Rabies Q

[Bacci]

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So I'm "lucky" enough that a few years ago I was bitten by a feral kitten, the bite was infected, and of course when I finally went to the hospital they insisted I get a rabies series. So, my question is: how long is this good for? I've heard different things. One of the doctors giving the shots told me it was good for life, while one of the vets I've worked with told me it's not, and that I would have to check my titers. So as far as getting a rabies series for vet school, does anyone know how you verify this?

 

[Willowhand]

If it's been a while, you should probably have your titer checked to find out if you need a booster.

 

[psilovethomas]

So I'm "lucky" enough that a few years ago I was bitten by a feral kitten, the bite was infected, and of course when I finally went to the hospital they insisted I get a rabies series. So, my question is: how long is this good for? I've heard different things. One of the doctors giving the shots told me it was good for life, while one of the vets I've worked with told me it's not, and that I would have to check my titers. So as far as getting a rabies series for vet school, does anyone know how you verify this?

Get a rabies titer. I heard it's less expensive than the booster (MSU runs titers for free!), not to mention less painful. But, yeah, rabies vaccines probably are not 'good' for life.
Also, if you are fortunate enough to have tricare, you will not have to pay anything for a vaccine/vaccine series.

 

[Bigcatlover]

Anyone know if it is more cost efficient to have the series done at the school's clinic vs at your regular doctor? Do most insurance companies cover rabies vaccs?

 

[No Imagination]

For the most part, if you are exposed (saliva, CNS tissue, ect) to a rabies positive animal (even if you are not bitten or scratched) - most hospitals will have you get post-exposure prophylactics (despite having a recent rabies vaccine and titers are not even run).

For me, I will probably just get a shot every 7-10 years; regardless of my titers - I don't really see the point in doing the titer test, as I am going to get a new vaccine even if they are adequate. Just not something worth messing around with.

(and there really has not been a lot of human clinical research done in terms of titer levels and areas of protection... what might be a sufficient titer for normal bites and scratches, might not be enough if you get bit in the face by a positive animal)

 

[Zany Tiger]

Anyone know if it is more cost efficient to have the series done at the school's clinic vs at your regular doctor? Do most insurance companies cover rabies vaccs?

My insurance company would not cover the cost of a pre-exposure series I needed for a program, I think do to the fact that it was voluntary. 🙁 Three shots at about $300 per shot. My normal doctor didn't even know that a pre-exposure series could be givin.

 

[quantized]

The new UC Davis insurance plan covers the rabies series now. I think it was something like a $10 or $15 copay per vaccination. It's a pretty good deal!

 

[Graduatedly]

My insurance company would not cover the cost of a pre-exposure series I needed for a program, I think do to the fact that it was voluntary. 🙁 Three shots at about $300 per shot. My normal doctor didn't even know that a pre-exposure series could be givin.

WOW - that's really expensive. Do most insurance programs make the patient swallow the cost for that?

Also, do many of you get vaccinated while volunteering? I haven't worked with clinics yet (only at the aquarium), but I'm going to start doing feral cat feedings (for a spay/neuter program) at my school. Any thoughts? I hope I don't get mauled by a vicious and rabid kitty

 

[Bacci]

If I recall correctly it was pretty expensive when I got it done. My insurance company covered a lot of it, but the remaining portion was still 😱. I don't remember the actual cost, other than it seemed outrageous at the time.

So, does anyone know if WI runs titers for free/reduced price? If not, how expensive is the test?

 

[squirrelsrule]

I paid $285 per shot to get mine. It wasn't covered because I got it so I could rehab rabies vector species, nothing wildlife rehab related was covered 😡.

 

[No Imagination]

It might also be worth noting that having your pre-exposure series (and documentation) can also go on a resume (probably under the "Other" section). As a future employer, I would certainly rather higher someone who had the vaccinations over someone who has not (even better if I didn't have to pay for it!)

 

[david594]

So, does anyone know if WI runs titers for free/reduced price? If not, how expensive is the test?

Local vet conference this weekend is doing them for $50 cash (no insurance involved). So not too expensive.

 

[LetItSnow]

For the most part, if you are exposed (saliva, CNS tissue, ect) to a rabies positive animal (even if you are not bitten or scratched) - most hospitals will have you get post-exposure prophylactics (despite having a recent rabies vaccine and titers are not even run).

This is the current standard of care, so it should be "all hospitals," not "most"....

If you are vaccinated, you will still receive post-exposure vaccine; it's identical to the pre-exposure in both nature and dosage. The only difference in post-exposure treatment is that you will not need the IG that would otherwise be given if you did not have pre-exposure vaccination. That's a nice thing, since the IG is a rather large volume that needs to be administered as near the exposure site as possible.

With regards to all the posts about costs - yes, it is that expensive. I had an interesting experience, though: when I found out the entire course of vaccination (3 doses, if I recall?) would run around $700, I called my insurance company. They told me it wouldn't be covered.

I went in to my doctor and had it done anyway. He billed it back to my insurance provider, who paid it without comment.

Go figure.

Anyone know how recent UMN will want my titer to be? I think my last one was in ... oh ... March or thereabouts (2010).

 

[variegata]

So, does anyone know if WI runs titers for free/reduced price? If not, how expensive is the test?

If you get the SHIP health insurance through the school, the vaccines are covered. I'm not sure about the titer, but I imagine they would be if the vaccines are.

 

[Willowhand]

I would recommend calling your insurance company to find out. I didn't expect mine to cover it, but they did 🙂

 

[eventualeventer]

If you have pre-exposure prophylaxis, you also have to get fewer vaccines after exposure.

YES, you should get vaccinated before working with feral cats (who may not all be vaccinated if there are regular immigrants to the colony), IMO. Unfortunately, many clinics do not pay for or require vaccinations for their paid help, let alone volunteer programs.

It's one thing that a doctor may not be current on pre-exposure recommendations - I've heard of vets who have had to ARGUE with doctors about POST-EXPOSURE prophylaxis for family members/clients who were exposed.

No Imagination, are you going to do any titers? I thought you were supposed to check a titer every couple years in case you were one of those people who didn't sustain immunity for very long. Yeah, I don't really understand why there are accepted titer levels in humans of all species but not in cats/dogs/etc. (well, some people use titers but most states don't accept them legally), where you COULD actually do challenge tests to determine a threshold.

 

[lareinesoleil]

WOW - that's really expensive. Do most insurance programs make the patient swallow the cost for that?

Also, do many of you get vaccinated while volunteering? I haven't worked with clinics yet (only at the aquarium), but I'm going to start doing feral cat feedings (for a spay/neuter program) at my school. Any thoughts? I hope I don't get mauled by a vicious and rabid kitty

It's never been required for me, but it might depend on your area.

 

[No Imagination]

This is the current standard of care, so it should be "all hospitals," not "most"....

Should be "All Hospitals", but I put most because you would be surprised. They don't all know what the current standard of care is. >95% of doctors (MD's) in the US, have never seen nor will they see, a rabies patient. It just not high on their radar, and they may or may not know the proper course of action. This is one of those cases where you the vet has to know more about it then the MD.

It's one thing that a doctor may not be current on pre-exposure recommendations - I've heard of vets who have had to ARGUE with doctors about POST-EXPOSURE prophylaxis for family members/clients who were exposed.

Great point!

Not just doctors and hospitals, but sadly enough, also health departments who are responsible for testing these animals (some departments actually have to be convinced to pick up and test a suspect animal).

Rabies is very scary, both from a health and life standpoint, but also from a liability standpoint. Don't want to reduce everything down to money, but I just read a story about a feral cat who bit someone in a vets office. The vet did the right thing in contacting the health department, and they initially didn't want to pick the animal up. It was positive!

Now what if the owners didn't want to relinquish the animal? The laws are very clear with what must be done (clear but hard to remember), I have a cheat sheet; goes into "Has the animal been vaccinated?" "Has the animal been bitten?" "Is the animal showing ANY signs?" - All these things determine course of action.

It really is up to you, the vet, to know more about rabies then any doctor, hospital or insurance administrator, and sadly enough, someone sitting behind a desk at the health department.

If you fail to do your job, you are legally and financially screwed!

No Imagination, are you going to do any titers? I thought you were supposed to check a titer every couple years in case you were one of those people who didn't sustain immunity for very long.

Honestly, I will probably just opt for a new series every 7-10 years. I may change my mind as I gain more experience/knowledge.

 

[sumstorm]

I thought current standard of care was titers ever 2 years.

As far as whether a clinic can require you to get a rabies vax post exposure, my understanding is that your vet clinic (ie veterinarian) can not make medical decisions for you. So while they can strongly recommend you seek medical attention and advise you to consider getting a rabies vax, I'm not sure they can actually dictate the medical care you recieve (but could notify the health department, which can then enact quarentine procedure if they deem it necessary.) They can require a rabies vax or titer for hiring purposes, but it would need to be across the board for a given level of staff.

Every state has different RV requirements. You need to know the requirements for the state you reside in, and most also allow state vets to make exceptions. At NCSU we are required to become state rabies vaccinators in our first semester.

I personally will get titers every other year. I will avoid having the vaccine again unless a titer indicates it is necessary, only because it puts me out of commission for 3-7 days, and that is a lot of time to be miserably sick laying in bed hurting. Unfortunatly, I don't titer well (my measles titer comes out low even when I have been vaccinated within the past 3 months) so I don't have a lot of hope that my titer will be strong.

The reason titers aren't accepted in pets is because of the public health concern; unlike distemper, parvo, etc, rabies is a disease that is readily zoonotic. I agree that rabies isn't a diseae we want to mess with. At NCSU you must have proof of vax or adequate titer within the past two years. I have to get titered this summer.

 

[No Imagination]

As far as whether a clinic can require you to get a rabies vax post exposure, my understanding is that your vet clinic (ie veterinarian) can not make medical decisions for you.

Yeah, I agree with you there (if that was in response to anything I said). All I meant is the veterinarian has to be the expert on the policies regarding rabies, can't expect the MD's or hospitals or even the health department in many cases to be up on it.

 

[that redhead]

So I'm "lucky" enough that a few years ago I was bitten by a feral kitten, the bite was infected, and of course when I finally went to the hospital they insisted I get a rabies series. So, my question is: how long is this good for? I've heard different things. One of the doctors giving the shots told me it was good for life, while one of the vets I've worked with told me it's not, and that I would have to check my titers. So as far as getting a rabies series for vet school, does anyone know how you verify this?

I got my rabies vaccines in 2006(?) and had to have my titers checked when I started working with bats in 2009. They were still good, as were my friend's who got his like, seven years prior or something. I'm planning to have to get a titer done again if I get accepted but I'd almost rather just get the booster because I hatehatehate having my blood taken 🙄 (In fact, my worst experience was getting blood drawn for the titer! The man from my university's health center couldn't get a vein in one arm and just RESTUCK ME in the other arm with the same needle. Sheesh.)

 

[Chinola]

My insurance (BCBS) does not cover the pre-exposure vaccines. I did everythingggg to try to convince them to cover it. I sent multiple appeal letters but no luck. They told me they'd cover the post-exposure which wasn't very helpful.

I found a place in South Florida that's $206 per vaccine for a total of $618 and that's what I'll probably end up doing. It's the cheapest I've heard of in this area.

 

[BuggerDoodle]

I would recommend checking with your local health department as well if you're going to be paying for the shots. Around here, the health department offers them for around $175 per shot. I'm working with my doctor to see if we can get my insurance to cover them but if not, I'm off to the health department!

 

[gone2dogs]

Related Q: Anyone with Kaiser HMO insurance ever get them to cover a pre-exposure series? Thanks!

 

[twelvetigers]

You could dig through this thread... a few people got it covered by insurance, but it seems like most did not.

http://forums.studentdoctor.net/showthread.php?t=712601

 

[gone2dogs]

You could dig through this thread... a few people got it covered by insurance, but it seems like most did not.

http://forums.studentdoctor.net/showthread.php?t=712601

Thanks, I'll dig!

 

[gone2dogs]

Related Q: Anyone with Kaiser HMO insurance ever get them to cover a pre-exposure series? Thanks!

Thanks to TT, I can now partly answer my question. On the linked thread, 2/3 people got Kaiser to cover the vaccine. Those are good enough odds for me to at least try!

 

[Jakesmom]

I have Medical Mutual of Ohio insurance and they said (at least in regards to my plan) that the vaccines are "covered", but only in the fact that they would count towards my annual deductible. I would still have to pay out of pocket for them👎
For Ohio State, if you plan on getting their health insurance, you get a $300 "pot" to use towards vaccinations (rabies, tetanus, etc.) The 3 shots cost a little over $200 each, but you wind up paying only half of it with the OSU insurance.

 

[NStarz]

I think I posted this on the other thread, but I got my rabies series last year (HBC/BS). I just submitted it without telling them (hehe) and they covered most of it. They may have thought it was a post-rabies series, but either way, I still got some money out of it. I had to pay out of pocket to begin with and was reimbursed some of the cost.

 

[bunnity]

Penn's student insurance covers them for free. Not sure if other schools do.

 

[pennyonthefloor]

Not just doctors and hospitals, but sadly enough, also health departments who are responsible for testing these animals (some departments actually have to be convinced to pick up and test a suspect animal).

It really is up to you, the vet, to know more about rabies then any doctor, hospital or insurance administrator, and sadly enough, someone sitting behind a desk at the health department.

^^ struck a nerve with me.... sorry for the following rant....

I know that the health depts in Ohio (at least) are quite responsive to potential rabies cases (have worked for two VERY different departments within the state-- one in a suburban area and one in an extremely rural setting).... Given that we have a huge rabies prevention program (to prevent raccoon rabies from spreading past PA and out west), a lot of HD's don't make light of the matter. There have been countless times where I've walked through environmental health's office and noticed a cooler packaged up to send to the state for testing....

I'd have to say the lack of response on the HD's part might be a reflection of state funding, politics and the state's concern about rabies. In Ohio we're looking at an enormous deficit and everyone in Public Health (and every other institution that relies on state funding) is mildly terrified of the new governor and what his cuts might mean....

Just trying to clear up that the lack of response from health departments might very well be few and far between rather than the norm. Most of the time they do the best they can with the resources they're given....

::steps off soap box::

 

[rosyreef]

^^ struck a nerve with me....

Just trying to clear up that the lack of response from health departments might very well be few and far between rather than the norm. Most of the time they do the best they can with the resources they're given....

👍👍

 

[sumstorm]

I'd have to say the lack of response on the HD's part might be a reflection of state funding, politics and the state's concern about rabies.

Just trying to clear up that the lack of response from health departments might very well be few and far between rather than the norm. Most of the time they do the best they can with the resources they're given....

I don't think anyone is suprised that limitations in resources are impacting everyone, including health departments, but those limitations aren't going away any time soon. The challenge results when we know what needs to happen (rabies testing on this animal due to human risk) and we can't get a HD to work with us to do so in an efficient or effective way. If a tragedy happens, and a loved one dies of rabies, we will be named in any consequential lawsuits, even if we did everything to the letter, and the HD elected not to test. HD's do vary greatly from state to state and region to region.

My husband lives just over a state line...and the response to rabies is 100% different. When I was bit in the face by a sick dog that was NOT current on RV, the responsibility to investigate fell on the AC's. Now, the strength of a response falis on its weakest component, and in that county it is AC. They were under the impression that as long as the DOG was vax'd that day, there was 0 risk to the human. That dog was euth'd at an emergency clinic 48 hours later for end stage renal failure (that was why he was here as well) and nothing was submitted. Owner signed a form stating dog hadn't bit anyone in the past 7 days. We didn't find out about it till after the body was at a crematorium when we recieved the records from the emergency hospital. I don't know where exactly the failing occured; the AC's were all HS drop outs, so can I blame them for not understanding rabies? did they have adequate training? The owner that lied? or was he too grief stricken to even read the form? Did the staff at the emergency clinic not ask the appropriate questions? Should the human doctors have done more (face bites are of greater risk.) Should the vet I worked for insisted on a quarentine or euth/test immediatly?

I don't know the answers, but I'm pretty sure if I was someone's kid that got bit, fell ill, died (I wasn't vax'd at the time) there would have been a big lawsuit, lots of complaints to licencing boards, and consequences, so regardless of how good or bad a particular HD is, as professionals we are going to have to be on our game to ensure human safety and protect ourselves. I doubt 'the HD didn't prioritize it' will be an adequate excuse.

 

[Pelagia]

So at NCSU, the shots cost $192 each. I was contemplating getting them before school (because it might be easier/more convenient for me to do it now, and if I had a vaccine reaction, I would rather have it now than during vet school), BUT I most most definitely be waiting until I get to school to get them. My physician's office doesn't offer it, only the passport/travel health clinic does, and they are $275 per shot, not to mention a $37 office visit and $15 vaccine administration fee! 😱 Say what? Makes the $192 seem cheap in comparison, especially since the price can partly be covered by the student insurance.

 

[Savethewhales]

I noticed someone mention a veterinary conference offering the shot for $50. How exactly does that work since this vaccine is a series of three and the third one is supposed to be given 30 days from the first?

 

[david594]

I noticed someone mention a veterinary conference offering the shot for $50. How exactly does that work since this vaccine is a series of three and the third one is supposed to be given 30 days from the first?

They offer titers, not shots.

 

[Savethewhales]

Ah thanks! see what happens when you try to read through an entire thread with too little time.

I looked into my undergrad school (got the idea from this thread) and found I can get rabies there a bit cheaper. Not sure why I didn't think about checking there before...

 

[squibby]

Found this on Ohio's "Incoming Class" page:

***It is not mandatory to complete the Immunization Record Form by August 31st. The rabies vaccine series is to be completed by the end of your first year. There is currently a temporary shortage of rabies vaccine. This means the rabies vaccine will only be given to those who have an animal bite or some other possible exposure to rabies. The rabies shortage should be over by Fall Quarter. We should be able to provide the pre-exposure vaccine on schedule in the Winter or Spring.

 

[LetItSnow]

Found this on Ohio's "Incoming Class" page:

***It is not mandatory to complete the Immunization Record Form by August 31st. The rabies vaccine series is to be completed by the end of your first year. There is currently a temporary shortage of rabies vaccine. This means the rabies vaccine will only be given to those who have an animal bite or some other possible exposure to rabies. The rabies shortage should be over by Fall Quarter. We should be able to provide the pre-exposure vaccine on schedule in the Winter or Spring.

I wonder if that's outdated? There *was* a vaccine shortage a couple years ago. When I started volunteering at the hospital (2 years ago) it was recommended, but when I looked into it I found it hard to come by. One year ago when I started in wildlife rehab it was required. When I went to get it at the doctor, he mentioned that it was recent that it was back in widespread availability.

Or are we back to a shortage of supplies again?

Or is this a vaccine that always fluctuates in availability due to lower demand?

 

[squibby]

I wonder if that's outdated?

I wouldn't be surprised if you are right.

 

[pennyonthefloor]

Found this on Ohio's "Incoming Class" page:

***It is not mandatory to complete the Immunization Record Form by August 31st. The rabies vaccine series is to be completed by the end of your first year. There is currently a temporary shortage of rabies vaccine. This means the rabies vaccine will only be given to those who have an animal bite or some other possible exposure to rabies. The rabies shortage should be over by Fall Quarter. We should be able to provide the pre-exposure vaccine on schedule in the Winter or Spring.

I'm just wondering what the cost will be through the university versus if I were to get it right now. I have good health insurance now and have begun trying to find out what it would cost for me on my own insurance.... Does anyone know if OSU's CVM offers it at a discounted rate or through OSU's hospital system?

 

[squibby]

Does anyone know if OSU's CVM offers it at a discounted rate or through OSU's hospital system?

I have Medical Mutual of Ohio insurance and they said (at least in regards to my plan) that the vaccines are "covered", but only in the fact that they would count towards my annual deductible. I would still have to pay out of pocket for them👎
For Ohio State, if you plan on getting their health insurance, you get a $300 "pot" to use towards vaccinations (rabies, tetanus, etc.) The 3 shots cost a little over $200 each, but you wind up paying only half of it with the OSU insurance.

.

 

[pennyonthefloor]

.

Sorry I missed that.

 

[squibby]

Sorry I missed that.

That's OK.

I think I am going to forget about the rabies vax until I get to Ohio.

 

[Armymutt25A]

...I'd almost rather just get the booster because I hatehatehate having my blood taken

Just had shot number one yesterday. No issues there. I'm not a fan of being bled on purpose. After 10 anthrax shots, yellow fever, small pox, flu, and tetanus, my injection site (left bicep) has become quite accustomed to being jabbed. My veins and I would prefer to be left alone. I only like to bleed from capillaries.

 

[thedogisgreen]

Trying to decide if I should get my rabies pre-exposure series now or after I travel. My two school options remaining at this point are Illinois (accepted) and Davis (will find out in several weeks). Illinois' insurance doesn't seem to cover the series, whereas Davis does. From research I've done, it looks like my current insurance will cover the vaccination in part but I won't know the details until after I've paid everything upfront, everyone says that someone else knows what to do about it. I'm leaving for abroad in less than two months and will be gone until not too long before school starts. Do schools fuss if you don't start your series until classes have started/does this pose a problem in participating in activities for the first 3 weeks? I figure it would be easier to get it done once school is started because everything will be right there and they will be used to dealing with this, people on the phone thought I was crazy asking for a rabies vaccine. What do you guys recommend from past experiences, now or later?

 

[eventualeventer]

I don't know about Illinois, but at Davis they have special rabies days in the first few weeks of the quarter where all the first years who haven't gotten their series yet go to the health center to get vaccinated en masse. You don't actually have to have it done before you go.

 

[AngSchmange]

Think I'll still have to rush to get the Rabies vaccine if I go to school at RVC in London? hehe. Since they don't have Rabies there and such.... 😀

 

[eventualeventer]

If you don't, though, you might have to sit in a quarantine kennel for a while. 😀

 

[that redhead]

What do you guys recommend from past experiences, now or later?

Depends how early before you travel. I was stay-at-home-beridden sick because of my vaccines and I've known others (though not all) who have had similar reactions. I think it took a couple of days and then I was fine. I'd hate for your trip to be ruined/cancelled/delayed because of a reaction 🙁