Risks & Shortage of Human Rabies Vaccine for University Job

[fileen]

Does anyone know the risks etc associated with the human rabies shot? Also, why is there a world wide shortage? I have to be vaccinated against rabies for work at the large animal surgery at my university and I can't seem to get a hold of the vaccine. I keep being told there is a world wide shortage. I have never had it and I am worried about possible side effects. I can't seem to find anything on the human vaccine, although there's lots about the one for our pets.

 

[mgb_phys]

The shortage seems to be just one plant manufactuing it and they temporarily closed to meet new regs.
see http://www.cdc.gov/RABIES/

 

[JorgeLobo]

True of many prophylactic/therapeutic treatments for relatively rare conditions. It's not financially viable to produce in light of extensive giovernmental controls. some are no doubt needed but many are just bureaucratic BS.

Talk to your vet.

 

[mgb_phys]

It's a particular problem for vaccines.
They are often very expensive to manufacture (especially those using live virus / animal serum).
They are also a bad sale - ideally you only sell one dose/person.

For 'give-them-to-every-baby' type vaccines the legal liability is huge together with the bad press from a one in a million bad reaction. The adverse reaction doesn't even have to exist - see the MMR jab scares.
If you develop a vaccine for a tropical disease you have to almost give it away for free else you are an evil drug company preying on suffering in Africa.

Most pharmaceutical companies have just got out of the vaccine market completely. It's especially ironic when they need to give prophylactic rabies shots to their own researchers working on animal tissue samples.

Sometimes especially university/teaching hospitals will give you vaccination in return for platelet donation or similair.

 

[fileen]

I am signed up for a clinic offered by the university but its going to cost me a LOT of money. Probably more than I will make at work. Unfortunately its not an experience I can pass up. I was just confused why there would be a shortage, I am under the impression that rabies is a real problem in many parts of Asia and South America. I didnt realize that it was only being produced by one company. I hope I don't have a bad reaction to it. I really don't like vaccines in the first place.

 

[Proton Soup]

rabies is a real problem in north america. as recently as a year or two ago, we were dropping food pellets with an oral vaccine for raccoons to find.

 

[mgb_phys]

I hope I don't have a bad reaction to it. I really don't like vaccines in the first place.

Remember the preventative vaccine only gives you more time to get a shot if you are bitten - it DOESN'T stop you getting rabies.
You should probably also get tetanus and whatever multi-strain hepatitis one they give to medics these days.

 

[fileen]

Im up to date on my tetanus, but I haven't had any hepatitis. I am working a vet clinic, and the one I worked at before didnt care, I just had to promise to stay away if something came in that was suspected of carrying rabies, and if I did come in contact I had to agree to go to the hospital immediately. It seems silly to me, as Ill be working exclusively with horses and cattle, and although they can catch it, its extremely rare. Most animals (especially if they are worth enough to warrant paying the university for special surgery) will be up to date on their shots. I will be exclusively working in the surgery, and so I imagine the chances of an animal coming in for surgery and carrying rabies is pretty small. I am under the impression that a person has to have body fluids from an infected animal enter the blood stream. My Doctor thought I was nutts when I told him I needed it. He can't get me the vaccine unless I've been bit by a rabid animal. I think its a pretty serious virus, and those who will be at a higher risk of contracting it should have it available to them. I can't believe the price of it, and I am getting it "cheap".

 

[mgb_phys]

My Doctor thought I was nutts when I told him I needed it. He can't get me the vaccine unless I've been bit by a rabid animal.

Does he understand you want the Pre-exposure vaccine - for people who may be exposed as part of their job?
The danger is if somebody brings in a pet that has been bitten by a possibly wild animal that may have rabies.

It all depends on your employer, a colleague had to have the shots to work with animal dropping samples - in a country that is rabies free!

 

[fileen]

Does he understand you want the Pre-exposure vaccine - for people who may be exposed as part of their job?
The danger is if somebody brings in a pet that has been bitten by a possibly wild animal that may have rabies.

It all depends on your employer, a colleague had to have the shots to work with animal dropping samples - in a country that is rabies free!

Yes he knows I need the pre-exposure vaccine, he knows me quite well and understands I need it for work. He just thought it was pretty crazy for the surgery to require it now when its so hard to get. He can't give out the pre-exposure vaccine, I would have to get it myself and then have it sent to him to administer. Its almost impossible to find right now.

 

[Moonbear]

I wonder if there's really any difference between the vaccine approved for human use and the ones given to other animals. Some days, I think I'd rather have a vet treat me anyway.

Everywhere I've worked, the pre-exposure vaccine was optional, and since I wasn't in states where rabies was common, I would pass on it...the possible side effects sounded too common to justify getting an optional vaccine. Of course, now I work in a state where rabies does exist. I don't work with animals that will have rabies, but there's more likelihood of encountering a rabid raccoon now, and of course, now the vaccine isn't even obtainable.

 

[Ukitake Jyuushirou]

I wonder if there's really any difference between the vaccine approved for human use and the ones given to other animals. Some days, I think I'd rather have a vet treat me anyway.

Everywhere I've worked, the pre-exposure vaccine was optional, and since I wasn't in states where rabies was common, I would pass on it...the possible side effects sounded too common to justify getting an optional vaccine. Of course, now I work in a state where rabies does exist. I don't work with animals that will have rabies, but there's more likelihood of encountering a rabid raccoon now, and of course, now the vaccine isn't even obtainable.

There is a difference between animal and human rabies vaccine. In veterinary medicine the rabies vaccine will sometimes cause the animals to develop vaccine related sarcoma. It has something to do with the adjuvant used in the vaccine that causes a reaction later on in the animal's life. In human medicine however there isn't any such cases (not that I know of).

http://en.wikipedia.org/wiki/Vaccine-associated_sarcoma

My advice would be to get the rabies vaccine, dying of rabies is simply not a pleasant way to die. Just go on youtube.com and search for "boy with rabies" to get a picture of what is it like to suffer from rabies. There is no cure, nothing modern medicine can do for you once the rabies virus gets into your neurones.

I'm going for my rabies vaccine soon as soon as I can find a hospital that has does it cheaply. Its called RABIDPUR vaccine, and it costs like $100 for 1 shot, and I need 3 of those.

http://72.14.235.132/search?q=cache...scrabip.pdf+rabidpur&cd=1&hl=en&ct=clnk&gl=au

 

[Moonbear]

The vaccine is available again for pre-exposure vaccination.
http://www.cdc.gov/rabies/news/RabVaxupdate.html

 

[Monia19]

Well, one risk is the cost! I just received the post exposure shots that were finished with 3 follow-up shots over one month. They made me feel dizzy, nauseaus and gave me a headache but it went away after about 2 days of getting each shot. I feel okay now. I'm pretty upset about the bill though. The ER was the only place that had the post exposure vaccines and they've turned out to be very expensive. They charged over $9,200 for the initial shots and one follow-up shot. I still haven't gotten the bill for the last 2. I live in MI. I don't know how they can get away with charging this much. Most of the cost was for the vaccine itself. I'm now searching around to see what other people are paying. It looks like the going rate is 1- 2.5 thousand dollars.

 

[CindyIL]

Monia19, our family had to go through the whole rabies vaccination (5 of us). We are in total shock over the amount the hospital is charging. We had no choice of where to go as it was the only place available to us. We have not received all of our bills but we do know that the initial shot was $11,000 for my husband and each follow-up shot was around $980. We are searching too for answers as to why it's so high. All I've found so far states a much lower cost, especially for the initial shots. Do you have anything further to add from what you found out? I'd love to know. We live in IL.

 

[Evo]

Monia19, our family had to go through the whole rabies vaccination (5 of us). We are in total shock over the amount the hospital is charging. We had no choice of where to go as it was the only place available to us. We have not received all of our bills but we do know that the initial shot was $11,000 for my husband and each follow-up shot was around $980. We are searching too for answers as to why it's so high. All I've found so far states a much lower cost, especially for the initial shots. Do you have anything further to add from what you found out? I'd love to know. We live in IL.

Why would 5 of you have to get rabies vaccines?

Also, please pay attention to when someone posted, the person to whom you directed your question hasn't posted since their first post in February. Also, they stated they had to get post exposure shots.

 

[Kenjay20]

Evo, I just returned from the ER after my final rabies shot due to a bat bite. I got home at 4 p.m. and at 4:45 the phone rang with my new financial councelor from the hospital on the other end. No one in the ER even hinted as to how much this would all cost. The woman on the phone told me that so far I owed $10,400. That was for the initial round of shots and the second shot. I'm assuming the remainder will be about $4000 or so. I guess I will try to settle with them for a lesser amount. Could you let me know how you made out?

 

[Evo]

Evo, I just returned from the ER after my final rabies shot due to a bat bite. I got home at 4 p.m. and at 4:45 the phone rang with my new financial councelor from the hospital on the other end. No one in the ER even hinted as to how much this would all cost. The woman on the phone told me that so far I owed $10,400. That was for the initial round of shots and the second shot. I'm assuming the remainder will be about $4000 or so. I guess I will try to settle with them for a lesser amount. Could you let me know how you made out?

Call them immediately if you have no insurance and tell them you need charity help. You can look up the hospital's financial aid page online. Each hospital is different. Hopefully you chose one of the easier ones to work with.

I don't know why you're asking me, I've never had a rabies shot.

 

[mosquitofeet]

Gee, several of you had your lives saved and now you are complaining about the cost!? Rabies is 100% fatal if untreated. If you have contracted rabies and don't get the shots you are going to die. Read the CDC info in rabies. Treatment is really not optional.

 

[hypatia]

The vaccine is very expensive. 2 years ago a friend of mine had to get the shots, and it was around $8,000.00. I agree with Evo, ask for some help to cover some of the costs.

 

[Nicodemus]

Gee, several of you had your lives saved and now you are complaining about the cost!? Rabies is 100% fatal if untreated. If you have contracted rabies and don't get the shots you are going to die. Read the CDC info in rabies. Treatment is really not optional.

Only life is 100% fatal, and various decapitations, but no disease. Rabies is more like 99% fatal, with serious complications in survivors. ;)

Kenjay20: I disagree with mosquitofeet that we should all drop to our knees in sheer joy at paying through the nose, but the point holds: keep getting those shots because the alternative isn't just death, it's a really bad death.

 

[bobze]

Only life is 100% fatal, and various decapitations, but no disease. Rabies is more like 99% fatal, with serious complications in survivors. ;)

Kenjay20: I disagree with mosquitofeet that we should all drop to our knees in sheer joy at paying through the nose, but the point holds: keep getting those shots because the alternative isn't just death, it's a really bad death.

There is 5 (possibly 6, I think the last one is unconfirmed) cases of people surviving rabies infections.

Of those one person was remotely functional (the others were essentially "brain dead") because rabies attacks the CNS. These people only lived by very, very aggressive treatments of symptoms.

It is 100% fatal if left untreated. Or in other words; if you develop the infection and do not seek medical treatment, you will die. Hypatia's statement was completely accurate.

Edit:It is not correct to say diseases aren't "100% fatal". Rabies isn't the only disease that is 100% fatal either. There are many. Some play out time-lines with scary accuracy. Spongiform Encephalopathy, Huntington's Chorea, Creutzfeldt-Jakob, Fatal Familial Insomnia (one of my favorite diseases), Amyotrophic lateral sclerosis--To name a few. And those are with treatment and still 100% fatal.

There are many, many other diseases that would have a 100% mortality rate if left untreated; Tetanus, necrotizing fasciitis, HIV, pneumonic plague, etc.

There are also many diseases that if left untreated essentially have a 100% mortality rate--Bacterial meningitis, different bacterial septicemias (streptococcus, pseudomonads, GNRs, etc), certain strains of Ebola or other viral hemorrhagic fevers, etc.

 

[Nicodemus]

There is 5 (possibly 6, I think the last one is unconfirmed) cases of people surviving rabies infections.

Of those one person was remotely functional (the others were essentially "brain dead") because rabies attacks the CNS. These people only lived by very, very aggressive treatments of symptoms.

It is 100% fatal if left untreated. Or in other words; if you develop the infection and do not seek medical treatment, you will die. Hypatia's statement was completely accurate.

Edit:It is not correct to say diseases aren't "100% fatal". Rabies isn't the only disease that is 100% fatal either. There are many. Some play out time-lines with scary accuracy. Spongiform Encephalopathy, Huntington's Chorea, Creutzfeldt-Jakob, Fatal Familial Insomnia (one of my favorite diseases), Amyotrophic lateral sclerosis--To name a few. And those are with treatment and still 100% fatal.

There are many, many other diseases that would have a 100% mortality rate if left untreated; Tetanus, necrotizing fasciitis, HIV, pneumonic plague, etc.

There are also many diseases that if left untreated essentially have a 100% mortality rate--Bacterial meningitis, different bacterial septicemias (streptococcus, pseudomonads, GNRs, etc), certain strains of Ebola or other viral hemorrhagic fevers, etc.

No matter how virulant, some section of the population will have some measure of immunity to or ability to attentuate a given virus. Most of the 55,000 people who die from Rabies each year are in Africa, and AFAIK there has never been a broad serological study to distinguish one catastrophic encephalitis from another. Rabies would be unique among all viruses if it were truly so lethal.

You mention these other diseases, but they ALSO do not have a 100% mortality rate, except for necrotizing fasciitis which is a condition brought on by bacterial infection, not a disease like the others (in your first list). You're getting a skewed view because of a lack of study due to the success of vaccines, or because of relative rarity. I'd add, you mention Ebola like it's 100%, and that's just not true.

http://en.wikipedia.org/wiki/Ebola_Zaire#Za.C3.AFre_Ebolavirus

The Zaire virus, formerly named Zaire Ebola Virus, has the highest case-fatality rate, up to 90% in some epidemics, with an average case fatality rate of approximately 83% over 27 years. There have been more outbreaks of Zaire ebolavirus than any other species

I'm not arguing that these illnesses aren't often fatal, or in the extreme such as HIV, you DO have a massive pool that's studied, and only a very few who have ever (apparently) "beaten" HIV.

In response to your edit, I'm talking about infectious diseases, not conditions or congenital disorders. I thoughtthat was clear in context, but now I'm spelling it out.

Look at my original post, complete with winking-face. Did it look like I was being literal in any way? What are "various forms of decapitations"? Your reaction seems extreme.

 

[bobze]

No matter how virulant, some section of the population will have some measure of immunity to or ability to attentuate a given virus. Most of the 55,000 people who die from Rabies each year are in Africa, and AFAIK there has never been a broad serological study to distinguish one catastrophic encephalitis from another. Rabies would be unique among all viruses if it were truly so lethal.

You mention these other diseases, but they ALSO do not have a 100% mortality rate, except for necrotizing fasciitis which is a condition brought on by bacterial infection, not a disease like the others (in your first list). You're getting a skewed view because of a lack of study due to the success of vaccines, or because of relative rarity. I'd add, you mention Ebola like it's 100%, and that's just not true.

http://en.wikipedia.org/wiki/Ebola_Zaire#Za.C3.AFre_EbolavirusI'm not arguing that these illnesses aren't often fatal, or in the extreme such as HIV, you DO have a massive pool that's studied, and only a very few who have ever (apparently) "beaten" HIV.

In response to your edit, I'm talking about infectious diseases, not conditions or congenital disorders. I thoughtthat was clear in context, but now I'm spelling it out.

Look at my original post, complete with winking-face. Did it look like I was being literal in any way? What are "various forms of decapitations"? Your reaction seems extreme.

Actually I stated that there are other diseases that "essentially have a 100% mortality rate", that is they do not have a 100% mortality rate, but certainly very close too. In the case of Ebola, I pointed out certain strains (untreated) essentially have a 100% mortality rate. You are forgetting that those "90% mortality rates" tagged on Ebola-Z includes people who are being aggressively treated for their symptoms (fluid replacement therapy, oxygen, clotting agents, fever reducers, etc). Without those treatments, the mortality rate for some strains of Ebola would, for all intents and purposes be 100%.

I think the point you've missed now for 2 posts is; "Rabies is 100% fatal if untreated". The operative word here (used in the post you initially disagreed with) was untreated. That post was correct, if left untreated rabies is 100% if you acquire an active infection from it. There is no documented cases of people having an active rabies infection and surviving it without treatment.

Having a genetic mutation which prevents a virus from causing an acute or latent infection obviously does not affect mortality rate; because that group is excluded from people who are able to be infected with the virus/disease.

Same thing with HIV. There is no one who has survived, untreated, a latent HIV infection. There are anomalous people who have mutations to receptors (Either CD4 or CCR5) HIV requires to establish a latent infection and ergo can clear the virus from their body.

Even spelled out for infections disease, there are ones if untreated are 100% fatal. I pointed this out in my post. NF is a infectious disease (Yes the underlying bacteria which cause NF can be transmitted person to person and could also develop into NF in the new host--Certainly not common, but it can happen). Untreated 100% fatal. You're body doesn't spontaneously clear the infection. Tetanus--You don't clear a C. tetani infection and its really the toxin that does you--Constant muscle contraction, respiratory failure and all that bag of flowers. Even with treatments tetanus infections have a 30% mortality rate.

Creutzfeldt-Jakob, Spongiform Encephalopathy, Kuru and Fatal Familial Insomnia are prion diseases and infectious. They are 100% fatal, whether we treat symptoms or not...Le Chatelier and his principle it turns out, is not your friend

Pneumonic plague is another one where people have a genetic basis which bars the bacteria (Y. pestis) from establishing an acute infection, incidentally this is probably where people who got an "immunity" to HIV got it from. Regardless, if you don't have this genetic basis, get an acute respiratory infection from pneumonic plague and go untreated--You'll die, essentially 100% of the time. Our bodies and immune systems simply aren't equipped to clear some infections.

 

[Nicodemus]

Bobze, it seems like you argued against the point I made, and now you've moved to be more in line with it. I do want to mention that your "death without treatment" pool is understudied (prion diseases are hardly understood at all) and still not 100%. You're not saying anything new here, and now you think that all carriers are uninfected carriers, which tells me all I need to know about the medical knowledge present. I'll stick with the physics section I guess: the answers there seem to have less dodging and more to do with reality.


I didn't claim that you should rock along with Rabies and roll the dice: I stated that the chances were miniscule. I'm not really interested in a semantic and stylistic debate here though, so run with it and have fun.

 

[bobze]

Bobze, it seems like you argued against the point I made, and now you've moved to be more in line with it. I do want to mention that your "death without treatment" pool is understudied (prion diseases are hardly understood at all) and still not 100%.

Actually prion diseases are much more understood than you imply here. We actually know a lot about them (believe me, I have had the misfortune of sitting through medical school lectures in biochemistry given by prion biochemists) . That you maybe don't know much about prion disease, doesn't mean others don't.

Of course not every disease has been "studied" where treatment wasn't offered. That isn't the point, the point is that there are diseases which if left untreated, from the evidence we have, say's you're going to die. All the time.

You're not saying anything new here, and now you think that all carriers are uninfected carriers, which tells me all I need to know about the medical knowledge present. I'll stick with the physics section I guess: the answers there seem to have less dodging and more to do with reality.

Right and can you quote where I said that "all carriers are uninfected"? No, you cannot because I never said that.

What I did point out however (albeit in a non-specific way) is that mortality rates for infectious diseases are related to the prevalence of the disease in the population. Specifically in this case, a population who is able to get the disease--Population is a specific target group of people, not "the population at large". The mortality rate of a disease can only reflect the mortality of individuals where infection can be established or in the case of those heritable disease; a population which has the disease. Maybe you are confusing the mortality rate of a disease with someone saying something like "the mortality rate of the US" (when they really mean a crude death rate) which is a "for the population at large" kind of deal?

I didn't claim that you should rock along with Rabies and roll the dice: I stated that the chances were miniscule. I'm not really interested in a semantic and stylistic debate here though, so run with it and have fun.

I'm not debating you, I pointed out a mistake you made--Not reading what the original poster, actually wrote.

Of course, if you want to "debate" it, then simply put forward a case-study of someone, untreated, surviving an active rabies infection. Or someone, untreated, surviving an active NF infection. Or someone untreated surviving a latent HIV infection. Etc, etc.

 

[Nicodemus]

Actually prion diseases are much more understood than you imply here. We actually know a lot about them (believe me, I have had the misfortune of sitting through medical school lectures in biochemistry given by prion biochemists) . That you maybe don't know much about prion disease, doesn't mean others don't.

Of course not every disease has been "studied" where treatment wasn't offered. That isn't the point, the point is that there are diseases which if left untreated, from the evidence we have, say's you're going to die. All the time.



Right and can you quote where I said that "all carriers are uninfected"? No, you cannot because I never said that.

What I did point out however (albeit in a non-specific way) is that mortality rates for infectious diseases are related to the prevalence of the disease in the population. Specifically in this case, a population who is able to get the disease--Population is a specific target group of people, not "the population at large". The mortality rate of a disease can only reflect the mortality of individuals where infection can be established or in the case of those heritable disease; a population which has the disease. Maybe you are confusing the mortality rate of a disease with someone saying something like "the mortality rate of the US" (when they really mean a crude death rate) which is a "for the population at large" kind of deal?




I'm not debating you, I pointed out a mistake you made--Not reading what the original poster, actually wrote.

Of course, if you want to "debate" it, then simply put forward a case-study of someone, untreated, surviving an active rabies infection. Or someone, untreated, surviving an active NF infection. Or someone untreated surviving a latent HIV infection. Etc, etc.

I'm supposed to debate with someone who says that Ebola is nearly 100% fatal untreated, doesn't bother to identify a strain, then goes on to tell me what I implied, that it was wrong, and offering nothing except your own good word to take? No thanks.

 

[Greg Bernhardt]

I'm supposed to debate with someone who says that Ebola is nearly 100% fatal untreated, doesn't bother to identify a strain, then goes on to tell me what I implied, that it was wrong, and offering nothing except your own good word to take? No thanks.

You can assume he is speaking of the Zaire virus which has a 90% mortality rate
http://emedicine.medscape.com/article/216288-overview

 

[Nicodemus]

You can assume he is speaking of the Zaire virus which has a 90% mortality rate
http://emedicine.medscape.com/article/216288-overview

I did make that assumption and dealt with Zaire earlier in the thread, but it's one hell of an assumption to make. We're talking about a group of viruses that ranges from completely non-lethal to humans (Ebola Reston), to being as good as a mouthful of Destroying Angel (Ebola Zaire). Epidemiology is a lot more than just assuming lethality without treatment, or relying on the data gathered in a very brief period of study.

By its very definition, this kind of natural immunity or attenuating ability is hard to study retroactively; frankly it's hard to study now. If you look at studies into groups of HIV positive men who, long before any functional treatment existed, survived and are currently negative on any test extant you'll see what I mean. That's a pretty extreme set of cases, and consider the numbers studied; as with astronomy do you assume that you've found a one of a kind, or just the one you've found so far?

 

[bobze]

I did make that assumption and dealt with Zaire earlier in the thread, but it's one hell of an assumption to make. We're talking about a group of viruses that ranges from completely non-lethal to humans (Ebola Reston), to being as good as a mouthful of Destroying Angel (Ebola Zaire). Epidemiology is a lot more than just assuming lethality without treatment, or relying on the data gathered in a very brief period of study.

Not sure what your quip is here. I pointed out that some strains of Ebola, if untreated would have mortality rates of near 100%, I believe 'essentially 100%" was the wording I used. Ebola-Z has a 90% mortality rate for individuals being treated (you can scroll up and see some of those aggressive symptom treatments I pointed out). Nothing I said there isn't consistent with reality.

By its very definition, this kind of natural immunity or attenuating ability is hard to study retroactively; frankly it's hard to study now. If you look at studies into groups of HIV positive men who, long before any functional treatment existed, survived and are currently negative on any test extant you'll see what I mean. That's a pretty extreme set of cases, and consider the numbers studied; as with astronomy do you assume that you've found a one of a kind, or just the one you've found so far?

Since HIV research is so "big name" and so much money goes into surely these studies of HIV+ men, who didn't receive treatment, had latent infections and now test negative should be well known. Perhaps you could reference some of these case reports?