As some of us may recall, rabies was quite uncommon in New York years ago. In 1989, 55 animals tested positive. However, over the next four years, a "rabies tsunami" rolled northward from Pennsylvania and peaked in 1993 with over 2,700 confirmed animal cases. Since then, the incidence has been steadily falling. In the first quarter of 2014, 58 positives were reported out by Wadsworth Laboratory.

Two human deaths, one in 1993 the other in 1995 have occurred in New York. Maria Fareri Children's Hospital was named after one of the victims. Both cases were from bat rabies.

Three weeks ago, we received two calls on the same day. Both were relatively common scenarios. In the first case, parents reported that a bat had entered the bedroom where an 11 month-old infant had been sleeping. Fortunately, the parents were able to catch the bat and it tested negative. We recently had another similar scenario but the bat was not caught. That can be a sticky situation.

The second phone call came from the parent of an 11 year-old girl whose dog had been attacked by a raccoon. The girl had comforted the dog. In theory in this instance, the fur could retain some infectious saliva. If a child, after comforting the pet, touched their eye or other mucous membrane, the rabies virus could theoretically gain a foothold. The rabies virus gains access to the brain by traveling through nerve roots. When a child is bit or inoculated on the head, the incubation period can be short (e.g. 7-14 days). With a bite on the foot, incubation is much longer (e.g. 7 to 14 months).

The most common scenario we get calls about involves an unprovoked attack by a neighborhood dog. In most cases, these pets have been vaccinated but as a measure of precaution, are confined and observed for a period of 10 days.

The latest rabies vaccine, when given after exposure, requires only four shots given over the course of two weeks. In high risk situation, a dose of Rabies Immune Globulin is also administered (at least some in injected directly into the bite / scratch sites).  

A few weeks ago, Brendan Nyhan PhD from Dartmouth College and other co-authors published the results of their study on the effect of pro-vaccine messages on vaccination rates. Their research involved almost 1800 parents. The messages included photos of children with severe measles and evidence against the association of the MMR vaccine and autism.

What was the result? Did the messages increase the likelihood that parents would have their kids vaccinated? No - they actually had the opposite effect!

This is kind of a big deal since the CDC alone spends $8 to $12 million annually on pro-vaccine messages. Who knows how much the AAP and pharmaceutical companies ante up?

Why did this happen? One explanation offered is that parents simply do not trust the federal government. Given the rampant conflicts of interest among the FDA, CDC, and big pharma industry, this is an encouraging finding - most parents are pretty sharp.  In a NY Times article, Dr. Nyhan recommends that parents discuss the risks and benefits of vaccines with their pediatrician.   

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