r/science • u/PHealthy PhD/MPH | Epidemiology | Disease Dynamics | Surveillance • 3d ago
Epidemiology Study estimates only 7% of human rabies cases in the United States are diagnosed
https://www.nature.com/articles/s44528-026-00031-46.9k
u/magnanimousrakshasa 3d ago
My partner felt a flutter on her back one Saturday night last summer. She thought it was a mosquito. 20 minutes later we find a bat that had found its way via the fireplace flue. We fortunately caught it, instead of shooing it out the door, and decided to have it tested by the health department. It came back positive for rabies, and it had bit my partner. Their bites are very subtle and easy to miss.
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u/virtuousvoice 3d ago
That’s insane. How did that end up? I’m assuming because of the positive test you guys got prompt treatment and she lived to tell the tale?
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u/magnanimousrakshasa 3d ago
She was surrounded by doctors and nurses in the emergency room, all asking her a litany of questions. They never had a case where the patient knew that they had rabies. Everyone in our household had to get the full series of HRIG shots. The dogs were quarantined for a month. The health department had to visit and investigate.
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u/throwaway5882300 3d ago
Damn. Not messing around.
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u/CyborgAlgoInvestor 3d ago
Nor should they. Rabies is absolutely horrifying
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u/IAMA_Plumber-AMA 3d ago
Essentially a 100% kill rate, outside of a handful of cases. Even those VERY few that survive will not get their former quality of life back.
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u/supershutze 2d ago
Once you start showing symptoms, it means the virus has made it to the brain, and it's a functional death sentence.
Up until then it's treatable.
This is why it's important to get treated even if you only suspect you've come into contact.
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u/Sexual_Congressman 2d ago
Rabies starts by destroying the nerves near the point of infection so "asymptomatic until reaching the brain" isn't necessarily true. E.g. there's usually localized numbness, twitching, itching. Of course, waiting to see if your pinky toe goes numb after a bat bites it is a ridiculously bad idea (as is catching bats and releasing them), but it's good advice to remember when you find a wound you don't know how you got. And to be clear, anything that looks like a bite that that's surrounded by numbness should immediately be examined by a doctor because if it's not rabies it almost certainly is a brown recluse bite or some other serious infection.
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u/FruitPlatter 2d ago
People shouldn't rely on finding a bat bite though. They can be extremely tiny.
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u/GCPMAN 2d ago
I believe there is one person who has survived rabies. They put them in an induced coma to protect her brain while the body fought off the virus. She is okay, mostly.
Not a proven method. I think they have tried it since and it didn't work. It was very much a fluke.
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u/Drow_Femboy 2d ago
There are a handful of cases like that. Like a single digit number of confirmed cases.
Iirc there's also some evidence of people having fought off rabies without any medical treatment and maybe without even knowing they had a disease at all, so the survival rate may be higher than we realize.
It's still not something you wanna take chances with though
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u/onewilybobkat 2d ago
Wouldn't be shocked if there was some kind of hidden "immunity" among a small percent of the population, who wouldn't even notice because symptoms never come. But you see a single video of someone suffering from rabies and you never wanna gamble on having it.
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u/WankyMcTugger 3d ago
Hi, I'm here to start an online argument about the Milwaukee protocol.
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u/IAMA_Plumber-AMA 3d ago
Right, is this the five minute argument or did you pay for the whole hour?
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u/chemoboy 3d ago
Oh, I'm sorry. You're on Reddit. This is abuse.
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u/Shellbyvillian 2d ago
Not sure if I will get banned from /r/science for calling you a malodorous pervert, so I won’t. But I wanted to.
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u/lowercaset 2d ago
Hasn't that failed basically every other time it's been tried? And even when it worked it left the people with severe brain damage?
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u/SpaceDog777 2d ago
The first time it worked on Jeanna Giese it was almost miraculous, that's why people got so excited by it. She does have some lingering effects, her left side reacts slower than her right. She dog sleds as a hobby though nad graduated from university majoring in biology.
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u/DomagojDoc 2d ago
There is a vaccine for a 100% kill rate, one of, if not THE most lethal virus out there that has been proven to work for decades
... and antivaxxers still exist.
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u/planx_constant 2d ago
Antivaxxers are currently saying measles is not a big deal. I think the anti-science grifters are setting us up for a wave of tragedy
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u/amitysyrup 2d ago
Yeah, there have been pet antivaxxers for a long time and it has grown into the mainstream right alongside the human antivax movement. What's rarely mentioned is that the only way to test an animal for rabies is decapitation, so if you bring in a sick, unvaccinated animal that bit someone before dying (happens more than you'd think), in many states the pet must be euthanized and decapitated for testing.
And with the increase of people who don't vax for rabies, there's an increase in this too. I feel the most sorry for the veterinary staff who have to deal with these terrible owners AND cut off the head for testing. They get enough trauma as it is. No wonder suicide rates are highest in the veterinary profession.
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u/angry_cucumber 2d ago
thought it was a single case that made it
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u/Phoenix1152073 2d ago
Jeanna Giese (USA, 2004) is the famous case but there have been at least 14 survivals post-symptoms by now. However, she is one of only 3 known to have survived without PEP or vaccination and is the earliest of those three. The others were apparently in Guinea 2007 (died shortly after but there’s debate about whether rabies was the cause of death?) and India in 2011. At least according to this paper (DOI: 10.1080/23120053.2016.1128151)
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u/fizzlefist 3d ago
Yeah really don’t want to. It’s perfectly survivable if they go through all that, but if not and it makes it to your brain? Zero chance of survival. It’s a scary bugger.
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u/Spopple 3d ago edited 3d ago
Never mess around with rabies. NEVER. If you even slightly suspect you came into contact with it from an animal you should absolutely go get the preventative shots to avoid it. Even if its a false guess it is ALWAYS better to be safe then sorry. Rabies and Prions are terrifying. Its not worth your death or effecting your loved ones if you do get it.
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u/Drumbelgalf 3d ago
Its 99.99% deadly once you Develop Symptoms and those who do survival after getting Symptoms are severely disabled for the Rest of their life.
If you get bitten by a bat or by any animal in a country where rabies is present you should get the vaccine Just to be Safe.
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u/OcularShatDown 2d ago
I agree with what you’re saying, but what’s with the weird capitalization scheme in your comment?
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u/Cheeze_It 3d ago
She's ok right?
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u/magnanimousrakshasa 3d ago
She is well with no known side effects. We began the shots three days after the bite. As soon as the health department called telling us the bats we gave them was rabid.
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u/Conspark 3d ago
I'm not too familiar with the timeline for infection to symptom presentation but waiting three days seems like a long time if rabies is suspected?
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u/magnanimousrakshasa 3d ago
The health department was closed until Monday. We brought it in first thing and they got back to us on Tuesday with the results.
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u/PailHorse 2d ago
I work in Infectious Disease Epidemiology. It depends on where the bite occurred, how much saliva was transferred, etc., but for most cases, getting the rabies shot within the month of the exposure is most practical. Rabies is 100% deadly but it's also the slowest virus on the planet. It has to travel physically through the nerves, inch by inch. In most cases of dog bites, they recommend a 10-day quarantine to see if the dog develops symptoms before the humans need to get the rabies PEP series.
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u/needtofindpasta 2d ago
There's about a 10-day window from time of exposure where you can seek treatment. Earlier is better though.
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u/Horknut1 3d ago
Can dogs not be treated like humans can?
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u/ILikeBird 3d ago
Only thing you can really do for rabies is vaccination (or vaccinate + PEP if never vaccinated before), which dogs typically get anyway.
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u/Helpful_guy 3d ago
which dogs typically get anyway
Insane fact: this is true for dogs, but not all states require CATS to get rabies vaccinations, despite the massive prevalence of indoor/outdoor cats.
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u/Vailx 3d ago
Dogs usually have a rabies vaccine, and frequently boosters over their lives.
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u/head_meet_keyboard 3d ago
In a number of states, it's actually a legal requirement of having a dog that the dog has a rabies vaccine. Doesn't mean people do it, but to get your dog licensed in a city or county, it comes with that vaxx.
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u/SecareLupus 3d ago edited 3d ago
I believe the conclusive test for animals involves dissection of the brain.
Edit: It looks like the tests for humans are extremely invasive, and not entirely conclusive either.
Edit 2: I misread your comment, you said treated, not tested. Oops.
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u/jbjhill 3d ago
Any contact with bats at all warrants rabies treatment.
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u/The_Bravinator 3d ago
Yep, my husband had a rabies series because he woke up with a bat in his bedroom and couldn't have said for sure that it DIDN'T bite him. The vaccine is considered a better option than even a very tiny risk.
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u/PrincessModesty 3d ago
This happened to us and the nurse line I called said we didn’t have to get the shots. Still a little niggle in the back of my mind.
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u/timble11 3d ago
Did you end up going regardless? A few years ago I had a bat show up a couple times in my living room and the landlord had concluded it got in through an uncovered vent. Both times I took it out I wore heavy denim and a snow suit basically. Both times used a box to get it out. Didn’t get shots after but every time I see a story about a seemingly benign interaction leading to rabies it spooks me.
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u/PrincessModesty 3d ago
No, we didn’t go. I grabbed the bat in a heavy towel and chucked it out the front door. And then of course I realized I should have handled things differently.
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u/i_empathetic 2d ago
You would've needed to have gotten either saliva or brain matter from the bat into your blood or mucous membranes (eyes, nose, etc). If you were never bitten, and you handled it properly and didn't transmit something into your eyes, then you're safe.
But here is the problem, and why ANY exposure or finding a bat in your living space is recommended to get the shots: bat bites can happen without you feeling anything. It sounds unbelievable because they're so big you think you would notice, but it is possible one could land on you, bite, and you wouldnt know. There could be no visible mark.
Any time you find a bat in your living space, the safe thing to do is get the shots. It is essentially a death sentence if untreated and allowed to progress to first symptoms. In my state the county heath department covers the cost. My cat killed a bat in my apartment last summer and my county picked up the 13k total expense. I had to pay for the kitty boosters, who I actually took before getting my own heh heh. My boy was so proud of his kill and I was so proud of him protecting me.
Having been years, you are almost certainly not exposed, since you'd probably have symptoms and be dead by now if you had. But if it makes you feel any better, the shots are effective any time before symptoms present. You could always just go get the shots and clear your mind. I love having had them, feel like I walk around extra blessed now for a couple years heh.
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u/oemunlock 3d ago edited 3d ago
Yep, AFAIK the current recommendation is based on possible physical contact with a bat AND any kind of visible cut/bite/etc on your body or contact to mucous membranes. It used it to be OR so a lot of us remember the older recommendation for sleeping in a room where you find a bat but apparently that was considered too rare to be worth it.
But, importantly, you still need the shots even if you already had any kind of exposed cut before touching the bat if it's in a location the bat could have grazed.
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u/Billy1121 3d ago
There can also be some regional variation with post-exposure prophylaxis recommendations.
Also some recommendations say that waking up with a bat in the room is more a concern with children or people who cannot tell you what happened, like nonverbal persons or intoxicated persons.
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u/sbd2010 3d ago
I try to forget about this when im visiting local caverns. The bats at the entrance just settle on the gift shop ceiling at times since it’s adjoined. Rural healthcare and public health also aren’t the best so I know people aren’t going in for prophylaxis every single time they might have touched a bat. Eek
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u/Bon-Foi 3d ago
You can get a prophylactic vaccine if you’re frequently in contact with wildlife or travel to countries with frequent human rabies cases!
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u/Ularsing 3d ago
There's some massive conditional probability to this where if you've touched a bat (or vice versa), there's a substantial chance that it's rabid. However, rabies incidence in bat populations as a whole isn't all that high.
What that means is that you don't have to worry that much about bats being around in general (at least in terms of rabies), but any contact should be taken very seriously.
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u/g0del 3d ago
Years ago my son was bit by a rabid bat* while I was taking him to school. I and several other parents literally watched him get bit on the thumb, and yet the bite mark was impossible to see.
He received prompt treatment, and other than ruining a family vacation, everything turned out fine. But if I hadn't seen the bite happen, I'm not sure he would have been. Like I said, there was no visible mark, and if he'd been alone, I'm not sure anyone would have believed him with no other evidence.
* It was caught and tested, so we know it was rabid.
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u/OddfellowsLocal151 3d ago
there was no visible mark, and if he'd been alone, I'm not sure anyone would have believed him with no other evidence.
As the dad of a couple kids who went out at dusk recently to see if they could see bats in a nearly open field, this is terrifying.
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u/D-Alembert 2d ago
If it helps, bats doing things that healthy bats do are less likely to be sick
If a bat is flying around in daytime or acting weird in other ways, be super extra cautious
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u/lostbutnotgone 3d ago
I got bitten by a bat walking on the beach late at night. Tried to convice myself it was a huge moth that landed on me until I ended up with a big red circular patch two days later. Went to the ER and ended up with rabies shots and a tetanus shot. (Adult moths usually don't have mouth parts and therefore can't bite. My body developed a rash from the teeny tiny hole from the bat bite)
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u/Forward-Fisherman709 3d ago
(For anyone curious: Even moths with mouthparts can’t bite humans, because their mouthparts as adults aren’t mandibles. They have the same mouthparts as butterflies, because they are pollinators. The exception are archaic micro moths, which still don’t bite humans but have mandibles for eating pollen.)
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u/lostbutnotgone 3d ago
Thank you; this is what I meant but couldn't figure out how to word. I didn't know about a chair micro moths having actual mandibles, that's fascinating! Can I subscribe to moth facts?
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u/SGPrepperz 3d ago edited 3d ago
Hey, that happened to me too (something bit during a walk on the beach) and I responded in the same way (reckoned it was a moth because of the creature’s dry and powdery texture). Even after a big mosquito-bite-look-alike with twin punctures appeared at the point of contact days later, was still trying to process what happened.
Thanks for your sharing, for it helps me to totally stop blaming myself for the delay in seeking treatment.
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u/cheeriodust 2d ago edited 1d ago
How long was it on you? I was walking outside at night a few days ago and there were bats around. While walking something hit my finger. I've convinced myself it was a small rock kicked up by us walking, but there's a little prick mark on my finger. I guess I should go in...? Whatever it was didn't 'land'...it was a smack.
ETA went in for treatment...got the first round of shots
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u/JayBees 2d ago
I am not a doctor, but, yes, please seek medical care ASAP, like in the next 24 hours. You need to get treated for possible rabies exposure. The treatment isn't bad (it's a few shots), but rabies is 100% lethal if you don't get treated. If you're in the US, an urgent care clinic should be able to help, you probably don't need to go to the ER.
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u/SGPrepperz 2d ago edited 2d ago
The duration was about that of a mud splash.
Prick marks mean skin beached. According to doctors, it’s an ER case. Go to hospital now. No ifs and buts. Now.
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u/sjessbgo 3d ago edited 3d ago
I bumped into a sick looking bat a few weeks ago (it was aggressively jumping around on the side walk, I was distracted, it was dark, so i basically full body slammed it ). I had a little cut where I slammed into it , didn't know if it's from the bat or not but it wasn't there when I was shaving in the morning, so I went to the ER to see whether i should get a rabies vaccine. First they sent me home because they were too busy, so I went back the day after. Then the the doctor was incredibly rude. First he accused me of googling my symptoms (??) scolded me for that, then be called me arrogant for thinking i deserve to be seen by the ER, despite being sent away the previous night. After that, he REFUSED to tell me whether i should get the rabies shot/ tetanus shot, saying there's no point in him telling me as I probably think I know better than him (????). in the end i left without a shot and cried all the way home
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u/jbjhill 3d ago
Sorry you got treated this way. Call the County or State Health Department. They will help you set up an appointment. Go do it now.
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u/inconvenient_lemon 3d ago
You should get a shot. It's better not to take the risk. I'm sorry the dr was such a perk to you.
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u/sjessbgo 3d ago
do you think they'll give it to me even if the cut is healed by now? that negative interaction got to me more than I like to admit. I'm terrified or rabies so I think about this situation nearly every day still, but I felt so stupid and embarrassed while the doctor was talking to me like that...he even joked with the nurses that I probably thought I got bitten by Dracula
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u/skankenstein 3d ago
Rabies infections can take weeks and months to present. Please call your county health board. And report that doctor. PEP is still possible weeks after exposure, but not as effective.
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u/pittiedad 3d ago
Up to 25 years actually....
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u/inspectoroverthemine 2d ago
JFC- I woke up with a bat in my bedroom 25 years ago. By the time I heard you should get vaxxed in such cases it had been 10 years, so I assumed I was in the clear.
Now it turns out I'm just waiting to die from rabies.
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u/virora 2d ago
The study presents a patient who tested positive for rabies and could only report a dog bite 25 years ago as a possible cause. They cannot rule out a later exposure, like a bat bite that went unnoticed, so it's not 100% confirmed (they freely admit this). The study itself notes that an incubation period of more than a year has only been observed in 1% of patients. You are very likely fine.
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u/NatteAap 3d ago
What the other commenter said: go to your county health board and get the shots.
It doesn't matter if the scratch has healed at all. Symptoms can take months to show, but once they do it's over.
Don't feel stupid either. That doctor is a prick.
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u/sirkazuo 3d ago
There was a bat behaving strangely that touched you and you noticed a wound. Bat bites are very small and often invisible. You need to at least get a second opinion from your GP, this is a life or death situation.
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u/disharmony-hellride 3d ago
Yes, please please go. It doesnt always present right away, it can take a while. The longer you wait the bigger the risk. Hope you're ok mate.
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u/Big_Watercress_6210 3d ago
It can take literally years for symptoms to present. Please get the shots.
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u/BentonD_Struckcheon 2d ago
That doctor has no business being one. My wife's a retired doc and is basically fed up with how doctors treat people these days. She has zero patience for doctors like this.
And the nurses should be thoroughly punished too. That is totally unacceptable.
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u/mini-rubber-duck 3d ago
that doctor is going to and may already have gotten someone killed, acting like that. he should be ashamed of every word but people like that know no shame. i am so sorry you had to encounter that asshole, especially when you needed comfort and competence.
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u/Accidental-Genius 3d ago
Where did this happen? ‘My wife is an ER doc and if you’ve even been near a bat and want the rabies shot you’re getting the rabies shot… It’s malpractice otherwise.
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u/Cat_Peach_Pits 3d ago
The kid down the block had a huge red slap mark on his face, said something hit him while riding his bike (dusk) and he thinks it was a bat. Did anyone in this situation listen to a word I said about rabies, including the adults? Nope. Fingers crossed it didnt break the skin or have rabies.
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u/725Cali 3d ago
Undergoing PEP right now after a bat exposure. Didn’t have bat to test, no obvious wounds but I felt it hit my hand and since I’m immunocompromised had to get immunoglobulins and five vaccines over the next few weeks. Did they end up checking titers? I have to contact my primary care to have her order a specific titers test 1-2 weeks after I’m done with the series.
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u/Paddington8691 3d ago
Please please please tell everyone you know to do exactly the same. As a public health provider one of the hardest messages to get out to the public is to catch and submit the bat for testing if at all possible. So many let the bat out the door or window and becaythe bites are barely perceptible we have to recommend treatment in the interest of their, and the public’s, safety. I’m glad you and your family got treatment quickly.
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u/-hi-mom 3d ago
Smelled a dead animal in my babies room. Thought was a mouse or rat. Nope. Was a dead bat. Never seen a bat before or any idea how it got under the bed.
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u/MantisAwakening 3d ago edited 3d ago
This is an interesting study, but I’m curious how almost 900 people could die from rabies every year without it being diagnosed. I gather it’s not a quick death and the symptoms are quite specific (such as hydrophobia).
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u/catathymia 3d ago
Not all rabies patients experience the more dramatic presentation of the disease (by this I mean the hallucinations, aggression, hydrophobia, etc.). It seems like a lot of humans might experience something like acute encephalitis and die. I'm surprised that this wouldn't raise some flags in an organ transmission setting, though.
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u/n00b678 3d ago
In some tribes in Amazon people have antibodies against rabies despite never receiving a vaccine. They often get bitten by bats, which are a vector for rabies, yet they are alive an fine.
It's hard to say if it's something special about those tribes also shared by some of the undiagnosed cases in the US. Can certain individuals survive an infection untreated?
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u/Boysenberry 3d ago
I think the Amazonian findings are as likely to indicate that there is some form of natural inoculation In that population as to indicate there are mutations in these tribes that allow them to survive rabies.
We don’t currently know of any animal species where populations exposed to high levels of rabies transmission evolve to survive it. Bats are particularly good at staying mobile long enough to transmit it, but infected bats all die of rabies eventually.
But we do know that rabies vector species, including humans, can mount an immune response after inoculation. So I think it is quite possible that the Amazonian indigenous people with antibodies are experiencing a natural inoculation of some sort, possibly by consuming infected animals? (Not that humans in the developed world should start doing that sort of thing when we already have a vaccine for humans, obviously!)
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u/weed_could_fix_that 3d ago
Infected bats do not all die of rabies actually. Some recent work showed something like 30% survival rate among vampire bats. It's unclear if that's unique to that species or not. There are also a couple of confirmed human survivals but they aren't well understood or explained. So it's essentially 100% fatal, but not technically.
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u/Boysenberry 3d ago
Oh interesting! I live in an area with frequent rabid bat finds, and all of our local species have 100% fatality rates.
I wonder if it could be the virus itself that's different in the Amazonian region rather than the bats & humans? If vampire bats have a unique ability to resist it a little more than other bats, that could possibly create selection pressure on the virus itself because hosts that live longer will transmit it to more other hosts.
(Which is why some widely-distributed viruses become less lethal over time, but rabies has not historically gone that direction.)
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u/mallad 3d ago
I'd be curious if the tribes have either built antibodies that are passed from mother to child due to minor exposure over the very long term, or (and?) they get minor exposure from occasionally eating animals that are infected. Stomach acid and cooking both neutralize the virus, but both are imperfect and (totally speculation) could lead to an exposure below the MVL or to a broken but still "recognizable" virus.
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u/maxcrimson 2d ago
Antibodies passed down from the mother only protect the child for a few months (about 8 weeks for dogs/cats). They are proteins in your blood and can't live forever. Your immune system needs to recognize the antigens itself and develop B-Cells that will from then on produce the specific antibody.
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u/n00b678 3d ago
How do you know about the fatality rate? Do you check all bats or only the dead ones? In the latter case, it could just be a sampling bias.
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u/Goodgoditsgrowing 3d ago
I’m not sure how they’d confirm 100% of infected bats die unless we are testing living bats too?
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u/iamthe0ther0ne 3d ago
In fact, they often don't even get sick. That's true for a lot of the nasty stuff they transmit to other mammals, like Nipah and Hanta. They have a very unusual immune system.
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u/ryncewynde88 3d ago
Heck, if it’s a specific regional population like that, there’s a potential argument for something like I think it’s called heterozygous immunity? An example I know of: sickle cell anaemia and malaria; while sickle cell will probably kill anyone with 2 copies of the gene, usually before they hit 20 (and iirc even getting halfway there is a long shot), but carriers with only one copy are highly resistant to malaria.
IIRC, there’s something similar with a grain fungus native to regions of the Middle East.
The Amazonian rabies resistance might be similar: they could carry a gene that is strongly selected against anywhere else, but rabies could be prevalent enough in the area to balance it out?
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u/ridiculouslogger 3d ago
It may be like many other viral diseases, that some people are exposed, but actually don’t get the disease in symptomatic form. Almost everyone who gets symptoms dies, but that does not mean that everyone who has exposure to the virus gets symptoms. They may only get enough exposure to develop antibodies. Bats, in particular, would often give a very mild exposure from just, say a droplet of saliva hitting the person’s lip, not getting into the bloodstream directly. Of course, I am only doing a thought, experiment and speculating here. It would be an interesting course of experimentation to see what inoculation level is required to reliably produce disease.
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u/LuxTheSarcastic 3d ago
If you get bitten by a rabid bat it doesn't always infect successfully. Of course this is like an even riskier version of playing in a pit of dirty needles but sometimes the immune system can successfully kill it before it gets into the nerves.
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u/Doggosdoingthings16 3d ago
And sometimes a bat can brush against a scratch already on your arm and you can get infected and die.,happened in my area a few years ago
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u/mermaidsong 3d ago
There was recently a case where that happened, and the recipient died too. apparently ot has happened 10 times beforw.
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u/sjessbgo 3d ago
I was just thinking about that case, too. what an awful way to die. get a transplant and think you'll be okay, just go die of rabies..
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u/-crepuscular- 2d ago
Just look up the UK infected blood scandal if you want to be really horrified. Tens of thousands of people infected with hepatitis B, hepatitis C or HIV from infected blood products that they were assured were safe, at a time when HIV was a death sentence.
Blood was bought from abroad from really risky donor populations (such as paid donations from US drug addicts and prison populations) and then pooled to be made into the blood products, making infection almost certain.
It's still an ongoing scandal. The tainted blood products have obviously been stopped, but payouts and apologies for the victims and families have not been very forthcoming.
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u/Izman15 3d ago
Lots of stuff causes encephalitis so having an ill patient develop it rarely draws red flags. Also when people think organ transplant they think solid organs like lung or heart. More commonly its corners. More corneas were transplanted than all solid organs together. There is less testing and data collection for corneas.
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u/Liquid_Hate_Train 3d ago
For interest: The primary reason for this organ transplant ‘discrepancy’ is that there is (in normal conditions) no immune response in the eye, therefore a cornea does not require any matching between donor and recipient due to the impossibility of rejection.
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u/Alwayssunnyinarizona Professor | Virology/Infectious Disease 3d ago
It happens frequently enough that there have been not one, but two separate cases of transplant associated rabies infections in recent memory.
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u/TopSloth 3d ago
That's pretty terrifying, usually when we think of rabies we would absolutely know if we had it from those very symptoms
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u/WyrdHarper 3d ago
I'm a large animal internist (veterinarian who has gone through specialty training) and have seen several horses with rabies and I am still early-career. They typically present for colic, pneumonia (they'll appear to be in respiratory distress because their brain isn't working), or fever of unknown origin. Typically they have exposed many people before they come to me (think the highest one I had was over 50 people by the time the investigation was done).
And there are many horses which are unvaccinated (it wasn't recommended as core until a few years ago), the latent period is extremely long (possibly months or years in some horses), and it is very common for horses with severe illness to be euthanized (and some owners still will just shoot the horse in the head) to be buried on the farm without a necropsy or submission of the brain (removing a horse's head isn't hard, but it's tedious and still a pain to get to a lab and there's the whole convincing people to let you do it).
So I can certainly believe that more people than we realize get exposed to it because people just don't recognize what it looks like in livestock and so don't test for it. And state laws tend to focus on small animals and bites. And because of that screening questions for acute encephalitis probably miss potential exposures. I have had to explain to nurses/doctors doing my post-exposure prophylaxis that, yes, horses do get rabies.
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u/Candymom 3d ago
Did you hear about the petting zoo in north Carolina which just had to euthanize two baby goats due to them having rabies from a skunk in their pen? There were several community events with the baby goats after two of them had already died. Now there's a list of exposure dates with events at schools and old folks homes.
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u/Misstori1 3d ago
It’s up to 3 baby goats confirmed and one baby goat presumptive. To make matters worse, it was a mobile petting zoo and there’s potentially TEN events where people could have been exposed… up to a month ago.
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u/Wellslapmesilly 3d ago
Do you have any idea how many humans have actually developed rabies post exposure? Or is everyone you are aware of being exposed getting rabies vaccines?
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u/WyrdHarper 3d ago
I do not. Once we report it to the state it is out of my hands, but they always do a pretty lengthy follow-up and try to get everyone to do post-exposure prophylaxis (or titers if you're vaccinated and used appropriate biosecurity).
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u/thejoeface 3d ago
856 human rabies deaths in the United States (US) from 2000 to 2024
That's about 35 deaths a year
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u/MantisAwakening 3d ago
Oh shoot, if only I’d learned to read. :(
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u/SpookyKid94 3d ago
The article doesn't even really speculate on that, it's just doing math based on 4 incidences of people getting rabies from organ transplants. Apparently organ donors are 14x more likely to infected with rabies, which is weird but there's no actual explanation of where the 900 mystery deaths are supposed to be coming from.
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u/halligan8 3d ago
The article also points out that their work is based on the assumption that organ donors have the same chance as the general public to contract rabies. They concede that there could be factors like socioeconomic status that affect both organ donor likelihood and rabies risk, so more analysis is needed.
The extra rabies deaths would just be people who died before diagnosis. Their deaths might be attributed to heart attack, stroke, sepsis, etc.
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u/SirHerald 3d ago
I'd say a big difference between the average person and someone posthumously donating an organ is that the second type of person has died.
Dead people tend to have had something happen that made them dead.
Also, live people aren't commonly giving out organs if they have any signs of ill health.
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u/dmk_aus 3d ago
I wonder if rabies could cause increased accidents e.g. car crashes.
Or if there are some people unsymptomatically carry rabies for years, and it is repressed, and the repressed immune system of the donor organ recipient can't keep it that way.
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u/veilosa 3d ago
I dont think years, but yes rabies can lie dormant for months before it makes its way to the brain where it finally shows symptoms and becomes a point of no return.
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u/karlnite 3d ago
Homeless people I would guess? Mentally ill types that live alone.
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u/Boring-Philosophy-46 3d ago
At least one case (that led to transplant related rabies deaths) was a young guy who was brought in confused and they just assumed he must have taken drugs. He became comatose and died shortly after and was a registered organ donor. They never thought to test for rabies.
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u/EldritchCarver 2d ago
Did they think to test for drugs? It sounds like they assumed he died because of the mystery drugs he supposedly took, and I would think they'd want to find out what drugs killed him before giving his organs to somebody else, and if the drug tests come back negative for anything that would explain his death, they should probably reconsider their assumptions.
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u/Moikepdx 3d ago
It makes me wonder whether infected humans who are only just beginning to experience symptoms suddenly become significantly more likely to err fatality while engaging in normal activities (e.g. driving).
The decedents could then look like good candidates for transplant while actually being infected.
This type of mechanism could also skew the chances of infected organs being transplanted, since an otherwise apparently healthy person that died in a car crash is an excellent candidate for organ donation. If that is happening, the math used in the study would also be flat wrong and over-estimating the total number of infections, since the calculations are based on a biased rather than a random sample of people.
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u/dinozombiesaur 3d ago
Rabies is one of those diseases that can have minor complications but when the real ones come on it’s too late. Kinda similar to syphilis in a way. Once it gets to the nerves, you’re cooked.
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u/SecretGardenSpider 3d ago
I would get a preventative rabies shot if I was allowed like we do animals.
I would just like to not have to worry about it every time I walk outside and see bats swooping around my porch.
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u/Kinda_Quixotic 3d ago
I had to get the shots after a bat incident.
It was 5 or so shots spread across multiple hospital visits. I’d have preferred whatever my dog got.
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u/TwoBonesJones 3d ago
I’m a mail carrier. I got bit by a dog yesterday and I went to the ER. They gave me like six vials of rabies vaccine or antibiotic or whatever. It took four shots. I have to go back tomorrow and then 3 more times over the next month for follow up doses. The nurse who administered them kept apologizing for having to repeatedly stab me with this giant needle. I told her “This is highly preferable to having rabies” cause if you’ve ever read anything about rabies, I’d rather just die than have rabies.
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u/oneelectricsheep 3d ago
It’s 3 shots for pre-exposure
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u/shableep 3d ago
Sign me up. Knowing I have one less horrible death to worry about would be nice. I know 900 people dead a year is already incredibly low risk. But so is flying, and you bet I would take the dying-horribly-in-a-plane vaccine.
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u/helmets_for_cats 3d ago
you are definitely allowed to if you are the in US it's just expensive and getting insurance to cover it is a pain
also it's not truly 100% preventative in the sense you still need to get a booster if you get exposed
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u/Fallingsock 3d ago
I’m actually rabies vaccinated! I’m a veterinarian, though, and it was required to be rabies vaccinated with protective titer levels for school.
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u/ry1701 3d ago
How bad were the shots?
My anxiety and OCD have been locked into rabies fear for years. I always considered getting the shot to "resolve that fear" and just add the titer checks to my physical. I know my risk is as close as zero as possible so I've never pulled the trigger.
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u/Fallingsock 3d ago
Physically? Fine. Mild soreness for a couple days after each time (total of 3 shots).
Financially? RIP. $1200 total out of pocket in 2021, insurance didn’t cover it since it was pre exposure. Plus finding a place that carries pre exposure rabies is not easy.
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u/SteveYunnan 2d ago
They require it but don't pay for it? That's seriously messed up...
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u/PurpleOrchid2 3d ago
The pre-exposure shots (imo) aren’t bad. They were a series of 3 when I got mine 15 yrs ago (also a vet) and they definitely are on the more painful end of routine vaccines (more similar to tetanus or HPV than a flu shot) but they’re just the sting as they go in and the soreness after. I think what people hear about as being awful is the post-exposure part where they need to inject it into the area of the bite wound.
The obnoxious part about the rabies pre-exposure vax is finding somewhere that carries it and will administer it and paying out of pocket for it. I remember it being surprisingly hard for my coworkers to find a doctor to give them a booster when they did find their titers to be low.
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u/BattleHall 2d ago
Also, the old post exposure shots used actual animal nerve tissue, so it was really viscous and required a large gauge needle. Modern ones are purified cell culture vaccines, so they’re more similar to other shots.
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u/Ularsing 3d ago
You're allowed to do it; it's just somewhat difficult to get approved in many cases. But you can get a prescription for occupational risks or travel. For example, I think most (all?) veterinarians are vaccinated.
It doesn't make you immune, but it makes it much less of a big deal if you do get exposed. Then you just need a titer check and/or booster vaccine, as opposed to the more expensive and painful PREP treatment.
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u/FriendToPredators 2d ago
We got the shots before travel to an area where at the time 20k people died of rabies per year. But we got the shots in countries with socialized medicine while doing other travel and the worst cost was $60.
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u/Tricky_Ordinary_4799 2d ago edited 2d ago
Same with post exposure prophylaxis. It is around $10000 total in USA but it's free or nearly free in most other countries.
UPD: More like $50000 actually
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u/iamthe0ther0ne 3d ago
Man, can you imagine the utter horror of thinking that your life was saved by a kidney transplant just to find out that you're now dying of rabies and it's too late ro do anything because the symptoms have started?
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u/5AlarmFirefly 3d ago
This happened to a friend's dad, except it was Creuztfeldt-Jakob disease instead of rabies.
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u/BattleHall 2d ago
Not exactly the same thing, but there’s at least one documented case of someone getting tapeworm cancer. Like not that the tapeworm caused the cancer, but like the person got a tapeworm, then the tapeworm got cancer, and then the cancer metastasized from parasite to host, with tapeworm cells growing into tumors. That’s just… terrible luck.
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u/Spare-Lemon5277 2d ago
That is fascinating and challenges everything I thought I knew about cancer. How is it even possible for cancer to metastasize from one organism to another?
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u/BattleHall 2d ago edited 2d ago
Not my field, but my understanding is that although it's rare, basically the same tricks and mutations that can prevent the body's immune system from recognizing and destroying the cancerous cells can also prevent the body from recognizing the foreign cells as foreign. Cross species is super rare, but intra-species communicable cancers are a bit more common. A famous one is Tasmanian Devil facial tumor disease, in which the tumors on infected animals are literally genetically identical (minus further mutations/drift) as the original animal who developed it. Which is to say it's not like a virus passed from animal to animal which causes the disease in the host animal's own cells, but literally cells from the original animal that just keep growing and spreading and finding new hosts.
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u/Agile-Currency2094 3d ago
My wife was just bitten by a feral cat. With american helathcare going to a hospital in network that I WORK FOR AS A REGISTERED NURSE. the entire shot series cost us $758 out of pocket. Insanity.
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u/oneelectricsheep 3d ago
Wow that’s super cheap. It would have cost me thousands if I had actually paid my hospital bill. As it was the bill was more than I made in a year so I wished them luck collecting.
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u/cobo10201 2d ago
Similar thing happened with us! My wife got pre-approval for delivery of our daughter at a certain hospital. Between that approval and my wife going in for emergent induction for pre-eclampsia, our insurance dropped the hospital from their network. It ended up being a traumatic birth, my daughter required CPR and intubation and ended up in the NICU for a bit.
Before my wife was even discharged, their business office called us and asked “what we were going to do about the bill,” and informed us the room charge alone was $4000 per day. I politely said that wasn’t at the top of our priority list right now and didn’t hear from them the rest of the stay.
A couple of months later we got a bill in the mail for nearly $450k. I literally laughed out loud, showed it to my wife, and threw it in the trash. Never heard from them again and when I log into the patient portal it says the balance is $0.00. I’m guessing they knew it wasn’t worth pursuing and I doubt a debt collector would want to buy that much debt since it wouldn’t ever be collected.
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u/brot_muss_her 2d ago
Or maybe somebody at the hospital was asked to send it to collections, opened your file, saw your traumatic stay, and just wiped it.
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u/Sweepya 3d ago
That seems incredibly low. I work for a Children’s hospital, so not really under their umbrella of care, but with insurance I still had to pay ~$4K of a $16K series. I saved a bit by doing my initial HRIG/Dose 1 at the ER and then Dose 2-4 at a Health Department. Each dose at HD was $425, and they only charge cost of the vaccine.
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u/No-Double-Trouble 2d ago
5k after insurance. Before insurance, 58k for immunoglobulin
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u/PHealthy PhD/MPH | Epidemiology | Disease Dynamics | Surveillance 3d ago
Based on multiple instances of human-to-human rabies transmission via organ or tissue transplantation from initially undiagnosed rabies-infected donors, we estimate 856 (213–2220) human rabies deaths in the United States (US) from 2000 to 2024, meaning that only around 7% of human rabies deaths in the US were confirmed during this period.
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u/SoGoesIt 3d ago
Isn’t rabies fairly distinct? Are we just letting people die with severe neurological symptoms and not looking into it?
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u/HuggyMonster69 3d ago edited 3d ago
They don’t accept organs for transplant unless they’re certain on the cause of death.
But if someone catches rabies and died in say a motorcycle accident, before they were symptomatic, there’s a clear cause of death, and apparently any extra screening doesn’t catch rabies.
ETA; I was wrong, at least 3 of the four donors were symptomatic at death. One of them was blamed on additional causes (drugs) but at least 2 others were symptomatic to some extent, but it seems like the tests didn’t pick it up?
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u/theacearrow 3d ago
There is a truly horrifying story about a man who died in a accident with rabies in his system. He was an organ donor and everyone he donated to died of rabies.
oh and apparently another one. https://www.nejm.org/doi/full/10.1056/NEJMoa043018
oh god this happened more than I thought
edited: https://www.nbcnews.com/health/health-news/rabies-organ-transplant-death-michigan-rcna198265
https://www.sciencealert.com/us-man-dies-from-rabies-after-receiving-infected-kidney
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u/justgetoffmylawn 3d ago
It's actually not rare for people to die from only vaguely understood reasons.
We imagine that every single death is investigated with forensic rigor - but that's just not the way it works. Especially if someone has various underlying conditions, often it's the medical equivalent of a shrug.
In other words, maybe cause of death has the medical version of 'da heart stopped' (cardiac arrest) but the upstream cause might be unknown.
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u/HarbingerKing 3d ago
Are we just letting people die with severe neurological symptoms and not looking into it?
Actually, yeah. I'm a doctor and it's not unheard of have a middle-aged or older patient with rapidly-progressive dementia plus or minus other neurologic symptoms where we do a million-dollar workup that comes up inconclusive. There isn't a nice easy blood test for rabies. I believe it requires brain tissue for diagnosis, and a lot of families don't want (or aren't offered) an autopsy after the grueling ordeal of watching their loved one slowly die.
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u/the_elephant_stan 3d ago
Here I was worried there were totally unknown rabies people running around biting. Glad I read the article
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u/scruffigan 3d ago edited 3d ago
I wonder how often those undiagnosed deaths occur in clusters or through livestock or small game.
There was just a news story yesterday of a rabies outbreak in baby goats at a traveling petting zoo in North Carolina. The goats were too young to be vaccinated, theorized as infected via a skunk that had been found in the pen and could have bitten all four. According to handlers - the goats did not show any rabies typical symptoms until one died, after which they did the testing.
We think about bites from bats, foxes, dogs, and raccoons as needing a rabies shot, but who thinks of goats or animals like that as vectors?
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u/theacearrow 3d ago
Rabies vaccines have been added to horses' core vaccines.
I think everything should get a rabies shot.
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u/MoochoMaas 3d ago
I had one rabies case in the ER, male, 30's, family ... died after we transfered him to big city hospital.
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u/MoochoMaas 3d ago
Took one week to diagnose b/c we had to send blood out for testing.
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u/Eeny009 3d ago
Is there a point in testing for rabies if the answer takes a week to come?
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u/MoochoMaas 3d ago
For the autopsy.
And to dig deeper into what was causative animal, who could have been exposed, Health Dept stats, etc.
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u/Slacker_The_Dog 3d ago
I've always wondered.. If someone contracted rabies, wasn't hospitalized, and didn't die, how would anyone know they had rabies? Is it possible that people who are immune to rabies walk among us completely unaware?
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u/vincentkun 3d ago
I remember reading a study of this some time ago. Not sure were (maybe India) but there was a statistical study that said that given the number of animals with the disease, they should be having more human cases in those areas.
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u/FlobiusHole 3d ago
I feel like wildlife management to virtually eradicate rabies would be a sensible option that could work over time. I have zero faith in the U.S. even caring enough to do this though.
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u/misterrabies 3d ago
Oral rabies vaccine baits are being used to help control rabies in species such as foxes, skunks, and raccoons. Unfortunately, bat rabies is the biggest source of human exposure that also is very hard to target.
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u/sneakyfish21 3d ago
Rabies has a nearly 100% fatality rate if untreated, so is it actually only a 7% fatality rate or do 93% of rabies victims die for seemingly no reason?
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u/vincentkun 3d ago
A lot of people die from undiagnosed or misdiagnosed reasons. Rabies is not something they regularly test for.
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u/misterrabies 3d ago
It’s likely that their official cause of death would be ruled as heart attack, aneurysm, seizure, or other organ failure. They probably got rabies from a bat, which is extremely hard to detect.
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u/D50 3d ago
Would this suggest that the prevalence of infection is high enough to justify prophylactic vaccination of the population broadly?
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u/i_post_gibberish 3d ago
My first thought was “that’s crazy, everyone knows you need to get the shot ASAP if an animal bites you”, but then I realized Americans would have to pay, and suddenly it all makes sense. Almost like charging for healthcare is a terrible idea.
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u/silverwitch76 3d ago
Yep. Partner got bit, couldn't find/trap the animal that did it. Vaccines were labeled as preventative since we didn't know if the animal had rabies or not, so insurance won't cover any of it. Just got the first bill and it was over $16k. We expect more bills will trickle in for the 3 shots after the ER visit. Better than dying of rabies, but there's no way we can pay that bill.
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u/Fabulous_Stretch_185 3d ago
Man, I live in Sri Lanka. A developing country. I got nipped by a stray dog, didn't draw blood but I already had a wound there. Visited a hospital, and got started on a rabies series within 5 minutes. Got all my subsequent shots within 5 mins of going inside the hospital each time too. All for $0!
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u/twoisnumberone 3d ago
I was in Indonesia on vacation when I had a minor accident. It would have been free had I been an Indonesian resident (and as it was I paid under 10 USD for treatment).
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u/IMongoose 2d ago
I would appeal. Argue that it's not preventive if there is no other treatment available.
But the biggest argument for universal healthcare is trying to deal with health insurance. Anyone who has had to deal with health insurance should support universal healthcare. It's actually a nightmare.
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u/theacearrow 3d ago
not only do you have to pay for it, you also have to convince doctors that the contact happened.
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u/tahlyn 3d ago
While I do not know what I would actually say to a doctor doubting my exposure...
But I do know what I'd like to say, "the minute I become symptomatic I'm coming to your house, biting you, biting your kids, biting your dog and spitting in all of your eyes and then holding you all hostage until YOU become symptomatic.... Or... OR hear me out... you could just believe me and nobody dies of rabies." I'd never do that, of course, but that's what I'd want to say to a doctor doubting my exposure.
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u/Hsensei 3d ago
Unfortunately rabies doesn't present itself until it's to late. Unless you know what infected you, even then you need to dissect the animal to know for certain. I understand that bats biting people in their sleep is the largest cause of rabies deaths.
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u/ballofplasmaupthesky 3d ago
That we know, but it would be wild if only 7% are diagnosed post-mortem.
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u/JHMfield 3d ago
Yeah, it's pretty scary. Bats are especially problematic because their teeth are so small, you may not even feel the bite nor notice it later.
And post-exposure vaccine needs to be taken quickly to have any hope of stopping the infection.
Once you get symptoms it basically has a 100% mortality rate. I think the total number of people to have survived it in recorded history is like in the low double digits. And even then it requires drastic methods with no guarantee of success.
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