All- Thought I'd chime in here. Rabies pre-exposure series is now four specifically timed shots of antigen -usually runs a few hundred dollars (~five hundred for the series would be a rough ball-park, but varies). Duration of response to the pre-exposure series also varies - you can get titers drawn every few years and a booster as needed. Post exposure, for those that have already had the rabies vaccination is one or two boosters of the same antigen vaccine. Because of the lack of challenge studies and imperfect association of titers in a cell-mediated process, booster(s) after a know exposure are recommended for all vaccinated people regardless of recent titer status. Post-exposure, for unvaccinated people, is a dose of immunoglobulin plus the full antigen vaccine series given over the following month. Immunoglobulin (RIG) is very expensive. 30 years ago, the post exposure series with RIG was at least a few thousand cost to the local health department. I'm not surprised if the cost to the patient through an ER is now several thousand as reported, depending on the county and specific circumstances. Many counties health departments cover the cost of post-exposure for those that need it. I had a post exposure series as a kid- 27 years later my titer is still high without booster. YMMV. My peers (vets and some army) are routinely given the pre-exposure series and titers generally remain high without regular re-vaccination, though boosters are not unheard of. Rabies risk to cavers is low as long as you don't handle bats or get bitten, but bat bites can go unnoticed. I know there's tenuous suggestion for air exposure (something non-caver public health professionals regularly cite) but given the number of unvaccinated caving hours out there in bat caves, without rabies cases (NSS publication at one point) risk is minimal if you don't have direct contact with the bats. Histo is a much bigger likelihood from aerosol if present. If you're interested in pre-exposure vaccine, or think you were exposed, start by calling your county health department. They're probably more up to date on rabies than your local physician. Disclaimer: if your physician or circumstances dictate otherwise, then don't believe everything you read on a disto list ;). Back to lurking.
Kelly Still Brooks (DVM, MPH, DACPM) NC currently Sent from my iPad On Feb 20, 2012, at 5:12 PM, Fritz Holt <[email protected]> wrote: > In my younger days (1950’s) I had quite a few free-tails swirling around me > with a few hits while on some summer trips into Frio Cave. I had not heard of > histo and apparently not concerned about rabies. I had a lot of fun and > ignorance was bliss. Lucky is my middle name for many reasons. > > Fritz > > From: Preston Forsythe [mailto:[email protected]] > Sent: Monday, February 20, 2012 12:43 PM > To: [email protected]; R D Milhollin > Cc: Jim Kennedy > Subject: Re: [Texascavers] Cost of Rabies Shots > > Thanks RD for checking as I was hoping the Miami price was inflated. I did > double check the Miami Audubon article and it cost the author $27,000.00. > > I would certainly hope the vaccine would be cheaper in TX and KY. I was > wondering if it would even be available in KY? > > When Crash gets time maybe he can enlighten us on the costs, procedures and > availability. I bet Crash has had the vaccines. Wonder how long the shots are > good for? > > There have been several times in my caving days when I was surrounded by > bats, swimming in thick guano covered water, not to mention walking, wading > and crawling in deep guano. > > Guano Go Caving, > > Preston > ============================================= > ----- Original Message ----- > From: R D Milhollin > To: Preston Forsythe ; [email protected] > Sent: Monday, February 20, 2012 11:55 AM > Subject: Re: [Texascavers] Cost of Rabies Shots > > Preston, that cost figure seemed a little out-of-range, so I took 4 minutes > to look around for other information to confirm or refute the article's claim. > > > This is from the North Dakota public health website: > > http://www.ndhealth.gov/disease/Rabies/QandA.htm > > "How much does rabies vaccine cost? > Rabies vaccine and immunoglobulin is very expensive. A typical vaccination > series with the rabies immunoglobulin can cost anywhere from $2,000 to > $7,000+ per person." > > and from a North Carolina new program: > > http://www2.nbc17.com/news/2011/jun/30/rabies-shots-are-expensive-hard-find-and-time-cons-ar-1169155/ > > "If you think the long wait and multiple visits are tough to handle, the > hospital bills are worse. Hutton said the first treatment resulted in a bill > of $10,289. But why so much? > The cost of the ER facility is only 7 percent of the bill, but then you need > a vial of immunoglobulin. That's where the big money factors in. Depending on > its weight, a vial of immunoglobulin can cost upwards of$1,500. According to > Rex Hospital Emergency Room supervisor Sherry Witt, immunoglobulin is like > liquid gold. > According to Rex, in Hutton's $10,000 bill, that one shot was 80 percent of > the bill -more than $8,000 for that one shot." > > So my unscientific, cursory survey of the information on the internet seems > to show that while very expensive, the figure quoted by the Miami Audubon > seems somewhat inflated, by a factor ranging from 2 to 4 times. What would be > more informative for us would be what Texas health providers charge for the > treatment. > From: Preston Forsythe <[email protected]> > To: [email protected] > Sent: Monday, February 20, 2012 10:23 AM > Subject: [Texascavers] Cost of Rabies Shots > > According to an article in the Miami Tropical Audubon Society newsletter, > Spring 2011, five rabies shots cost---$27,000. > > The author one evening picked up a "little fluttering thing," a bat, which > bit her repeatedly between the thumb and forefinger. After 3 days she > "yielded to reason (and fear)" and went to the doctor. Regular doctors do not > stock rabies vaccine so she had to go to the Emergency Room. She received > Five shots in the upper arm, painless, and a bill for $27,000. But, that > prevented the possible rabies virus from migrating to the brain, where it is > always fatal. > > The bat was a Brazilian Free-Tailed bat and it lived for 3 days, hence the > shots. > > The author says if you must handle bats wear heavy gloves. > > By the way the Tropical Audubon Society headquarters in sw Miami at Coral > Gables is a great place to visit. Lots of birding in that very tropical and > jungle like area. > > Cavingly, > > Preston in KY > > --------------------------------------------------------------------- > Visit our website: http://texascavers.com > To unsubscribe, e-mail: [email protected] > For additional commands, e-mail: [email protected] > >
