Wednesday, September 10, 2008

Exposing Myself

Before I start, I’d just like to point out that I do take rabies very seriously. I’m a little cavalier about some zoonotic diseases (i.e., diseases that can be transmitted from animals to humans) because the diseases just aren’t that serious, they’re hard to transmit, or they’re fairly easy to get rid of if you do get them. Chlamydophila psittaci (psittacosis) is a good example. Last Fall we probably had about three raptors that were shedding Chlamydophila come in every week. The approved protocol for handling suspect birds involves isolation gowns, gloves, and a mask, but sometimes we wouldn’t suspect Chlamydophila until the bloodwork came back, and we didn’t gown up for every wild bird that came in. I know I’ve been exposed to it many times, and I’ve never gotten ill. If you do get ill (cyclic fevers are the most common symptom), doxycycline will cure you.

Rabies, on the other hand, is a virus that is uniformly fatal if not treated. Worse yet, if you wait until the symptoms appear, it’s fatal despite treatment. There is exactly one reported case of a person recovering from a rabies infection after symptoms appeared. That’s it.
All students entering vet school are required to be vaccinated against rabies, and at least two of my classmates ended up having severe enough reactions to the vaccine that they were hospitalized. This happens every year and the school still requires the vaccine because the disease is so serious.

However, (and this is the important part) rabies requires direct contact for transmission, generally from saliva in a bite wound.

The following is a good example of how it just doesn’t pay to be helpful.

The exotics ward received a call from the main reception area that there was a dead bat on the walkway coming into the hospital. First off, the receptionists knew it was dead, so I’m not exactly sure why they were calling us instead of, say, doing whatever they did for dead squirrels and birds and the like. In any case, they called us, so one of the technicians put on latex gloves, went outside, carefully picked up the stiff-as-a-board Mexican Hoary Bat, placed it in a bag, and then came back inside and placed it on the counter in the treatment area. During this entire time I was in the office, which is about twenty feet away.

Rabies is relatively common in bats in this area, so even though we didn’t have any evidence that suggested that any person or animal had handled the bat, I decided that the responsible thing to do was to send the bat off for rabies testing. There are probably over a hundred dogs that walk on that walkway every day, and I was worried that someone would call later to let us know that their dog had been playing with a dead bat that day.

So… I filled out a pathology report to have the bat tested, and because the reports require a doctor’s signature, I signed it. Now my name was associated with it. On the report I was fairly specific: “Bat found dead on walkway to VMTH. No known exposure to humans or animals. Please rule out rabies.”

For those of you that haven’t been paying attention, I never came closer than twenty feet to this bat. I certainly was never bitten by it.

Two days later it started.

The administrative assistant in the pathology department called me to tell me that the bat had come back positive for rabies. I told her what I’d written on the form – there definitely wasn’t any exposure to anyone after it was found, but I couldn’t promise that something hadn’t gotten to it earlier.

Silly me, I thought that was the end of it.

The next day the county health officer called. I again explained the circumstances. No exposure, blah blah blah. I added that I’d never even seen the bat. After repeating this a few times the health officer seemed satisfied. Now, I thought, I’ve really heard the last of it.

Ten minutes later somebody from employee health services called so that I could set up an appointment to have my rabies titers checked. I reminded her that I’d had my titers checked at employee health services not six months before, and besides, I hadn’t been exposed. The health services employee said that there was some irregularity with the way the testing company had handled that batch of samples. She got a little snippy when I asked if they were calling all of the other people who’d had titers checked at that time. Then I spent a few minutes trying to get her to admit that there was no point in rechecking my titers since I hadn’t been exposed. Finally, she said “I’ll just write on the form that you declined to have your titers checked” and hung up.

I got three more calls over the next two days.

As far as I know, no member of the public every called to report an earlier exposure, and the county didn’t publicize the finding of a rabies positive bat near the hospital.

The next time I see a dead bat, I’m throwing it in the garbage.


jeff said...

Now I understand the reason for this blog: you can show off all that learnin' and educashun.

Chlamydophila psittaci (psittacosis)? Is that ROT13?

One of the cool things about this blog is you are capturing that coveted veteranarian/software developer mindshare. I've got to think that's a huge market...

Did the bat people contact you, asking if you wanted to build a bat shelter on the roof?

Theresa B (of Nebulopathy) said...

Huge, huge market. I'm guesting on Oprah next week.

No bat people have contacted me. They may have noticed the hole in my roof and decided not to even try.

Or, as Ax said: "You have rabies! That's hot!"

Eric said...

If you start drooling how will we know it's rabies and not just because you've come back to programming?

I'm gonna call my county health officer.

Theresa B (of Nebulopathy) said...

Good question. Both diseases are progressive. I think you'll have to look for secondary signs of carpal tunnel syndrome.

rvan said...

A blog post entitled "Exposing Myself" and nothing personal is actually exposed. That's as predictable from Theresa as me bringing up the black Toyota Corolla she test drove that had steering alignment problems.