"Textbook" Bat Bite per the CDC. Antibodies Absent. Terrified.

[RabiesFear]

Hi All,

Woke up about two months ago with something that looked like a scabbed bite on my hand. Texted a picture to a friend who said it looked like a snake bite. Tried to put it out of my mind for about a week, and then contacted the CDC hotline. The hotline operator told me to text a picture to her - she then told me that it looked like a "textbook" bat bite ("sharp edges and everything"), and that I should get it checked out at the ER. The ER took a look (at the picture, since the scabs were by then gone) and ordered the shots.

We subsequently had our house checked out, and apparently there used to be a known bat problem - the people who lived in the house before us installed a one-way bat door on the roof, but it had since been broken, creating, essentially, a "two-way" bat door. There were droppings in the attic.

I may have gotten the shots too late. After the last shot, I got a rabies titre test to ensure I was creating antibodies. It came back negative (antibodies were "absent"), and I had to get a booster. Nobody knows what to do. The hospital I went to, ranked 11th in the country, basically shrugged and said they had no data on my situation, and that I should try to work with my PCP for next steps. My PCP says I may never create antibodies, and has no idea of what to do next.

The CDC was borderline useless - the doctor I spoke to said that if I hadn't experienced symptoms a week after the bite, I should be fine, although their own website (and everyone else's - WHO, etc.) says the incubation period is around 2-3 months. Everyone has just thrown up their hands. I'll hit two months in about a week. My husband doesn't think I was bitten by a bat (as we never actually saw one), so he doesn't feel the same sense of urgency. I hope to God I wasn't, but I can't rationalize it away. My husband was sleeping in the other room the night before I woke up with the bite as he had a bad cold and was snoring and restless. I distinctly remember leaving the door wide open and wondering if I should shut it.

Every muscle ache is terrifying. I'm having panic attacks, which is new. I feel like I'm trying desperately to save my life and nobody cares. Thanks for listening.

[Scass]

I think you have to finally accept that there’s nothing else you can do, you’ve literally done everything you were asked to do and you’re ok, no physical symptoms of rabies. Will you relax once the 2m is up? Is it worth this last week of high anxiety?

Honestly I don’t know what else to say. I can imagine that this has been a horrible experience, but still nobody actually knows if you were bitten by a bat [emoji853].

Let us know how you get on x

[RabiesFear]

Thanks for listening. Honestly, I might feel better after month 3 - at this point, I've read a million case studies and 20 - 90 days seems to be the usual range, with most people developing symptoms around weeks 7-8 (I think the number was 72% under week 10, for bat bites specifically). I'd feel better if I got a positive antibodies test, though.

The one last thing I can try is getting a second test (per my PCP) and if that doesn't work, trying to convince them to hit me with immunoglobin again, but honestly, I think it's just too expensive for them to give it to me. It's something like six figures. My PCP basically said that they would probably just keep boosting me, but she's not sure how that would work since rabies can hang around for years.

I can't stop vacillating between trying to put it out of my mind and overcome the anxiety or trying everything I can to get the medical community to work with me - I don't want to develop symptoms and know that maybe there was something I could have done to stop it. I mean they all do recognize the seriousness, it's just that nobody is an expert on rabies. That top-ranked hospital apparently talked to a bunch of infectious disease specialists who had no idea what I should do. One doctor I spoke to at an ER (you have to keep going back for the series) mentioned restarting the series of the titres were negative, but I haven't been able to find her since.

Honestly, the only thing that's keeping me going is that you're right - nobody knows if I were bitten by a bat. The trapdoor to the attic was slightly ajar, and my door was wide open, and the CDC (!) said I'd never know it if I were bitten, but I do have cats and they're both killers. I would hope that there wouldn't be an isolated instance of one bat flying down, biting me, and us never seeing bats again, and I imagine that they'd be pretty alert to the presence of bats. But I've looked at every instance of bat rabies in the US/CAN since 1990 and I just can't stop shutting down my own hope. Thank you again for listening. It's just that the medical staff I've talked to are all curious, sympathetic, but ultimately useless, and everyone else is either annoyed or just like - "wow, yikes. Hope you don't die!"

[SpookyCat311]

Hey, just wondering what ever happened to you. Are you all right?

[RabiesFear]

Hey, I'm alright. The CDC actually contacted my state and county health and human services to help me out, and my second titre test came back positive for antibodies so there's really nothing left for me to do and I'm out of the general "danger zone" when rabies seems to pop up. The epidemiologist the CDC sent basically told me that (1) there are very, VERY few rabies "experts" in the medical field - they just don't have good data and (2) they'd literally never encountered someone in my situation (i.e. date of shots to bite, and then no antibodies - people usually either get the shots right away and get antibodies, or they don't get the shots at all and they die - rabies is just so rare they don't have good case studies). About a month afterwards, my hair started falling out handfuls and they thought maybe it was the shock to my system (unfortunately, got the Covid booster a few days before the rabies shots) but after a blood test it turns out I've got hypothyroid, so it's possible that I had an unknown autoimmune condition the whole time, and that's why the shots initially didn't take. They give more to people with autoimmune issues. Thanks for asking, though. I appreciate it.

[kyllikki]

Thank you so much for posting this follow up, I admit yours was one of the only posts I've eve seen here where I thought: "Welp, that sounds pretty gosh darn not good" -- mostly because of the CDC's response to you + the absence of antibodies (which would have freaked me right out!) I am so glad it all turned out ok, and wishing you the best with your thyroid issues (I'm hyper. Thyroids are so annoying.)

[RabiesFear]

You're welcome! Honestly, at every point I kept expecting to be dissuaded of what I'd hoped was an irrational fear. I called the CDC the first time thinking/hoping they'd tell me I was just anxious, but they ended up scaring the crap out of me. Then I thought the wildlife service would find nothing conclusive, but the guy straight-up said, "Whelp, you've got bats." Fun fact: rabies antibody tests usually take about a week to turnaround because there's only two places in the US that does them (MI and Kansas) and literally, after the first test, they had a contamination in the MI lab and had to send it to Kansas. I was about going out of my mind and had a full-on breakdown when I found out I had no antibodies. I am sorry to hear about your thyroid as well! I'm fairly sure I overmedicated myself right into hyper (suddenly very hot instead of cold, but same fatigue, hair loss, and a lot of heart palpations) and I feel your pain / am waiting for the test results. I very much agree with your assessment! Wishing you the best as well!

[rd266]

Glad you are doing well. Do you happen to have the picture of the bite still? I’m curious to see what a textbook bite looks like.

Thanks

[RabiesFear]

Sure, I still have the exact picture I sent the CDC hotline on my phone. I'll post here when I get a second. I will say that it was just two tiny scabs, not swollen, red, or painful at all, and I would likely never have noticed it if it wasn't right on top of my hand. I actually got bit by a neighborhood cat this Saturday (I was dumb enough to pet a strange cat that came walking up to me), and as it wasn't up to date on its rabies vaccine the county HHS is having me go in for more titres (the owners claim they can't find the cat to quarantine it). So I'll let you guys know what my antibodies look like five months from my positive titre test.

[RabiesFear]

Quick Update with some Rabies info for you all. Some people asked for pictures of the bat bite - I can't seem to get this website to log in on my phone (says it's not supported?), so I'll have to email the pics to myself and then upload but will post them here when I get around to that. I wanted to pass along some info I thought might be helpful for someone in my situation.

I got a titre test for my stupid unvaccinated cat encounter in early November. That test came back "POSITIVE - LOW", meaning, about six months + from the last titre test where I had sufficient antibodies (early June), now an "incomplete neutralization" at 1:25. Better than ABSENT, but still not great. I was recommended to get the rabies booster (Imovax, not Immunoglobin) just in case.

If I can tell you anything about rabies - if you DO have a legitimate potential exposure - YOUR PCP IS USELESS. THEY DON'T KNOW ANYTHING ABOUT RABIES, but they are also probably way too arrogant to admit it. My PCP outright refused to give me the titre test despite the HHS recommendation, and despite the nurse saying that my PCP could call and speak to them about it (which my PCP refused to do). My PCP said that my antibodies should be good for years. I had to jump through hoops to get a different doctor to prescribe me the test (to be fair, the HHS was trying to get me in at the county health department, its just that it was really hard to do w/in work hours since it was fairly fair from me). During my first go 'round, the county epidemiologist told me that most doctors don't know anything about rabies, which tracks with my experience. If you have questions, either call one of the rabies labs (in Michigan or Kansas) or call your local health department (in my case, the CDC also directly connected me to the people at my health department).

Hope this helps! Feel free to ask me any questions. I have learned a lot on this stupid journey.

[Flapj]

Can you step back for a second and acknowledge why PCPs and other doctors might not immediately think "antibody titres" and other excessive testing when dealing with a patient who thinks they might have an ultra rare virus that kills 1-2 people per year in the entire country? You seem mad at them for the way they reacted.

A domesticated cat bit you and you went in for rabies concerns? I can't find any cat-human rabies transmission in the U.S. in all of the CDC surveillance data at all.

You have an irrational rabies fear. You need to move past it. Other people are not the problem here.

[RabiesFear]

Nah. It was an outdoor cat with a collar and it bit me out of nowhere after I stopped to pet it. The owners told Animal Control that (1) they had not vaccinated the cat for rabies although they'd had it for years and that (2) they didn't know where it was. It was a virtually fully outdoor cat. CDC guidance is to get the shot. About 250 cats are reported as rabid each year in the US, which isn't a lot but that's just what's reported. It's considered rare because most owners get their cats vaccinated, and/or most people don't have random contact with cats. There have been two cases of cat-human rabies since the sixties. Guidance is ACTUALLY to get boosters regardless of whether you've got rabies PEP but the HHS wanted to wait for the titre because cats aren't as much of a rabies threat. They actually told me to get antibiotics; they were a bit more worried about that.

I am, in fact, very mad at the way my PCP reacted. I didn't just show up asking for a blood test. I called the HHS because I didn't know how I should proceed, and had dealt with them re: my prior rabies issue. They told me to get a blood test. They just can't order the test themselves; you can get it done AT the health department, but its a much more onerous process. The HHS (again - doctors who actually deal with this stuff) was absolutely baffled as to why my PCP wouldn't give it to me.

The reason I say that PCPs do not know about rabies is because they do not. Most doctors don't. Rabies is rare in the US, so nobody really cares much about it. You seem like you are pretty defensive of the doctors here, but this is just the truth. My PCP significantly delayed me getting a test that is time-sensitive and refused to speak to an actual epidemiologist about whether it was necessary. That seems pretty negligent to me.

I hope my fear is irrational - that's why I originally posted here, after all. Do I know I got bitten by a bat? No, but I had bats in my house, and the CDC told me to get the shots. Do I know I got bitten by a cat? Yes. Was the cat vaccinated for rabies? No. Was it an outdoor cat without supervision? Yes. Was it acting strangely? Kind of. Came over to me all friendly and then bit me hard - breaking skin - with no warning. Did I want to get more shots that make me feel like shit? No. Did I seek medical guidance first? Yes. Did I have sufficient antibodies? No. Was anybody able to find the cat afterwards? No.

Was it unlikely to have rabies? Sure. But I'm not on a forum about health concerns because I like to roll the dice.

EDIT: I'll also add that my PCP was 100% wrong. I don't actually have sufficient antibodies right now. CDC guidance would have been to get the shots after getting bitten by the cat regardless of whether I'd gotten them earlier in the year. I know we're trying to dispel panic here, but insinuating that people SHOULDN'T get shots because they've been bitten by an animal UNLIKELY to have rabies is not it.

[Flapj]

There have been two cases of cat-human rabies since the sixties.

Do you hear yourself?

[BlueIris]

Just to clarify, that isn't strange cat behaviour. A lot of cats do this when they're overstimulated.

[RabiesFear]

Do you hear yourself?

Yeah, I do. You were the one that said there were zero cases. BTW, the reason for that? Is because people usually vaccinate their cats, and because the CDC tells you to get the shots if you get bitten by an unvaccinated animal. Unlike bats, people absolutely know when they get bitten by a cat/dog. This isn't me making stuff up, it's literally what you're supposed to do in this instance. I'm not sure why you're on a forum about rabies anxiety if you're so cavalier that you wouldn't.

Not sure what your problem is. Guessing you're a doctor who is feeling called out, in which case - get over it. I'm not going to tiptoe around one negligent doctor's feelings because the risk is extremely low where another, more experienced doctor tells me to get the shots.

Edit: I see in a previous forum post that you believe PEP makes you "immune for life". I'm guessing that this is where your ire is coming from, in which case - stop giving people bad medical advice. PEP is incredibly variable, which is why people in high risk categories have to check every six months. You also called rabies "ultra rare" in a post above, and that's kind of true. It's rare in the US, BECAUSE we vaccinate our animals, we get the shots, and they are high quality. It's still rare but not quite as rare in other places like India, where they do not. There's a HUGE difference between an irrational rabies fear of brushing against something in the dark, and having direct contact with an animal and thinking eh, it's rare.

[Flapj]

Are you in India? Your avatar says you're in the U.S.

This is not a forum for spreading panic and bad information, as you are doing. It is a place people come for help with their anxiety and irrational fears. You don't seem to want help, you want an echo chamber of like-minded irrationals. This is not the place.

I suspect you enjoy being challenged and "clapping back," and if that's part of your personality, fine. It wont get you very far in life.

[jayke]

The oddest thread I have ever read.