Next Doc Question - Rabies Exposure

[Toonces]

Stupid story short: I had a mouse in a glue trap in my drop ceiling. The mouse was flailing around and it was an awkward grab. So I dispatched it with with a pair of needle nose pliers. Ended up crushing its head and getting fluid in my face/eyes…I think from its eye. Did I expose myself?

This sounds even dumber writing it out.

[TCB]

I’m not a Doctor but it sounds like you probably had enough alcohol in your blood system to counteract any of the virus you may have been exposed to…:cool:

[RoyGBiv]

Mice are not known to transmit rabies to humans.
https://www.cdc.gov/rabies/exposure/animals/other.html

Small rodents (like squirrels, hamsters, guinea pigs, gerbils, chipmunks, rats, and mice) and lagomorphs (including rabbits and hares) are almost never found to be infected with rabies and have not been known to transmit rabies to humans.

Plague? Possibly. But rabies, unlikely, it seems.
https://www.cdc.gov/plague/transmission/index.html


*** I am not a Dr. Google is my guide. :cool:

[Wise_A]

I’m not a Doctor but it sounds like you probably had enough alcohol in your blood system to counteract any of the virus you may have been exposed to…:cool:

As we say about one of our frequent flyers--

"He had blood in his alcohol system."

[JCN]

I’m disappointed you didn’t take it out back and use a 10mm Glock.

[pangloss]

Stupid story short: I had a mouse in a glue trap in my drop ceiling. The mouse was flailing around and it was an awkward grab. So I dispatched it with with a pair of needle nose pliers. Ended up crushing its head and getting fluid in my face/eyes…I think from its eye. Did I expose myself?

This sounds even dumber writing it out.

I am not a physician but teach the better part of one lecture on rabies to graduate students. It's actually my favorite lecture even though I've never worked with rabies. As RoyGBiv pointed out, it's quite unlikely that'd you'd catch rabies from a mouse. In your part of the country, skunks are the terrestrial mammal that you need to watch out for. If I were you, I wouldn't be too concerned about rabies unless you also have bats in your house. If you ever need to kill a mouse with pliers again, you might try holding the pliers horizontal to spine just behind the head and then simultaneously push down on the pliers and pull the tail. I've killed thousands of lab mice with just my hands it doesn't take much force at all to put them down via cervical dislocation.

Having said all of that, there's no compelling reason not to call your physician and see what he/she says. If I could get my insurance to pay for the rabies vaccine, I'd get it. Sometimes I contemplate just paying for it out of pocket, but it's several hundred dollars and I'm not at risk for rabies. I'm very pro-vaccine though!

EDIT: Did you flush your eyes out after you got mouse juice in them?

[Sensei]

Having said all of that, there's no compelling reason not to call your physician and see what he/she says. If I could get my insurance to pay for the rabies vaccine, I'd get it. Sometimes I contemplate just paying for it out of pocket, but it's several hundred dollars and I'm not at risk for rabies. I'm very pro-vaccine though!

EDIT: Did you flush your eyes out after you got mouse juice in them?

The most compelling reason that I can think of for not calling is that this is a relatively straightforward answer that can be found via any combination of Google searches. If Google is not your thing, then do what our grandparents did and rub some dirt in it. In fact, at least one member of this forum has hit the nail (or mouse) on the head. This was a little mouse juice - not a spitting cobra.

Moreover, people who keep accessing the healthcare system for trival shit end up with expensive, bad outcomes. For example, let’s say that his doctor doesn’t know shit about rabies and agrees that he needs the vaccine for this non-event. Or, more likely, he never speaks to the doctor because they are busy seeing someone’s Lyme disease, and the nurse (who knows less than shit about rabies) says, “Sugar, you need to take yourself to the emergency department and get that vaccine.” That’s right, most doctors offices do not have access to the rabies vaccine, and it almost always involves a trip to the emergency department. The overhead for walking into the ED starts at about $1000 and goes up quickly. If he finds a unscrupulous emergency physician who is willing to administer this, the cost is not a few hundred, it’s several thousand. Like, tens of thousands of dollars. That is because the vaccine is administered with immune globulin (RIG) so that an exposed person has antibodies while they wait for their immune system to respond to the vaccine. This lady was billed $43,000 for rabies vaccine + RIG that she probably didn’t need. https://www.advisory.com/en/daily-briefing/2019/02/28/cat-bite

Then there is the issue of RIG itself - not a completely benign experience for an unfortunate few who get anaphylaxis or any of the other serious reactions.

Im sorry if Im being a dick. However, part of the reason why healthcare is exceedingly expensive is because people keep accessing it for trivial issues. They do this thinking, “oh, my insurance will pay.” Then, insurers don’t pay because it was bullshit (leading to the inevitable, “but my doctor said…”), have to jack up the prices for everyone else, or raise our copays. This dependence on someone telling us that it’s going to be OK needs to stop.

[Aisin Gioro]

Rabies is very, very rare in mice in North America and Europe, but splashing any wild animal's bodily fluids into the eyes, nose, mouth, or broken skin is probably a good enough reason to call your doctor or local hospital. Rabies is the scariest and probably worst thing in mind, but there are lesser and more common infections that a doctor might consider warding off with some antibiotics, or things to be on the lookout for. A lot of the risk from rabies depends on your area, including the prevalence and types of animals that are the main culprits. Mice would have to be down near the bottom of the list anywhere in the world, but especially in the US. I would, however, take issue with the CDC's official positions that rabbits are a non-issue, as I am aware of at least one instance in the US of a pet rabbit being infected and putting two or three humans at risk through contact that, pre-vaccine days, would have carried a considerable risk of infection**. Also, when they say that whatever animals "have not been known to transmit rabies to humans", it might be worth pointing out that about 30-35% of human rabies cases identified in the US over the past 12 years or so (admittedly a small number, about 30), were from unknown sources of infection, so a measure of uncertainty surrounds it.

I've been "lucky" enough to get not only the initial rabies IG/vaccination sequence, but also a booster some years later. The first exposure was a fair risk, but the booster was probably more being safe rather than sorry in a place with relatively high prevalence and a risky animal in question. I don't regret either one at all. DO NOT be afraid of the prophylaxis and vaccination, if it comes to that. It's nothing at all like the horror stories from the older prophylaxis, which has been outdated for more than 40 years in most places. Plus, the good part is that it sets up a very robust baseline immune response that lasts for years and is fully reactivated by a booster.

**Not really applicable here, but there was actually a small outbreak of rabies among pet rabbits in Thailand about 10 years ago, with a number of people getting bitten and requiring vaccination. Add to that, Thailand is one of the very few places to have recorded failures of the prophylaxis (bad management of the cases or improper handling of the pharmaceuticals, Third World problems also not applicable here). I'm sure those people are going to avoid pet shops for a while after that experience.

[LittleLebowski]

I’d be more concerned about Hanta virus, but you’re fine.

[pangloss]

The most compelling reason that I can think of for not calling is that this is a relatively straightforward answer that can be found via any combination of Google searches. If Google is not your thing, then do what our grandparents did and rub some dirt in it. In fact, at least one member of this forum has hit the nail (or mouse) on the head. This was a little mouse juice - not a spitting cobra.

Moreover, people who keep accessing the healthcare system for trival shit end up with expensive, bad outcomes. For example, let’s say that his doctor doesn’t know shit about rabies and agrees that he needs the vaccine for this non-event. First, most doctors offices do not have access to the rabies vaccine, and it almost always involves a trip to the emergency department. The overhead for walking into the ED starts at about $1000 and goes up quickly. If he finds a unscrupulous emergency physician who is willing to administer this, the cost is not a few hundred, it’s several thousand. Like, tens of thousands of dollars. That is because the vaccine is administered with immune globulin (RIG) so that an exposed person has antibodies while they wait for their immune system to respond to the vaccine. This lady was billed $43,000 for rabies vaccine + RIG that she probably didn’t need. https://www.advisory.com/en/daily-briefing/2019/02/28/cat-bite

Then there is the issue of RIG itself - not a completely benign experience for an unfortunate few who get anaphylaxis or any of the other serious reactions.

Im sorry if Im being a dick. However, part of the reason why healthcare is exceedingly expensive is because people keep accessing it for trivial issues. They do this thinking, “oh, my insurance will pay.” Then, insurers don’t pay because it was bullshit (leading to the inevitable, “but my doctor said…”), have to jack up the prices for everyone else, or raise our copays. This dependence on someone telling us that it’s going to be OK needs to stop.

No apology necessary. I didn't consider the cost of the RIG. I've only had one animal bite (semi-stray cat) that required medical attention. I didn't use that to try to get the vaccine even though the the NP that I saw was very disturbed about me not being able to monitor the cat. I was sure thankful for the antibiotics though!

I know that the number of people in the US who die from rabies every year is in the single digits if not zero, but the unsettling thing to me is that some of those people don't know how they got rabies. To circle back to the point of this thread, none of the listed fatalities in the CDC's table appear to involve mice (LINK (https://www.cdc.gov/rabies/location/usa/surveillance/human_rabies.html)).

[Toonces]

Gentlemen,

Thank you for the responses. I feel silly that I didn't google the fact that mice are not carriers, but I knew those little buggers carried rabies. I am plenty happy to be wrong in public and look a little foolish. Hanta is exceedingly rare in WI (freshly researched), so that's not much of a concern.

As for not using the 10mm, I did the pliers thing because I've had escapes when trying to move rodents that were not well glued down. But next time I'll use a 12 gauge or 416 Rigby to make up for this situation.

Toonces

[Hambo]

Gentlemen,

Thank you for the responses. I feel silly that I didn't google the fact that mice are not carriers, but I knew those little buggers carried rabies. I am plenty happy to be wrong in public and look a little foolish. Hanta is exceedingly rare in WI (freshly researched), so that's not much of a concern.

As for not using the 10mm, I did the pliers thing because I've had escapes when trying to move rodents that were not well glued down. But next time I'll use a 12 gauge or 416 Rigby to make up for this situation.

Toonces

Throw trap in bucket of water.

[UNM1136]

I’d be more concerned about Hanta virus, but you’re fine.

A running joke at one of my wife's former employers, back when Hanta was nebulous mystery disease that was ravaging the Four Corners region (before DNA typing and pretty sure this discussion predated the actual, public accessible internet; think dial up modems, email and usenet) was that she wanted to create a unique, exportable New Mexico Foodstuff. She declared that she was going to wrangle Four Corners Deer Mice and milk them to produce.....

Drumroll.....

New Mexico Four Corners Hanta Pinon Cheese.

Little commercial interest was realized and the concept never got off the ground for practical reasons....

pat

[BobM]

I’d be more concerned about Hanta virus, but you’re fine.

That was the first thing I thought of too. I don’t really know how prevalent that is either though.

[Sensei]

No apology necessary. I didn't consider the cost of the RIG. I've only had one animal bite (semi-stray cat) that required medical attention. I didn't use that to try to get the vaccine even though the the NP that I saw was very disturbed about me not being able to monitor the cat. I was sure thankful for the antibiotics though!

I know that the number of people in the US who die from rabies every year is in the single digits if not zero, but the unsettling thing to me is that some of those people don't know how they got rabies. To circle back to the point of this thread, none of the listed fatalities in the CDC's table appear to involve mice (LINK (https://www.cdc.gov/rabies/location/usa/surveillance/human_rabies.html)).

No worries.

Cat bites are a completely different story and need antibiotics. I’m also a big proponent of severing the cat’s head to have the brain biopsied for rabies - even if it’s a neighbor’s domesticated cat. In fact, you may want to bring in a few heads of neighborhood cats to get tested and make sure rabies hasn’t spread. Just bring the bag of heads with you to the emergency department and we will do the rest…;).

[Hambo]

No worries.

Cat bites are a completely different story and need antibiotics. I’m also a big proponent of severing the cat’s head to have the brain biopsied for rabies - even if it’s a neighbor’s domesticated cat. In fact, you may want to bring in a few heads of neighborhood cats to get tested and make sure rabies hasn’t spread. Just bring the bag of heads with you to the emergency department and we will do the rest…;).

Sharpening my machete...

[Caballoflaco]

No apology necessary. I didn't consider the cost of the RIG. I've only had one animal bite (semi-stray cat) that required medical attention. I didn't use that to try to get the vaccine even though the the NP that I saw was very disturbed about me not being able to monitor the cat. I was sure thankful for the antibiotics though!

I know that the number of people in the US who die from rabies every year is in the single digits if not zero, but the unsettling thing to me is that some of those people don't know how they got rabies. To circle back to the point of this thread, none of the listed fatalities in the CDC's table appear to involve mice (LINK (https://www.cdc.gov/rabies/location/usa/surveillance/human_rabies.html)).

That CDC list sure would make me think about either trying to get the vaccine before going to central/South America or Asia, or at least cutting my trip short and going home for some sweet vaccination if I got hit by anything.

Around here we have a high raccoon population and you can’t really tell the difference between distemper and rabies when one is stumbling around in the middle of the day. That’s one reason there’s a company suppressed .22.

And since this post is a list of rabies related thoughts your state health department probably has a list of confirmed rabies cases by county and animal. The most interesting thing I saw for AL was that a couple of years ago the State health department had to deal with a rabid donkey.

[0ddl0t]

N=1 and all, but my sister had an exposure while working as a vet tech as an undergrad and got the vaccine (paid by worker's comp). She gets pretty much any vaccine she can and usually has no reaction, but she said the Rabies vaccine was "horrid" due to severe & prolonged injection site pain. The only other vaccine she found unpleasant was for Yellow Fever.


Incidentally, my region had one of the first well-documented rabies survivors (https://www.cdc.gov/mmwr/preview/mmwrhtml/mm6104a1.htm), but "survivor" is almost an overstatement since she was left with substantial life-long neurologic deficits.