a very similar situation and get anxious in similar ways. I went to urgent care because I couldn't figure out from the internet if it counted as broken enough. The doc said as long as I could get the paperwork I should make sure, and in my case I was lucky that ended up being possible. If it hadn't I think I'd have asked for the shots, his thinking basically being that rabies PEP works and rabies is a bad way to go. (It can be extremely expensive, though.) You might read through the Michigan rabies exposure assessment flowchart and see if that helps you feel more confident in a decision either way.

Your profile says you're in the Detroit area. Maybe you were out of town and obviously a random hiker can be from anywhere, but google says the last known rabid dog in Michigan was in 2021 and the one before that was in 2011. As of a couple weeks ago there've been 18 rabid animals found in the entire state this year, all of them bats. Of the US human rabies cases tracked by the CDC 2009-2019, 8 were from dogs and zero of those dog exposures happened in the US.

I, random internet stranger, am not worried about you, but I'm sorry this happened and I totally understand why you're concerned because I was freaking out. My read based on what you've said is that it's worth your peace of mind to ask your doctor, and I might actually try and talk to the health department since they almost surely deal with rabies more.
posted by jameaterblues at 8:34 PM on July 8, 2022 [2 favorites]


Of course you wanted to get away from a dog that was biting and not controlled. Please don't feel bad about your absolutely understandable and self-protective actions. I'd call your doctor to get actual medical advice. As a dog owner, I would always be concerned about my dog attacking someone, and I'm so sorry this happened to you. I'd make sure you report it to the park staff, as well.
posted by theora55 at 8:49 PM on July 8, 2022 [3 favorites]


Call your doctor's office. But, in that situation, if I couldn't get the dog's certificate, I'd be getting the shots. I know they're unpleasant but I think it'd be just as unpleasant for my anxious brain waiting out the weeks for SIGNS OF A TERRIBLE AND INEVITABLE DOOM, you know?
posted by praemunire at 9:07 PM on July 8, 2022 [1 favorite]


I’d call your doctor’s office to connect with their after-hours help line - I’m assuming you’re in the US. A number of insurance policies also now offer a free teledoc/triage video-call service, including the BCBSes and Kaiser.

If you can’t reach anyone on the medical side first, check your local rabies contact info here: some states have 24/7 rabies numbers, and the people there are probably as boss as the poison-control folks (I called for the first time a few weeks ago, and was so impressed!). At a minimum, they will have lots of experience around rabies risks in your area and good next steps. When you can talk to your provider in the morning, it will be easier to move forward with their advice.

If it would make you feel any better: I once woke up in rural Ethiopia because a rat had chewed through my tightly-tucked bed net and was biting down HARD on my thumb. I yelled like hell and flailed and the rat took off . I called the emergency med service my org provided access to in the field, and after an hour or two they had found that there were no shots available *in the country* that would be available to me, and that the closest place for treatment, South Africa, would be at least two days to med-evac me to (too late to start shots). They also let me know that they’d spoken to a research center at some university, and that there had been no reported cases of rabies in this district in a number of years. 7, maybe? Anyhow, did I want to be medevaced, given all that info? I asked my driver if he’d ever heard of anyone getting bit by a dog or other angry animal and the person going wild and dying - he hadn’t. I figured that I would need to be medevaced if I wound up getting sick anyways, so I took some deep breaths and kept working - and nothing happened. Ethiopia is wonderful, and the US is far from perfect, but we have a MUCH more robust public-health and veterinary structure here, and I am confident that it is diminishingly likely that a pet dog would be able to get rabies here.
posted by rrrrrrrrrt at 9:53 PM on July 8, 2022 [3 favorites]


More CDC advice!

“ If you’ve been in contact with any wildlife or unfamiliar animals, particularly if you’ve been bitten or scratched, you should talk with a healthcare or public health professional to determine your risk for rabies or other illnesses. Wash any wounds immediately with soap and water and then plan to see a healthcare provider. (It’s important to know that, unlike most other animals that carry rabies, many types of bats have very small teeth which may leave marks that disappear quickly. If you are unsure, seek medical advice to be safe.)

Remember that rabies is a medical urgency but not an emergency. Decisions should not be delayed.

See your doctor for attention for any trauma due to an animal attack before considering the need for rabies vaccination. After any wounds have been addressed, your doctor – possibly in consultation with your state or local health department – will help you decide if you need treatment known as rabies postexposure prophylaxis (PEP). Decisions to start PEP will be based on your type of exposure, the animal you were exposed to, whether the animal is available for testing, and laboratory and surveillance information for the geographic area where the exposure occurred.

In the United States, PEP consists of a regimen of one dose of immune globulin and four doses of rabies vaccine over a 14-day period. Rabies immune globulin and the first dose of rabies vaccine should be given by your health care provider as soon as possible after exposure. Current vaccines are relatively painless and are given in your arm like a flu or tetanus vaccine; rabies vaccines are not given in the stomach.”
posted by rrrrrrrrrt at 9:55 PM on July 8, 2022 [1 favorite]


“ While rabies is rare in people in the United States, with only 1 to 3 cases reported annually, about 60,000 Americans get post-exposure prophylaxis (PEP) each year to prevent rabies infection after being bitten or scratched by an infected or suspected infected animal.

Because of laws requiring dogs to be vaccinated for rabies in the United States, dogs make up only about 1% of rabid animals reported each year in this country.”
posted by rrrrrrrrrt at 9:59 PM on July 8, 2022


“Sixty-three rabid dogs were reported in 2018, representing a 1.6% increase from the 62 reported in 2017. Most of the rabid dogs were reported from Texas (15), Puerto Rico (13), Georgia (7), Pennsylvania (5), Colorado (4), North Carolina (3), and Virginia (3). However, the percentage of dogs tested for rabies that were positive (0.3%) did not change compared to the mean percentage for the previous 5 years.

Not sure how the CDC is getting 0.3% here, but my takeaway is that very few dogs get reported, and *of those*, almost none have rabies.
posted by rrrrrrrrrt at 10:01 PM on July 8, 2022


Best answer: I’ve had rabies shots (which were supplied free by public health in Canada) due to messing with raccoon saliva on my dog with a fairly good cut on my thumb.

From that experience and the article I wrote after, I think it’s very unlikely that you would need shots. First, the dog was almost certainly vaccinated and even if the owners delayed (which I had with mine, we were 6 weeks late which is why I took him to the vet right after the raccoon bit him, and the vet had me get shots!), rabies shots actually are effective for much longer than a year. Second, if the owners were unconcerned by the behaviour it’s unlikely the dog was rabid and shedding virus. Third, saliva would have had to get through your legging and your scratch doesn’t sound deep enough. Fourth, rabies from dogs is just vanishingly rare in North America.

You could call public health and it might help you feel reassured, but I think your doctor probably is correct.
posted by warriorqueen at 3:40 AM on July 9, 2022 [5 favorites]


Best answer: Hello! I went through this myself very recently. I have info now from both online sources (hopefully relatively good ones, I think), and multiple actual medical doctors in more than one country.

To start: it can be a tough situation. On one hand, the chance of getting rabies from a dog in the U.S. is extremely, extremely low. The prophylaxis/vaccine is extremely reliable, as long as you get it before you start showing symptoms.

On the other hand, there's no way to test if you have it before you show symptoms, and after you show symptoms, it's too late--there are only a couple of documented survivors among cases that reached that point.

If you feel worried--I would validate your worry, because that's a difficult set of factors to decide between.

The difference between me and you: my dog encounter was in another country, so the risk was higher for me than it is for you.

There hasn't been a case of rabies from dogs in the U.S. in...years. As I'm rechecking, the last one was in 1979? Deaths from rabies in the U.S. happen maybe once a year or so, typically from wild animal bites. But a common pattern in news stories about these: the deceased person refused the treatment and vaccine.

A bit about my experience (without going into too much identifiable detail): I saw a medical doctor in the region where the incident happened. I was told the bite/scratch didn't look particularly concerning, overall I seemed fine, and I was given some standard advice in case any bacterial infection might show later. I asked about rabies--the country in question is one where rabies is still officially found in dogs--and was told the vaccine/treatment wasn't available at this clinic, or in the area I was staying.

Six days later, I'm home. I contact my travel medicine doctor for a second opinion. I was told to get prophylaxis as soon as possible.

Rabies prophylaxis is not common in the U.S. anymore--not every clinic or emergency room has it in stock. I was told to go to one of a couple of emergency departments in my large-ish metro area that do have it on hand.

There are two parts to the treatment: the immunoglobulin prophylaxis and the vaccine. You get both. The immunoglobulin dose is calculated based on body weight. The amount you need to get will be more than the volume of a standard injection--I got four. The first one they inject with a series of mini-injections around the site of the bite. The other ones they keep sticking into you until you run out of arms and legs. They're not particularly painful beyond a regular injection--but it does turn into a lot of sticks. I was joking with the nurses that I could drink a glass of water and have it squirt out all the holes, like in an old cartoon.

(The old belly shot hasn't been done in many years--that was the one that was so painful.)

Then at that same visit, the last injection is the first dose of the actual vaccine. The full vaccine program is not complete at that point. You return (probably not to the actual emergency department) according to a set schedule for the rest of the series, on days 3, 7, and 14. Immunocompromised people may get an extra vaccine dose on day 28.

So....how soon do you have to do this? How much time do you have? You should, of course talk to your own medical professional. Mine said that if rabies is present, symptoms typically show between 20 and 60 days. If symptoms show, you're beyond treatment. The person above who said that seeking advice and/or treatment is "urgent but not emergency" was correct--your first encounter shouldn't be delayed, but it can be with a regular clinic (noting that if you do get recommended for treatment, you might have to get it at the emergency department).

The only way to test for rabies is through an autopsy--that's not an option.

Your doctor may or may not recommend prophylaxis. If they do, and you live in the U.S., you will also have to consider the insurance considerations, sadly. Full retail for rabies treatment can be criminally expensive. If you have some manner of getting insurance pre-approval, take advantage of that. In any case, be prepared for battle. Be prepared to use the exact phrase "rabies post-exposure prophylaxis" to describe your treatment. Be prepared to make multiple phone calls to explain things to people, but also give as little info as needed, and emphasize that at every step you were only following the documented direction of a medical provider.

Specifically, if you are referred to an emergency room, you may fall into a gap where the insurance company tries to deny you coverage because you supposedly went to an emergency room for non-emergency treatment. I fought this successfully, but it took multiple communications to both the provider and the insurance company to get the situation resolved. At one point, I was threatened with a bill for $19,000. This is not the worst-case scenario: there are a few reports from my state of uninsured persons being billed as much as $47,000 in recent years for the same treatment.

(Anecdote: at one point, a person on the phone asked me "Did the other driver have insurance?" I replied in a fairly firm but somewhat sarcastic voice "The other driver was a DOG.")

Wrapping this up on a couple of positive notes: at the end, my out of pocket payment was about $300 or so. It did take a fight, but it was a winnable fight.

And, it's not super common to get the prophylaxis, but a few tens of thousands of people in the U.S. do get it in a year, and what they all have in common is that they're still alive and fine with no harm done. It really is one of the victories of modern science.

Anyway, good luck. It's tough to think about, but the odds are very much in your favor.
posted by gimonca at 6:58 AM on July 9, 2022 [4 favorites]


Response by poster: I've been advised by my doctor I don't need a vaccine. They basically said what warriorqueen and cooker girl said - that the skin wasn't considered broken, so I marked those as best answer. Thanks for all the advice and information, I'm definitely much better armed in case this ever happens again.
posted by Sabby at 8:45 AM on July 9, 2022 [2 favorites]


Just dropping in additional info as someone who had a medium serious bite a few years ago—rabies was not considered a big enough risk for me to get prophylactic shots, even though the bite was hard enough that I needed several stitches. BUT I was immediately put on antibiotics and the doctor said that with dog bites, they just assume it's gonna get infected without intervention. Despite the conventional wisdom that dog mouths are cleaner than human mouths, they're pretty filthy! So while I agree with everyone that you don't need to worry about rabies specifically, I still think there's an argument for medical attention for minor bites generally. (A bite that didn't really break the skin... I dunno, probably not? But maybe?)
posted by babelfish at 7:06 PM on July 11, 2022


Response by poster: I have an update. When I talked to the doctor's office, I talked to a nurse who took the info to the doctor and then they called me back and said "Since the bite did not break the skin, vaccination is not needed." I couldn't let go of the fact that I didn't feel that they had listened to what I said about the top of the skin being broken. I was having huge anxiety attacks and not sleeping, I kept thinking that the kind of people that take such a reactive dog into a park on a busy weekend are also the kind of people that wouldn't keep up to date on shots. So I called the health department like jameaterblues suggested, thinking they would tell me I was over reacting and that there was no concern. Instead they told me this situation was an edge case that there wasn't much data on, and that they would recommend vaccination.

So, I got my first round of shots last night. It wasn't terrible, I got 4 shots total, only one of the ones by the bite site really hurt, the others were pretty minor. My health department has a clinic where I can do the rest of the shots. I'm armed with the insurance info that gimonca provided and ready to fight my insurance company on this if needed. And I feel so much better!

Going forward I'm making it my mission to make sure everyone I know is informed that if they happen to get bit, they need to get the vaccination status of the dog so they don't have to worry about this. Thanks again for all the info and advice.
posted by Sabby at 7:30 AM on July 13, 2022 [2 favorites]


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