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Worried about rabies

Posted by roro1990 on 13/11/2013 at 01:40

I'm currently on an 8 week trip in SE asia and im really scared that ive contracted rabies. I have been here 5 weeks, to Thailand, Laos and now Cambodia. I'm 99.99% sure I haven't been bitten by a dog, I have also not hung out near any caves but I have a feeling I could have possibly been bitten by a bat. I recall a stinging pain on my neck after a bite from what I thought was some kind of flying insect on the slow boat to luang prabang which I didn't think much of at the time but now it's all i'm thinking of. I've read of rabies starting off with chills or parasthesia which I have had for the last 2 days, coupled with really bad anxiety. I know if I have rabies im a dead man walking, but im wondering is the best thing to book a flight home? It's either skip Siem Reap and go to BKK for rabies tests, or skip Siem Reap and fly home.

#1 roro1990 has been a member since 9/8/2013. Posts: 38

Posted by DLuek on 13/11/2013 at 06:57 TF writer

If you really think you've contracted rabies, please go to Bangkok ASAP to get tested. Samitivej Sukhumvit Hospital or Bumrungrad Hospital are both excellent. You don't mention where you are right now, but if possible, I'd be on the next flight if I were you.

#2 DLuek has been a member since 19/6/2008. Location: Thailand. Posts: 1,148
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Posted by DLuek on 13/11/2013 at 07:02 TF writer

Or you could go to Royal Angkor Hospital -- http://www.royalangkorhospital.com/en/default.asp -- in Siem Reap , which is associated with Bangkok Hospital. I suppose that would be the fastest way to get tested, and it sounds like you'll need to go to Siem Reap before anything else anyway, so you might as well stop in and get tested immediately.

#3 DLuek has been a member since 19/6/2008. Location: Thailand. Posts: 1,148
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Posted by roro1990 on 13/11/2013 at 21:59

I'm currently in Siem Reap. As a side note, I've always struggled with health anxiety and when i was 14 developed irrational fears of having cancer and other diseases. But that was 6 years ago so now I find myself in the unfortunate catch 22 of not knowing whether my sympotms are caused by anxiety, or actually caused by rabies. I was on the verge of booking a flight to BKK just now, not sure what to do!

#4 roro1990 has been a member since 9/8/2013. Posts: 38

Posted by DLuek on 14/11/2013 at 08:57 TF writer

Like I said in my second post, Royal Angkor Hospital in Siem Reap would be a fine place to get tested.

#5 DLuek has been a member since 19/6/2008. Location: Thailand. Posts: 1,148
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Posted by Tilapia on 14/11/2013 at 13:29

Roro (and DLuek),

There is no quick and easy test for rabies on living creatures. If you went to Bangkok, or even home, you would most likely be given what is called "post-exposure treatment" which would consist (depending on your weight) 4-6 shots of immunoglobulin (IGG), as well as 5 shots of vaccine spread over a 4 week period. This would likely be done whether there was virus transmission or not as there is usually no way of knowing. Treatment is provided based on one's word or say-so when there is no animal available for testing.

Keep in mind some facts. Bats are nocturnal, so while it's not impossible, it's very unlikely that you were bitten by one on the boat to Luang Prabang as the boats do not operate at night (unless coming into LP later than usual.) It's true that rabid animals behave atypically, but a sick bat flying around on a crowded boat in the daytime would be extremely rare. It's equally unlikely that you would NOT have noticed a bat clinging to the back of your neck and biting you. They are not like ticks or bed bugs ... you know when they are on you and you know when they bite. The boats are quite jammed, if I remember correctly, so it would also have been very unusual if someone else hadn't noticed, or noticed and then did not say something to you. There would, at least, been a little commotion, no? People often freak out when a bat is flapping around their heads.

The virus, when transmitted, cannot create any symptoms until it reaches the brain, so the closer to the head the shorter the time before the virus reaches the brain and manifests itself. The policy for rabies post-exposure treatment where I work (in public health in Ontario, Canada) is that face/head/neck bites require immediate post-exposure treatment regardless of whether-or-not the animal in question is available for testing. So, if you're in Siem Reap now, it must have been some time since you think you were bitten and, if so, you would probably be in much worse shape by now. If bitten on an arm or leg, it's possible to hold-on for up to around 3 weeks before getting treatment. Not so with head-bites.

So, keep these things in mind. You weren't bitten by a dog or any other domestic animal that you're aware of. You would have noticed if you were bitten by a monkey. There is the unlikeliness of a bat biting in the daytime on a crowded boat. The unlikeliness of you not noticing the thing on your neck. The unlikeliness of others not noticing, or noticing and not saying anything.

But if you really aren't sure about anything and you can't focus on your trip without worrying, then post-exposure treatment is the only way to go, and the best place for that is going to be Bangkok and you should get there without delay. Keep in mind that you MUST complete the entire series of shots for them to be effective and that takes 4 weeks as you will require shots of vaccine on Day 0, Day 3, Day 7, Day 14, and Day 28.

And just so you know, it is possible to begin treatment in one place and finish it in another, but make sure you get the paperwork from the hospital stating what has been done and when.

Hope that helps.

#6 Tilapia has been a member since 21/4/2006. Location: Canada. Posts: 1,491
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Posted by MADMAC on 17/11/2013 at 05:42

Man, he hasn't posted back since August 9th. I wonder if he's dead.

#7 MADMAC has been a member since 6/6/2009. Posts: 6,957

Posted by Tilapia on 17/11/2013 at 10:22

I think if that was the case, we'd all have found out by now. Let's hope it was just the anxiety and/or a bit of a fever talking and nothing more.

#8 Tilapia has been a member since 21/4/2006. Location: Canada. Posts: 1,491
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Posted by exacto on 17/11/2013 at 10:34

he joined on august 9th but posted at least twice on november 13th, so it hasn't been too long since we last heard from him. roro, are you still out there? how are you doing?

based on Tilapia's post above, it doesn't sound like rabies to me either. but i wonder if it could be something else that you might pick up in southeast asia from a mosquito bite or such. then again, it could be nothing - just the normal wear and tear from backpacking it around thailand, laos, and cambodia. i had something similar pop up in nepal once, and a few hot lemons and a good night's sleep later, it was gone. hopefully it's just a bit of fever and roro is better now.

#9 exacto has been a member since 12/2/2006. Location: United States. Posts: 2,630
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Posted by roro1990 on 17/11/2013 at 11:41

I'm still alive yes, but feeling weird. Had a full blown moment of panic and booked a flight home because I was so scared. If it wasn't a bite on my neck, I've convinced myself that I must have been bitten elsewhere such as my leg when I was drunk or when I slept in a bungalow one night when the door wasn't closing properly. I have a feeling like a tight band around my head, so scary. I'll go to ER tomorrow

#10 roro1990 has been a member since 9/8/2013. Posts: 38

Posted by LeonardCohen1 on 17/11/2013 at 18:11

If it was a bat you'd know about it. Might be dengue. Bat bites can kill u though - there's a disease that has been kiling horses called hendra virus that also kills people.

#11 LeonardCohen1 has been a member since 24/7/2012. Posts: 2,148

Posted by MADMAC on 18/11/2013 at 04:49

Well Roro, keep us up to date man. Let us know how you are.

#12 MADMAC has been a member since 6/6/2009. Posts: 6,957

Posted by Tilapia on 18/11/2013 at 08:15

People don't become infected with the Hendra virus through bats, and even if they did the bats that carry the virus are the largest bats in the world. You'd have to be really hammered not to notice a Flying Fox on the back of your neck or leg.

#13 Tilapia has been a member since 21/4/2006. Location: Canada. Posts: 1,491
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Posted by roro1990 on 21/11/2013 at 10:30

so i got mri, blood tests and nerve conduction tests which were all fine. I know rabies wouldn't show up in any of them but the doctors didnt consider it a possibility and im still alive so it was probably just a bout of severe anxiety.

#14 roro1990 has been a member since 9/8/2013. Posts: 38

Posted by exacto on 21/11/2013 at 11:38

here's hoping you are feeling better. glad to hear the tests were all fine. regards.

#15 exacto has been a member since 12/2/2006. Location: United States. Posts: 2,630
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Posted by antoniamitchell on 21/11/2013 at 13:01

Glad to hear the doc checked you out as fine. Hope you can go back to enjoying your trip without any more anxiety.

#16 antoniamitchell has been a member since 13/5/2012. Location: Singapore. Posts: 476
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Posted by karibou on 30/12/2013 at 19:25

Just fyi, I have an anecdote about bat bites... Our travel medicine clinic insisted that my husband, my kids and I get the full series of post-exposure rabies shots after we saw a bat (resembling a Luna moth in the dark) flitting around our beds in a vacation cabin in a part of Northern California where the disease had been identified in animals. None of us had felt the pain of an obvious bite, but the doctor said bats can have such fine teeth that we could have slept right through it. My husband killed the bat with a broom and put it it the freezer to preserve it for testing, but the tissue didn't hold up, so we had to have the shots just to be safe. Bottom line: bat bites might not always be obvious, and the CDC apparently recommends shots if there was even a remote chance of exposure.

#17 karibou has been a member since 14/2/2013. Posts: 63

Posted by Tilapia on 2/1/2014 at 12:19

That used to be the case in Ontario, but the Ministry of Health and Long Term Care changed the definition of "exposure" due to the ridiculously high number of people coming in for shots, two massive shortages of rabies vaccine that resulted, and the cost to the health system (at around $1200 plus per person for a full course of shots.)

There is one exception to this, and that is when a bat is found flying in the "closed" room of an infant.

Other exceptions can be made, such as when someone wakes up and finds a bat behaving strangely in the room. But if a bat is flying normally, circling the room or doing figure 8's, then the odds are very good that the animal is perfectly healthy and just trying to find a way out.

Since changing the definition of exposure a few years ago the number of post-exposure treatments has plummeted, vaccine supplies have stabilized, and nobody has contracted the disease.

#18 Tilapia has been a member since 21/4/2006. Location: Canada. Posts: 1,491
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