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Rabies – Coming Your Way? by Dr. Cynthia J. Koelker

Rabies – a legitimate concern or fear-mongering? 
As I watch my pet Golden Retriever “Doodles” cautiously sniff at the curb sewer, I believe the threat is real.  A family of raccoons lives in the sewer pipes, and just a few months ago a local dog died of raccoon rabies.  Could my children be next?

Ohio is on the frontier of raccoon rabies, but despite yearly aerial and ground baiting programs for oral rabies vaccination, the uniformly lethal infection is moving westward.  Bat rabies, the other common threat, is distributed more evenly across the United States.  (If you’re wondering about your own state, check out the maps at Rabid Raccoons Reported in the United States during 2010 [1] and Rabid Bats Reported in the United States during 2010 [2]

Odds are you’re unaware of anyone who’s died of rabies. That might not be the case if you live in India.  In the U.S., human rabies is so rare that every case is investigated by the CDC [3] (only 2–4 per year). In India, annual deaths top 20,000, with someone dying of rabies every 30 minutes. (Read this article [4].) This is largely due to under-vaccination of the dog population.  Per the World Health Organization, 15 million people worldwide are treated with post-exposure vaccination, which is estimated to prevent 327,000 rabies deaths annually.

So what would happen in America if the vaccine became unavailable and the population of stray dogs exploded? This could well occur in a true end-of-life-as-we-know-it scenario.  Though our population density is not that of India, clearly the number of cases would skyrocket. 

The next logical question is: what can be done about it?  Avoiding contact with bats, raccoons, wild canines, skunks, and suspicious dogs is obviously indicated.  Even pacifists may be motivated to acquire a gun and the knowledge to use one safely.  Clearly you should vaccinate pets and other domestic animals now

But what about pre-exposure vaccination in humans?  This is already recommended for veterinary students, spelunkers, and travelers to endemic regions where dog contact is likely.  In 2009 a Virginia physician diagnosed his own subsequently fatal case of rabies a few months after returning from India – and without suspicious animal exposure! His agonizing end is detailed at the CDC web site [5]

If you ask your family doctor whether you should be vaccinated against rabies in case of widespread disaster, the answer will likely be no.  At a cost of up to $800 for the series of three shots, your insurance is unlikely to cover immunizations without a clear indication. However, if you visit a travel clinic, perhaps at your local health department, you may be able to obtain the vaccine, especially if you fall into one of the high risk categories mentioned above.  The low-risk state of Indiana has a nice summary regarding vaccination on their web site [6]. Your own state should offer something similar, or read the CDC’s guidelines on Human Rabies Prevention [7].

If you do desire vaccination, how long is immunity expected to last?  Unfortunately only a few years.  Current recommendations for those at high-risk include blood testing for effective immunity every 2-3 years, followed by re-vaccination if titers are low. (Pets simply receive repeat vaccination.)

I have also investigated the question of using canine rabies vaccination on humans.  This has not been tested and likely never will be.  I expect the likelihood of allergic reaction might be increased.  However, per the doctors I consulted, they felt canine rabies vaccine has a good chance of effectiveness in humans.  If I were bitten by a bat or suspicious raccoon, skunk, or dog, and the only thing I had available was animal vaccine, I would certainly use it.  Curiously, some states, including Ohio, allow purchase of veterinary rabies vaccine by non-medical personnel, although most states limit sale to veterinarians only. The same dose is used for dogs of all sizes, with twice as much administered to horses.

So where does this leave us?  As a family physician, stockpiling human rabies vaccine is cost-prohibitive.  On the other hand, at $20/dose, stockpiling dog rabies vaccine is a consideration, both for professionals and laymen.  Vaccines do require refrigeration and commonly list a shelf-life of only a year or two, but having something on hand may be preferable to having nothing.  

While I cannot offer a one-size-fits-all answer on this topic, rabies vaccination is a valid question for serious preppers.

Dr. Koelker is the SurvivalBlog’s Medical Editor and hosts the popular medical prepping site ArmageddonMedicine.net [8].