Rabies PEP Anxiety - Bats + Vaccines

[SpookyCat311]

TL;DR: I had a possible bat exposure and I’m in the middle of the vaccine series for rabies, but I’m having symptoms so I’m scared that I started treatment too late and it won’t work.

I recently had a possible bat-related incident that resulted in me getting the PEP (post-exposure prophylaxis) vaccines for rabies. I’m struggling so much with anxiety about this whole thing and I’m feeling very overwhelmed.

The incident: I stayed in a cabin over Labor Day with a bunch of bats roosting all over the outside of the cabin, in bushes/trees, on the porch, etc. One evening, I stuck my arm deep into a bush to reach some berries. The bushes were thick, I couldn’t see well inside of them, and it was dusk so the lighting was poor.

Later on, I noticed marks on my arm that I initially thought was a rash. I looked it up online to see if it might be poison oak or something, then saw images of bat bites that looked like what was on my arm. We also saw bats flying around the bush that I reached into later on, but I did not see a bat when I actually reached in. However, I did feel some mild pain when I reached into the bush (I assumed it was scratches/pokes from thorns/brambles at the time).

After seeing the photos, I called the CDC and the Health Department. They told me we’ve already had 7 bats (and 1 fox) test positive for rabies in my state this year, and since we did see bats actively living/roosting in the area and near the bush, I should go to a doctor ASAP.

Now, I know the “ninja bat” fear is common here and I also assumed that if I were bitten, I’d know it. But some pretty reliable sources, including the CDC, say that you can’t always feel a bat bite, and my state has “micro bats” that are so small, it’s possible to not feel bites. Other sources (like bat expert Dr. Merlin Tuttle, who I’ll discuss later in this post) say that’s BS and that he’s always felt bat bites, even with gloves, during his career working with bats.

So I did go to the ER, but not until 4 days after the possible bite. They decided better to be safe than sorry, so they gave me the HRIG (human rabies immune globulin) injections, and I’ve had 3 out of 5 vaccines for rabies PEP. My 4th and 5th shots will be over the next two weeks.

As you might imagine, my HA has been in overdrive. I’ve read a few great posts from other members here that helped, but I can’t shake one particular fear: I’m worried that I didn’t start the PEP vaccine treatment soon enough. Everything I’ve read says that the PEP should begin no later than 72 hours after a bat exposure; I started treatment 1 day late.

I don’t think I’ve had any clinical symptoms, but it’s hard to tell because the rabies vax itself can mimic the symptoms of rabies. I’ve had some headaches after each vaccine. I've been terrified that I started PEP too late and it won’t be effective, especially after reading about a Minnesota man who had the vaccines fail on him last year (he died) due to an undiagnosed autoimmune condition, which my doctors also suspect I have.

The ER and CDC said that it’s not too late unless clinical symptoms have manifested, and I did not have any symptoms when I began treatment. But now I have a sore throat that won’t go away and y’all know how HA can be when we start doubting what doctors say and doing the whole “what if” thing.

I’ve heard that people who’ve been bitten by cats/dogs quarantine the animal for up to 10 days before starting PEP, waiting to confirm whether the animal was or wasn’t rabid before they initiate treatment. This is true as long as the wound is on an extremity (mine is) but my bite is possibly from a bat so I’m not sure if that makes a difference.

I alternate between crippling anxiety about all of this, then feeling ridiculous because I'm not even sure I was bitten at all. I'm struggling so much with the "what ifs". There are moments when I feel like I'm going to have some kind of mental breakdown I'm so anxious about it, then at other times I feel calm and more rational.

If anyone has any sources about the timeline for starting PEP, I’d be grateful. I’d also really appreciate general tips for dealing with rabies anxiety (helpful stats, techniques that you use to cope, etc).

Things I’m already doing to mitigate anxiety: I’m in therapy, I’m on MH meds, I’m getting PEP treatment on the schedule recommended by my doctors.

I’m also listening to and reading information from a bat expert named Dr. Merlin Tuttle, with more than 50 years’ experience in the field, who advocates for bat conservation and who talks about how rare rabies is in the US (only 1% of bats are thought to be rabid here, and only 1.5 people die from rabies in the US and Canada combined each year on average).

This all helps, but I’m still struggling so much with anxiety. I’m facing my biggest fear of all time right now, and it’s so difficult to stay even somewhat calm and rational.

[RabiesFear]

Hey, I was recently in your position, friend. I got my rabies shots about a week after I noticed my bite. You're fine. First off, you wouldn't think a bat bite was a rash. You would be more likely to not notice it at all.

Second, one thing I've learned about rabies is that there are precious few doctors who know shit about it (although they all sound very confident when they talk about it). I heard completely different things from doctors who should have been knowledgeable about this. it took me a really long time before I got ahold of an epidemiologist who "specialized" in rabies, and that's what he told me. There's just not a lot of data on rabies, and it's so rare that most doctors don't bother to learn about it.

I also spoke directly to one of the guys who handles rabies testing in Kansas, and the 72 hours is optimal, but ABSOLUTELY NOT a hard line. I heard 48 hours, 72 hours, 7 days, all kinds of timeframes. Really, they just don't have enough data for things like this, so they go with what they usually see, which is people going directly to the ER to get the shots. People usually go immediately or not at all, but that doesn't mean you won't be protected. One doctor told me that they gave shots to a guy who was possibly exposed like a month prior. If you're in the US, I assume you got Imovax, which is the gold standard of rabies vaccines. If you actually look at the package insert for Imovax (https://www.fda.gov/media/75709/download), it says that "[f]orty-five persons severely bitten by rabid dogs and wolvesreceived Imovax Rabies vaccine within hours of and up to 14 days after the bites. All individualswere fully protected against rabies."

That said, I sympathize with how you're feeling, but I promise - you weren't late in the treatment, and you'll be fine. Hang in there.

[Flapj]

Rabies in humans is so rare that this is one you can put out of your mind. You know, when those 1-2 people each year die from rabies, there is a pretty intense workup of the source. The health department (or CDC) interviews people and works very hard to determine the source of the infection. They are able to find it almost every time. A family member recalls that the deceased was handling a bat or woke up and found a downed bat in their room - something definitive. Very, very rarely do they conclude that the source could not be determined.

This tells me that you would know if you should get PEP. It sounds like you started PEP anyway. Although it was probably unnecessary, it won't hurt you and now you are immune for life! I see you wrote this in September. The immunity will take hold 5-7 days after the FIRST shot so if you're still alive, I'd say you're good!