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About two weeks ago we found out we may have

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About two weeks ago we found out we may have a small colony of bats in our attic above our house. We have not seen any bats in the house but last Thursday we found two little marks on my 10 year old son's forearm. Out of abundance of caution we took him to the pediatrician and he thought the chances of it being a bite were very low since he had never seen a bat, or felt anything. He thought it was probably just scratches but wanted to be safe. When we were at the hospital getting his shots the nurses had me call the county health department just to ask if his father and I should be vaccinated too (there are only the three of us in the house). They said they usually suggest the entire household is vaccinated so we are all in the process of finished the entire series. Because bats are a protected species they can't be exterminated and can only be excluded using a process that seals all possible entry points on the house and leaves one way valves, so that they can get out and can't get back in. The problem is we are only in the end of January with snow on the roof, so we have to wait for the work to be done until there is weather making it possible, and then we have to wait for the bats to actually leave voluntarily, which doesn't happen until Spring. We went through the house and sealed up the interior as best possible, and like I said we have yet to see one in the house. But it's still scaring me to death to stay here, even though the wildlife management team says it's safe, lots of people get bats in their attic in NE and go through the same process. My question is about the vaccine we just received. It was the post exposure prophylactic series, so immunoglobulin and the series of vaccine shots. How long do the shots provide immunity to rabies? I know it's not forever, and I've read several different things, saying we should get booster shots if we have an exposure again, and also that it's 1-2 years immunity and we should be fine until they are sealed out. Just trying to get some clarification. Thanks!
Fri, 9 Feb 2018 in Infections
 
 
Answered by Dr. Bonnie Berger-Durnbaugh 55 minutes later
Brief Answer:
In high risk situations for continuous exposure, test antibodies at 6 m

Detailed Answer:
Hello and welcome,

I can understand your concern having had a bat in our attic (in Wisconsin). It came in the fall and left in the spring.

It sounds as though your son and the rest of you are well covered. The recommendations for follow up is based on the risk of re-exposure. And different people have different responses to the prophylactics so here are the guidelines according to "Human rabies prevention-United States, 2008: recommendations of the Advisory Committee on Immunization Practices. MMWR Recomm Rep 2008; 57:1". The MMWR (Morbidity and Mortality Weekly Report) is a function of the CDC (Centers for Disease Control). These are the most recent guidelines:

1. If:
Virus present continuously, often in high concentrations. Specific exposures likely to go unrecognized. Bite, nonbite, or aerosol exposure.
Typical population: Rabies research laboratory workers; rabies biologics production workers.
Recommendation: Primary course (of pre-exposure prophylaxis). Serologic testing every six months; booster vaccination if antibody titer is below acceptable level.*

2. If:
Exposure usually episodic, with source recognized, but exposure also might be unrecognized. Bite, nonbite, or aerosol exposure.
Typical population: Rabies diagnostic laboratory workers, cavers, veterinarians and staff, and animal-control and wildlife workers in areas where rabies is enzootic. All persons who frequently handle bats.
Recommendation: Primary course. Serologic testing every two years; booster vaccination if antibody titer is below acceptable level.*

3. If:
Infrequent exposure (greater than population at large)
Exposure nearly always episodic with source recognized. Bite or nonbite exposure.
Typical population: Veterinarians and animal-control staff working with terrestrial animals in areas where rabies is uncommon to rare. Veterinary students. Travelers visiting areas where rabies is enzootic and immediate access to appropriate medical care including biologics is limited.
Recommendation: Primary course. No serologic testing or booster vaccination.

4. If:
Rare (population at large)     
Exposure always episodic with source recognized. Bite or nonbite exposure.
Typical population: US population at large, including persons in areas where rabies is epizootic.
Recommendation: No vaccination necessary.

* Minimum acceptable antibody level is complete virus neutralization at a 1:5 serum dilution by the rapid fluorescent focus inhibition test. A booster dose should be administered if the titer falls below this level.


So- to answer your question, I would put your family in the infrequent or rare category. But if you are concerned, the highest level of caution would be to get your blood tested in 6 months for antibody level. The minimum coverage would be 6 months.
Above answer was peer-reviewed by
 
Follow-up: About two weeks ago we found out we may have 29 minutes later
Thank you so much! This is the most concise answer I have gotten and it helped a lot! I think my concern came from thinking we only had to worry about it if we actually saw/found a bat in the living space of our house, and hadn’t considered an unknown exposure. We were told to still report or try to catch a bat if it ended up inside the living space, even after the vaccine. But other than that not to worry about checking his skin and searching for possible rogue bats every night (my husband calls it my bat OCD). Your response has made me feel more comfortable following those instructions. Thank you so much!
 
 
Answered by Dr. Bonnie Berger-Durnbaugh 11 minutes later
Brief Answer:
Your welcome

Detailed Answer:
Your welcome! You are not alone in having "bat OCD" but you can rest assured that you and your family are covered now.

Best regards,
Bonnie Berger-Durnbaugh, MD
Above answer was peer-reviewed by
 
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