tag:blogger.com,1999:blog-3492197469143963742.post2889473702206434189..comments2023-06-13T04:45:22.434-04:00Comments on Infection Landscapes: RabiesMichael Walshhttp://www.blogger.com/profile/05038031388622939797noreply@blogger.comBlogger60125tag:blogger.com,1999:blog-3492197469143963742.post-34639433753982849202016-03-09T23:52:11.912-05:002016-03-09T23:52:11.912-05:00Rabies seems difficult to deal with from both pote...Rabies seems difficult to deal with from both potential prevention/mitigation angles. On the vector side, it seems unlikely that we will be able to cull or vaccinate the urban wildlife population, much less the peri-urban or sylvan one. Rangers have been trying to hunt down the raccoons of central park for decades with basically no success, and they continue to bite people (as the article link with really strange photos below attests).<br /><br />On the vaccination side, I've been unable to get a clear answer on exactly why the cost of PEP is so high (around $3,000 for the series, according to the CDC). It must partially be because of the combination of the multiple shots necessary with the relatively infrequency of the need for them. Since the CDC does estimate the cost of rabies infections in the United States alone at at least $245 million per year, it would seem potentially cost effective to figure out some better production/distribution method for both the pre and post exposure vaccinations. I eargerly await the advent of the 3D medication printer.<br /><br /><br />http://www.nydailynews.com/new-york/brooklyn-singer-attacked-central-park-raccoons-article-1.1415408<br />http://www.cdc.gov/rabies/location/usa/cost.htmlMax Mecklenburghttps://www.blogger.com/profile/18413082131755339117noreply@blogger.comtag:blogger.com,1999:blog-3492197469143963742.post-12075012736473271862016-02-27T13:25:13.517-05:002016-02-27T13:25:13.517-05:00I found it interesting that even though the rabies...I found it interesting that even though the rabies virus is an enveloped virus -- which tend to be disrupted by drying and must remain wet -- could be passed via inhaled, dried saliva particles. I think this fact reiterates how dangerous the disease is, especially in the developing world (where resources can be limited for treating patients once they are infected with the virus).Anonymoushttps://www.blogger.com/profile/13872756155519670878noreply@blogger.comtag:blogger.com,1999:blog-3492197469143963742.post-83053458046345686102016-02-11T08:14:20.687-05:002016-02-11T08:14:20.687-05:00Thank you for sharing these two experiences Alexan...Thank you for sharing these two experiences Alexandr, you brought up some interesting points. Growing up in the suburbs of Ohio we are taught to steer clear from raccoons, skunks and possums because they probably have rabies. These critters would scavenge around the neighborhood at night and commonly come onto porches. It did not occur to me until now that our pet cats (unlike NYC apartment pet cats) are indoor/outdoor and also roam around exploring at various times of day and night which put them at risk of coming in contact with wild animals and getting into brawls. We could have been welcoming rabies into our homes via our cute pets. I am glad you brought up the perception of what an infected animal would look like. If you are familiar with the old movie “Cujo” then I believe that would be the portrait of what many people could associate an infected animal with. I agree that we should inform people of the seriousness of seeking medical attention. I also believe we should educate people of the cycle of a rabies infection, what the common and not so common host could be, what cues to be aware of in an infected creature or ourselves. Someone had mentioned in an earlier post about educating young ones in schools as kids are curious likely to approach animals, I think that is a good start. Carolyn Marie Kochhttps://www.blogger.com/profile/00433281016560472480noreply@blogger.comtag:blogger.com,1999:blog-3492197469143963742.post-25480511023269934542016-01-28T11:45:26.826-05:002016-01-28T11:45:26.826-05:00Thanks for posting that link. It was a great resou...Thanks for posting that link. It was a great resource to find out more information, especially more local information. I didn't know that they used the animal's brain tissue to test it for rabies. I'm sure if NYC has known cases of rabies then it is accessible. I wonder how RPEP is similar to PEP because PEP is very available and used for stuff like needle pricks at hospitals or labs and as HIV medication. This post got me googling places to get vaccines and I came across this booklet (http://www.nyc.gov/html/doh/downloads/pdf/chi/chi29-suppl1.pdf) and it seems like most of the raccoons are located in staten island.<br />Anonymoushttps://www.blogger.com/profile/14802623229871266801noreply@blogger.comtag:blogger.com,1999:blog-3492197469143963742.post-68462220706294738322016-01-28T10:12:45.561-05:002016-01-28T10:12:45.561-05:00
I would postulate that the reason stray dogs are ...<br />I would postulate that the reason stray dogs are said to be of the highest concern is because dogs are more of an aggressive animals than cats. A stray dog would more likely interact closely (perhaps even aggressively) with a passing human, say if it was hungry, than a cat would.<br />As far as making it part of the mandated vaccination schedule I agree with David that it would not be economical. Additionally, I believe that heard immunity is practically impossible to achieve in the case of rabies and that is something we try to achieve with vaccinations.<br />Anonymoushttps://www.blogger.com/profile/16674259297324970989noreply@blogger.comtag:blogger.com,1999:blog-3492197469143963742.post-3013664758873601132016-01-22T00:49:24.480-05:002016-01-22T00:49:24.480-05:00This was really informative and interesting! I did...This was really informative and interesting! I didn't realize that many people still die from rabies.... also scary to know that animals with rabies are living in NYC. Awhile back I read somewhere that scientists are actually using this virus to help fight against HIV infection. I'm not sure if they made any progress in developing actual medication. It was interesting to read that they use PEP to treat rabies, since it is also used as HIV medication.Anonymoushttps://www.blogger.com/profile/14802623229871266801noreply@blogger.comtag:blogger.com,1999:blog-3492197469143963742.post-57242404502899039362015-12-05T17:25:41.478-05:002015-12-05T17:25:41.478-05:00he thought that rabies could be transmitted in the...he thought that rabies could be transmitted in the air is terrifying, no matter how exceedingly rare it might be. It is no surprise however that NYC raccoons have rabies because you have to be mad to live in this city! The wild raccoon population in New York is large all over the five boroughs especially in areas where there are parks that provide cover, shelter and other wild animals to eat. The problems is, is where there are large parks, there are usually a lot of people to come into contact with as well. This magnifies the possibility of an encounter with a rabid animal. Additionally, since rabid racoons are not on a top list of threats for most New Yorkers, a lack of awareness might lead to complacency in dealing with them. Racoons are known for going through trash for food and living in basements and garages. When a human is near, they become very confrontational and will attack. I have seen one attempt to bite through a steel trap. More awareness must be given to New Yorkers about rabid raccoons on two fronts. First, the physical bite from a raccoon is sufficient to cause significant injury especially to small children. Compound that with the resulting disease burden and you have insult to the injury. Rabies is not an isolated disease relegated to the developing world or rural areas.Anonymoushttps://www.blogger.com/profile/12618329636845777067noreply@blogger.comtag:blogger.com,1999:blog-3492197469143963742.post-4445609320359258092015-12-05T17:24:05.187-05:002015-12-05T17:24:05.187-05:00The thought that rabies could be transmitted in th...The thought that rabies could be transmitted in the air is terrifying, no matter how exceedingly rare it might be. It is no surprise however that NYC raccoons have rabies because you have to be mad to live in this city! The wild raccoon population in New York is large all over the five boroughs especially in areas where there are parks that provide cover, shelter and other wild animals to eat. The problems is, is where there are large parks, there are usually a lot of people to come into contact with as well. This magnifies the possibility of an encounter with a rabid animal. Additionally, since rabid racoons are not on a top list of threats for most New Yorkers, a lack of awareness might lead to complacency in dealing with them. Racoons are known for going through trash for food and living in basements and garages. When a human is near, they become very confrontational and will attack. I have seen one attempt to bite through a steel trap. More awareness must be given to New Yorkers about rabid raccoons on two fronts. First, the physical bite from a raccoon is sufficient to cause significant injury especially to small children. Compound that with the resulting disease burden and you have insult to the injury. Rabies is not an isolated disease relegated to the developing world or rural areas.Anonymoushttps://www.blogger.com/profile/12618329636845777067noreply@blogger.comtag:blogger.com,1999:blog-3492197469143963742.post-75064735755893340462015-11-20T18:28:54.062-05:002015-11-20T18:28:54.062-05:00Manhattan definitely suffers from a raccoon proble...Manhattan definitely suffers from a raccoon problem. Walk anywhere along Central Park after sundown, and you will definitely run into some. I've seen many, and I had to sneakily run by so as not get away without drawing attention. When I was in undergrad, there was a rabies infected one on campus, and a student was bit by it. In the small microcosm of the school, it was easy to get animal prevention on campus to get rid of the one rabid raccoon. However, in a large city with a large raccoon population, I can imagine that it would be a lot more difficult to find and capture the rabid animal.Anonymoushttps://www.blogger.com/profile/14455301455977148925noreply@blogger.comtag:blogger.com,1999:blog-3492197469143963742.post-28783472538855152782015-11-13T16:09:09.164-05:002015-11-13T16:09:09.164-05:00I did not know that the name "rabies" co...I did not know that the name "rabies" comes from the Latin word for madness. I also hadn't known that if no vaccine is administered, rabies almost always results in death. Furthermore, I was surprised to read that Manhattan has a large raccoon population and that many have tested positive for rabies. NBhttps://www.blogger.com/profile/07062917683379409807noreply@blogger.comtag:blogger.com,1999:blog-3492197469143963742.post-79591356564024291482015-11-06T16:27:11.171-05:002015-11-06T16:27:11.171-05:00Thank you for sharing your experiences Alexandr, t...Thank you for sharing your experiences Alexandr, they really highlight how dangerous misconceptions of this disease can be. Growing up, whenever the topic of "rabies" would come up, it was always associated with angry, wild, or belligerent behavior. However, as this article underlines, rabies is much more common that we think. While vaccination of animals is a good public health strategy, I think more needs to be done on the community education side in both developed and developing countries. For example, I had an idea that the raccoons that roamed around Queens Village were rabid, but I didn't know that "wild" behavior was not a required sign of infection. Furthermore, in developing countries where contact with stray animals is more commonplace, community education should be done, starting from elementary school levels, so that a simple an action as petting a stray animal won't lead to serious illness or death. Anonymoushttps://www.blogger.com/profile/01217677113061116551noreply@blogger.comtag:blogger.com,1999:blog-3492197469143963742.post-63015350133452171972015-10-23T10:55:06.816-04:002015-10-23T10:55:06.816-04:00
After reading your comment, I decided to read mo...<br /> After reading your comment, I decided to read more about post-exposure prophylaxis and how it depends on the type of contact with the confirmed or suspect rabid animal. According to the WHO guidelines, these types of contact include: touching or feeding of animals, licks on intact skin, nibbling of uncovered skin, minor scratches, single or multiple transdermal bites or scratches and contamination of mucous membrane with saliva, among others. Given the multiple types of contact that can result in exposure to rabies, it is important for people to have some knowledge of the cause and effects of rabies, especially if they have contact with animals on a daily basis. As mentioned in the post, rabies can be controlled in the canine population if 70% of dogs are vaccinated using inactivated virus vaccine, which if most people aided in this, it could definitely be possible. Sadly this is not the case, especially in countries or areas at high risk of rabies (i.e. large population of free stray dogs). However, campaigns such as the World Rabies Day promoted by the American Veterinary Medical Foundation can go a long way when creating awareness of the importance of understanding that rabies is a public health issue that can be prevented. <br /><br />Works Cited: http://www.who.int/ith/vaccines/rabies/en/<br />Anonymoushttps://www.blogger.com/profile/10812728419197385223noreply@blogger.comtag:blogger.com,1999:blog-3492197469143963742.post-52255410249767126192015-10-17T01:55:11.167-04:002015-10-17T01:55:11.167-04:00It is informative and interesting to know that rab...It is informative and interesting to know that rabies is an infection for which immunization can be administered after the exposure due to the duration it takes virus particles to reach the CNS and begin pathogenesis. Discussed in the entry is the importance to administer post exposure prophylaxis soon after the exposure because the incubation period can be a few days. The duration of the incubation period is determined by the number of virons that enters the infected person and the introduction site. I learned that bites on the hands, face, neck, and head have shorter distance for virions to travel before reaching the CNS. As mentioned in other post, it is unfortunate that PEP is expensive and scarce in areas of the world in which rabies is endemic; this makes it difficult to prevent infection.CassandraDhttps://www.blogger.com/profile/11409445804775833571noreply@blogger.comtag:blogger.com,1999:blog-3492197469143963742.post-65948875539744214212015-10-10T16:12:19.603-04:002015-10-10T16:12:19.603-04:00Hi Sayed,
I can completely relate to your accounts...Hi Sayed,<br />I can completely relate to your accounts from Bangladesh as I go back every few years. Although there arent as many stray dogs in urban cities, they are definitely plentiful in rural villages, such as the one my grandparents live in. Everytime we would begin eating, a pack of dogs would show up waiting for us to toss them some scraps (the dining room was essentially outside). <br />Here in the United States, we often dont realize the severity of acquiring the rabies virus, especially because of how available vaccines are here. As the article mentioned, if left untreated, an individual infected with rabies will surely die. It is a sad reality that Post Exposure Prophylaxis are scarce or unavailable in regions such as South Asia and Africa, where rabies is endemic. This is a similar situation to regions in Africa where Ebola is endemic, but the means to serologically identify the virus/disease are not available. <br />I wonder if passive immunity measures are cheaper, and perhaps effective without PEP. In any case, it is nice to see countries such as Bangladesh making efforts to warn the public about a very deadly disease.Anonymoushttps://www.blogger.com/profile/15141449400602467756noreply@blogger.comtag:blogger.com,1999:blog-3492197469143963742.post-68201790784365900242015-10-02T11:31:34.115-04:002015-10-02T11:31:34.115-04:00Very interesting article about a disease that I th...Very interesting article about a disease that I think more people should know about. At least in terms of the animals that can transmit the disease...I think most people are still under the impression that rabies is transmitted only through stray dogs, because of media and culture. Compared to other countries, there are fewer stray dogs in the U.S.. However, there are plenty of other transmission routes that are actually pretty common, such as bats (in basements or attics), raccoons, and skunks. Since we went over vaccines in class this week, I wonder what is in the rabies vaccine, and how it is made...Anonymoushttps://www.blogger.com/profile/00094818324874815633noreply@blogger.comtag:blogger.com,1999:blog-3492197469143963742.post-58360536522876488092015-09-24T00:47:22.348-04:002015-09-24T00:47:22.348-04:00https://www.health.ny.gov/diseases/communicable/zo...https://www.health.ny.gov/diseases/communicable/zoonoses/rabies/<br /><br />Above is a link to how to capture a bat in case it bit you or your pet to test it for rabies. I don't know how rabies treatment availability is in NYC but it fluctuates according to the CDC site.<br />Coming from a country with the endemic problem of stray dogs and constant worry of getting rabies, immunization availability was a constant concern especially with the old abdominal shots for 23 days...Anonymoushttps://www.blogger.com/profile/01959289654941672974noreply@blogger.comtag:blogger.com,1999:blog-3492197469143963742.post-74581812571844271902015-09-18T13:27:48.821-04:002015-09-18T13:27:48.821-04:00Rabies: the infamous term but when compared to oth...Rabies: the infamous term but when compared to other infectious diseases, the common public is mostly unaware of the true nature of this disease because of its rarity. Similar to general understanding, I have heard of the disease with the common association of dog bites; however, this post provided a great overview of the type of disease, transmission, symptoms, prevention, and treatment methods. As one of the very few infections where effective immunization can be administered after the exposure, this presents great opportunities for effective intervention methods. Although rabies is noted as uncommon, it is interesting to note that this disease has been documented up to 4,000 years ago (that’s a really long time!). In 2015, the New York Times published an article that identified a recent study on rabies, which is now believed to kill 59,000 people a year, or about 160 a day. Learning these statistics seems to show that rabies is definitely a disease that should not go overlooked despite the low prevalence in the US. When I went to visit my family this past summer in Haiti, stray dogs were as common as pigeons in New York City! With the high number of stray animals that were in close encounters with the general population, it provided insight as to why Haiti previously had high incidence rates of rabies when compared to other Caribbean countries. Thankfully with improved control efforts and national vaccination of dogs the number of cases have decreased. With cholera still being a main concern in Haiti, many people did not mention the high risk of rabies. <br />Despite the lack of attention I believe that rabies has familiarity with today's society because it was used as inspiration for the zombie genre of television and film. I have watched countless zombie movies such as Dawn of the Dead, 28 Days Later, and as a Walking Dead fan, I am susceptible to associate the transmission methods and some of the symptoms (i.e. fever, muscle spasms, rage, violence) to what is portrayed in entertainment. <br /><br />After reading this post, I think I will remove off my bucket list doing another excursion such as exploring a bat cave while traveling...<br /><br />Ref:<br />http://www.nytimes.com/2015/04/21/health/rabies-deaths-higher-than-previously-thought.html?_r=0<br />http://crudem.org/rabies-in-haiti/<br />Anonymoushttps://www.blogger.com/profile/14532091147791908279noreply@blogger.comtag:blogger.com,1999:blog-3492197469143963742.post-79178048348072314032015-09-09T11:24:12.877-04:002015-09-09T11:24:12.877-04:00Regarding your comment, Difaa, on transmission of ...Regarding your comment, Difaa, on transmission of rabies via bats, it's important to recognize that it is both aeresolized rabies virus as well as an unnoticed bite that could be the source of exposure. I can never forget the story of a coworkers daughter that was sleeping in a dorm room that overlooks a park in NYC; it was also inhabited by a few bats that had gone unnoticed for a week or so. Upon discovering them, the advice from the ID docs was that she should receive the post-exposure prophylaxis as there was a chance of having been bitten while they were sleeping. Creepy!<br />Again, being aware of this is critical to prevent such a devastating disease. I am not sure if it is common knowledge, and I agree that access to the internet allows everyone access to information that would previously have been unavailable to the general public. Anonymoushttps://www.blogger.com/profile/06851929241182903843noreply@blogger.comtag:blogger.com,1999:blog-3492197469143963742.post-58429720286400747842015-09-04T10:29:42.451-04:002015-09-04T10:29:42.451-04:00Rabies is always on our minds in the ER when seein...Rabies is always on our minds in the ER when seeing children with dog bites, which unfortunately, is very common. This article was able to put this issue into perspective for me. There are plenty of racoons running around that could be a reservoir in our NY communities! First, it's critical to know that canine vaccines are only effective for three years; not sure if dog owners are aware of this and maintain their pets vaccination status, something that I will now inquire about. I had heard about post-exposure prophylaxis for students exposed to bats in dorm-rooms in NYC and thought it far fetched but now appreciate that, while rare, it is possible to have aeresolized infected saliva. In NY, post exposure cards are sent to the DOH when there is a dog bite for the purpose of tracking outbreaks of rabies. This practice came to mind when we were discussing "Passive Reporting" because it is one of the few practices in the ER setting in which we are actively reporting a potential exposure to the DOH. While the prevalence of rabies may be low in the US it is critical to know about it's presenting symptoms- which are vague and nonspecific at first, with a potential for a long latency to pathogenesis- in our global community with international travel it is important to have this disease in mind so that proper treatment can be initiated. While it's never pleasant to treat a child or adult with the post-exposure protocol, clearly the sequelae of not treating is far worse. As with many other diseases, it is unfortunate that where prevalence of this disease is highest, there is very limited availability of vaccine. Prevention of this horrific disease if transmitted with it's high fatality rates is clearly a concern in certain regions, such as India and South Asia, in which more could be done to prevent the 55,000 deaths reported per year. Thankfully, I have never personally seen a rabies infected human, but clearly more resources need to be available for those with a known exposure in highly endemic regions to prevent rabies disease and death. Anonymoushttps://www.blogger.com/profile/06851929241182903843noreply@blogger.comtag:blogger.com,1999:blog-3492197469143963742.post-28888456639997844482015-07-23T07:07:57.692-04:002015-07-23T07:07:57.692-04:00S.Wallace-I think a majority of rabies comes from ...S.Wallace-I think a majority of rabies comes from dogs because of the potential contact rate with humans (excluding more affluent countries such as the United States). In this article it notes that rabies in dogs is particularly found in South and Southeast Asia and Africa. Dogs are typically strays and aren’t considered “pets” and are not treated the way pets are treated in the U.S. for example. I don’t think it’s the makeup of a dog that make them more susceptible to infection since there are a number of others including cats, domestic livestock, and bats that are important sources of rabies infection to humans. I think the fact that dogs are strays in these countries, free roaming, and like any animal (or human being for that matter) whose life is not of good quality, they will be more susceptible to infection. Anonymoushttps://www.blogger.com/profile/09001868693815415856noreply@blogger.comtag:blogger.com,1999:blog-3492197469143963742.post-9851305318494109152015-07-22T21:25:32.431-04:002015-07-22T21:25:32.431-04:00I had never heard of TNR before this blog post. I ...I had never heard of TNR before this blog post. I was somewhat skeptical about it being more effective than simply killing off feral animals. It's interesting though, apparently euthanasia programs actually result in clearing the ecological niche that the feral cat population is inhabiting, and allow for a new population to move in and to explode in size in the community. It winds up being more costly than TNR, which is focused on reproductions. By re-releasing the cats into the wild, they continue to compete for resources in the same habitats, but do not reproduce (or exhibit undesirable reproductive behavior), and thereby more effectively control the feral cat population in communities, apparently. They also apparently are less likely to get diseases, but I couldn't find whether or not that applied to rabies, would be interesting to find out.Anonymoushttps://www.blogger.com/profile/00446188801114332575noreply@blogger.comtag:blogger.com,1999:blog-3492197469143963742.post-56622716398981993082015-07-20T20:07:48.554-04:002015-07-20T20:07:48.554-04:00I wonder if it might not be so much about the biol...I wonder if it might not be so much about the biology of dogs but maybe their social "pack" nature that makes them more susceptible to infecting each other? I know that sometimes dogs play fight, so maybe they can't distinguish playful behavior and aggression, or even overly friendly behavior that might be a result of the rabies virus in infected dogs.Anonymoushttps://www.blogger.com/profile/05756619009978934237noreply@blogger.comtag:blogger.com,1999:blog-3492197469143963742.post-63353877037444024962015-07-17T00:02:07.913-04:002015-07-17T00:02:07.913-04:00I agree with you, David. Granted vaccination might...I agree with you, David. Granted vaccination might be effective, we have only had 5 cases of animal rabies thus far this year within NYC even given the large raccoon population within the 5 boroughs. Those are only cases in animals, so we would only need to vaccinate if we had a reason to believe that human rabies would become a problem. It seems as though bats are the #1 reservoir in NY state as tested by labs (http://www.wadsworth.org/rabies/monthly/May15nmb.pdf), but not within NYC (http://www.nyc.gov/html/doh/downloads/pdf/cd/animal-rabies-2015.pdf). <br /><br />I wonder why the two maps are not consistent with the data presented...is the state not obligated to report on NYC? Are they independent bodies?Anonymoushttps://www.blogger.com/profile/05756619009978934237noreply@blogger.comtag:blogger.com,1999:blog-3492197469143963742.post-38995760896742223702015-07-09T23:01:05.912-04:002015-07-09T23:01:05.912-04:00I thought the same thing, Richard. What is it abo...I thought the same thing, Richard. What is it about the makeup of dogs that allows easier transmission than other animals? Additionally, speaking to your point about not adding it to the immunization schedule- I don't think it would make much sense from an economic perspective since it really is not endemic in the US and in most parts of the world. The mortality rates are still quite low and unlike Measles, mumps or rubella, rabies has never been a dire problem. I believe that there are a number of other vaccines that would take priority.Anonymoushttps://www.blogger.com/profile/16624706820510231248noreply@blogger.comtag:blogger.com,1999:blog-3492197469143963742.post-26870580845394972022015-07-09T19:07:47.691-04:002015-07-09T19:07:47.691-04:00I understand your fear of getting bitten by any wi...I understand your fear of getting bitten by any wild animal. But sometimes you have to understand that we live in the world that is not possible to prevent a lot of things from ever happening to us. The only option you have right now is to avoid getting out during the night while wild animals usually get out of their hiding places and look for their food and are more active. Also you have to stay from the abandoned places where all homeless animals sleep and live. Plus it is not possible to prevent wild animals from entering our private areas because we live in an open area where anything can get to us no matter what we do or try to do to prevent it from biting us. There are always other animals that might gain their entry into our private property only if one of the animal species are controlled by the environmental protective agency. Katarzyna Sulimahttps://www.blogger.com/profile/07636683058715747638noreply@blogger.com