Rabies (or fortunately, no rabies)
On Saturday afternoon in Las Cruces, I was sitting outside the RV with Rumple, when I heard a horrendous scream. It sounded as if someone were being physically attacked. Being the good Samaritan that I am, I immediately headed for the sound, and discovered a woman in the dog park screaming that her 3 dogs had been attacked by someone else’s dogs. By the time I got there, there were a number of people milling around outside the dog park, and the two sets of dogs were separated. However, the woman was quite hysterical.
I decided to step in and try to calm her down. I offered to walk her back to her RV while she prepared to take the injured dog to the vet.
Unfortunately, one of her other dogs had been very agitated by the events, and nipped at my loose pant legs. He got a bit of me in the process. I did not think much about it until I got back to the RV and noticed that although it was a tiny scratch, it was oozing blood.
The woman, who was still agitated and not taking care of the dog at all, assured me that her dogs were well-taken care of and vaccinated, so I just disinfected the scratch and carried on with my day. However, I wanted proof of vaccination, which she kept promising to get, but did not produce. Each time I talked with her she got more hostile. 3 days later, her boyfriend admitted that the dogs were NOT vaccinated.
As we were leaving for Tucson, I decided the most appropriate thing to do was to get my rabies booster when we got to our next destination, Tucson. (I only need a 2 shot booster because in 2012, while I was in Delhi, India, I was bitten by a street dog and got the entire series of shots. That was a much more serious incident, because India is having a rabies epidemic, and most cases in humans originate from dog bites.)
I took a risk in waiting, because rabies is essentially always fatal once you have the symptoms. However, I recollected from my first set of shots that the instructions said “within 10 days” and I thought I had 10 days to proceed. It turns out that this was not the smartest thing I could have done, because the symptoms can actually emerge in 5 days, although that is rare. Once you are symptomatic, it is time to write a will and say your goodbyes. On the other hand, given all the wrong information I got from Las Cruces animal control and even the ER doctors, I am glad that I waited, because I got to talk to the Tucson epidemiologist, Mike Callahan, who is very knowledgeable.
The bottom line is that infected animals are not contagious until they display symptoms, and then the animal generally dies within 10 days. Rabies is extremely rare in house dogs, even if unvaccinated. The dog in question was a permanent resident of the RV park, and hence essentially an indoor dog, and quite unlikely to have been exposed. Standard procedure after a domestic dog bite is to quarantine the animal in a facility where they can be observed, and begin rabies vaccination of the human only if symptoms occur in the dog.
I decided that I would be best off just having the shots, rather than getting involved with this woman. Actually, I think I was getting more afraid of her and her boyfriend than I was of getting rabies. However, it then turned out that the Urgent Care facility where I planned to get the shots would not administer the booster without documentation that I had been previously vaccinated. With the Thanksgiving holiday, I figured it would take a few days, and in the end I decided that I would wait until the day after Thanksgiving (7 days after the bite) and if I did not get the documentation, I would call animal control in Las Cruces. By then I figured that if the dog were still healthy, it would only need to be quarantined for a couple of days and the owners would not be so upset. And if it were healthy, I would not need the shots.
However, by Friday I still had not got the documentation from the hospital at UNC (where I had my follow-up after returning from India) and so I decided to follow through with the Las Cruces Animal Control. (The documentation arrive on Monday.)
It is not at all clear how to contact Animal Control in Las Cruces, because, unlike Tucson, they do not seem to have their own number. After several tries, I ended up calling “Central Dispatch” which had Animal Control call me. The Animal control officer told me that if the dog had rabies, I would probably have symptoms already and would be dead within 10 days. (I later confirmed with Mike that this was unlikely – the incubation period can be quite long, which is why animals shipped to Britain need to be in quarantine for 6 months.) According to the internet, typical periods in humans are 20-60 days, but can be as short as 5 days.) The girl who was the first to survive rabies had symptoms after 2 weeks.
In any case, the Animal Control officer went out to the RV park to check the dog. I called the RV park to let them know that she was coming. The office assured me that there were no unvaccinated animals in the park. However, in 10 months of RVing, no-one has ever asked to see our dog’s vaccination records and this was also true at La Hacienda. Many parks ask the breed of the dog, as they often do not allow breeds with a history of aggression. Many parks limit the number of dogs per RV to 2 (although even those will usually allow 3 if the dogs are small). In this place, at least one RV had 8 (yes, 8) small dogs. But vaccination records? Never.
In any case, an hour later the agent called to tell me that the dog was alive and well. So I decided to wait for the end of quarantine. 3 hours later, she called back to say that she was not able to observe the dog. For the initial visit the owner was not home, and she had just looked through a window. When she met the owners later in the day, they told her they had “rehomed” the dog outside of Las Cruces. The agent was really annoyed both with me and with the owners, but not as annoyed as I was. I suspect that either she left a note stating that she was coming to quarantine the dog, or the office let them know.
In any case, with no documentation of my previous shots, and no dog under observation, it was clearly time to go get shots. For the full immunization you have to go to the ER for the first set of shots, because both an active and passive vaccine are administered. The active vaccine (which already has active antibodies) is available only at the hospital.
Imagine my surprise when I got to triage. There were two admitting doctors. The first told me that if the dog were infectious, I would already be having symptoms (and she seemed quite unconcerned about that). She also said that in the US there are so few rabies cases in domestic dogs that all I needed to do was to check with the owner after 10 days to see if the dog is still alive. (This even after I had told her what happened with Animal Control, and also noting that the whole point of the quarantine is so that the shots could be administered immediately if the dog had symptoms.) The other doctor told me that, although they would take my word for it that I had the shots, shots given 5 years ago were no longer effective and I needed the entire series. However, because I had spoken with Mr. Mike, I was pretty sure I only needed the booster, so he then went to the CDC webpage. The recommendation is that once you have had either prophylactic or post-exposure vaccination, only the 2 booster shots are required.
After that I was passed on to “FastTrack” where, 3 hours later (not so fast) I finally got my first shot, along with a tetanus shot. I then had to wait around for another hour to make sure I did not have an allergic reaction to the shots. However, I was happy to have got started on the shots, and that I would get the second shot while still in Tucson. I got that on Monday at an Urgent Care Center.
So, what did I learn from all this?
1) Even if the owner says the dog is vaccinated, you need to see documentation.
2) If the documentation is not forth-coming in a day, call Animal Control and let them know when you think the owner will be home.
3) If the owner does not appear to be concerned with the fact that you got bitten, don’t be “nice” – just call Animal Control.
4) The risks in the US with a dog that is essentially an indoor dog (at RV parks dogs do not run loose) is small, but not zero. The last case of a domestic dog with rabies in Tucson was 2009 – I am not sure about Las Cruces.
5) An infectious animal dies within 10 days, so in a low risk scenario you can wait for confirmation, as long as the animal can be observed during that time and you can live with your level of risk.
What I learned previously, is that rabies virus does not travel through the blood stream, but actually moves along the nerves. So a bite to the extremities will become symptomatic more slowly than a bite to the head, and a bite that penetrates to the muscle is more dangerous than a superficial wound. I had a superficial wound close to my ankle. Still, I did not behave wisely, given the lack of co-operation from the owners and the fact that once you are symptomatic, it is too late to get treatment. On the other hand, the risk was probably less than what I sustain every time I get on my bike to go to PSU. Anyways, I will declare myself rabies-free in 60 days.