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Hi There, I Was Talking To A Doctor On Here

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Posted on Sat, 10 Aug 2019
Question: Hi there,
I was talking to a doctor on here regarding exposure to a bat 6 weeks ago with no bites to be felt or seen. I did not get the rabies shot however he wanted me to still get it 6 weeks later. The only one available to be is the RabAvert (Dose day 1, 7, 21, 28) It is the preventative shot he told me it would help with past exposure. I also got my CBC count done to see if my white blood cells were elevated showing if my body was fighting an infection or not and all results were normal, he then told me that if even if I had rabies in my blood, my results would remain normal? Ive had 8 doctors tell me otherwise, that my WBC would be elevated during incubation period as well and that WBC are not subject to symptoms but to the infection inside your body. The other doctor told me that all that information was false. Basically Im trying to ask if I need the RABAvert preventative vaccine at 6 weeks time after exposure or if my blood results tell me that I am healthy and do not need it? I have also seen 2 GP in person that said that my blood work would have been abnormal so I dont need the vaccine. WHat do I do? Someone smart please help!
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Follow up: Dr. Dr. Antoneta Zotaj (0 minute later)
Hi there,
I was talking to a doctor on here regarding exposure to a bat 6 weeks ago with no bites to be felt or seen. I did not get the rabies shot however he wanted me to still get it 6 weeks later. The only one available to be is the RabAvert (Dose day 1, 7, 21, 28) It is the preventative shot he told me it would help with past exposure. I also got my CBC count done to see if my white blood cells were elevated showing if my body was fighting an infection or not and all results were normal, he then told me that if even if I had rabies in my blood, my results would remain normal? Ive had 8 doctors tell me otherwise, that my WBC would be elevated during incubation period as well and that WBC are not subject to symptoms but to the infection inside your body. The other doctor told me that all that information was false. Basically Im trying to ask if I need the RABAvert preventative vaccine at 6 weeks time after exposure or if my blood results tell me that I am healthy and do not need it? I have also seen 2 GP in person that said that my blood work would have been abnormal so I dont need the vaccine. WHat do I do? Someone smart please help!
doctor
Answered by Dr. Dr. Antoneta Zotaj (3 hours later)
Brief Answer:
WBC count can be increased or normal in Rabies, there is no single test that should guide the decision for the vaccine but the risk of exposure to Rabies.

Detailed Answer:
Hello and welcome to 'Ask A Doctor' service,

I read your query carefully and understand your concern.

Many patients with rabies have an increased WBC count during the time that the body is fighting the infection.

On the other hand, studies show that patients may have from normal to elevated WBC count so a normal WBC count is not a reliable index to rule out Rabies infection. There is no mention in the literature that we can safely rule out Rabies infection if the WBC count is normal.

If one checks CDC (Center for Disease Control), which is the most reliable resource when it comes to updated medical information for infective diseases, there is no mention there that CBC is a test that is conducted at all, neither to confirm or rule out Rabies infection. It is explicitly said that there is no single test is sufficient.

Actually, there is a wide list of tests mentioned there for this purpose such as tests of the saliva, blood, spinal fluid and skin biopsy (which are conducted on patients who are suspected to be developing the disease).

It is clearly stated though, that tests should never be used as a basis on which we determine if vaccination is started or not. This decision is made based on the risk of the event.

To conclude:

- I understand the confusion with different medical opinions, especially when it comes to such a condition as Rabies.

- Expert opinion is the weakest medical evidence if it is not fully supported in the most recent data

- CDC serves as a good source of information and nowhere there CBC is mentioned as a test to be conducted at all or to rule out Rabies infection or confirm it.

- Among the variety of tests mentioned it is clearly stated that there is no single test that determines if the vaccine is applied or not but determining how risky is the encounter.

- When it comes to vaccination, it is said that it has to be administered as soon as possible after a high-risk event (bats are a high-risk group). There is no maximum period of time after which the vaccine can not be given, but it is recognized that once Rabies symptoms appear the vaccine is unlikely to offer protection.

- When it comes to days 1, 3, 7, 14, (according to CDC), these should ideally be days referring to the day of the bite but if this is not the case, these days can be days from the first vaccine. Thus, if you start the vaccine now, then the next dose will be on day 3 from now, then day 7 from now, etc.

I hope this answers your query.
I remain at your disposal in case further medical assistance is needed.

Regards,
Dr. Antoneta Zotaj,
General and Family Physician


Above answer was peer-reviewed by : Dr. Arnab Banerjee
doctor
doctor
Answered by Dr. Dr. Antoneta Zotaj (0 minute later)
Brief Answer:
WBC count can be increased or normal in Rabies, there is no single test that should guide the decision for the vaccine but the risk of exposure to Rabies.

Detailed Answer:
Hello and welcome to 'Ask A Doctor' service,

I read your query carefully and understand your concern.

Many patients with rabies have an increased WBC count during the time that the body is fighting the infection.

On the other hand, studies show that patients may have from normal to elevated WBC count so a normal WBC count is not a reliable index to rule out Rabies infection. There is no mention in the literature that we can safely rule out Rabies infection if the WBC count is normal.

If one checks CDC (Center for Disease Control), which is the most reliable resource when it comes to updated medical information for infective diseases, there is no mention there that CBC is a test that is conducted at all, neither to confirm or rule out Rabies infection. It is explicitly said that there is no single test is sufficient.

Actually, there is a wide list of tests mentioned there for this purpose such as tests of the saliva, blood, spinal fluid and skin biopsy (which are conducted on patients who are suspected to be developing the disease).

It is clearly stated though, that tests should never be used as a basis on which we determine if vaccination is started or not. This decision is made based on the risk of the event.

To conclude:

- I understand the confusion with different medical opinions, especially when it comes to such a condition as Rabies.

- Expert opinion is the weakest medical evidence if it is not fully supported in the most recent data

- CDC serves as a good source of information and nowhere there CBC is mentioned as a test to be conducted at all or to rule out Rabies infection or confirm it.

- Among the variety of tests mentioned it is clearly stated that there is no single test that determines if the vaccine is applied or not but determining how risky is the encounter.

- When it comes to vaccination, it is said that it has to be administered as soon as possible after a high-risk event (bats are a high-risk group). There is no maximum period of time after which the vaccine can not be given, but it is recognized that once Rabies symptoms appear the vaccine is unlikely to offer protection.

- When it comes to days 1, 3, 7, 14, (according to CDC), these should ideally be days referring to the day of the bite but if this is not the case, these days can be days from the first vaccine. Thus, if you start the vaccine now, then the next dose will be on day 3 from now, then day 7 from now, etc.

I hope this answers your query.
I remain at your disposal in case further medical assistance is needed.

Regards,
Dr. Antoneta Zotaj,
General and Family Physician


Above answer was peer-reviewed by : Dr. Arnab Banerjee
doctor
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Follow up: Dr. Dr. Antoneta Zotaj (23 minutes later)
Hi there,
Thanks for your reply. So I did not feel the bat bite me nor see bites. There’s a very low chance of getting rabies as they haven’t found a bat in my town tested positive for rabies yet. It has also been 6 weeks since exposure and the vaccine costs 600 dollars not covered by insurance. Your saying that majority of people show an elevated wbc fighting infection correct?
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Follow up: Dr. Dr. Antoneta Zotaj (0 minute later)
Hi there,
Thanks for your reply. So I did not feel the bat bite me nor see bites. There’s a very low chance of getting rabies as they haven’t found a bat in my town tested positive for rabies yet. It has also been 6 weeks since exposure and the vaccine costs 600 dollars not covered by insurance. Your saying that majority of people show an elevated wbc fighting infection correct?
doctor
Answered by Dr. Dr. Antoneta Zotaj (16 minutes later)
Brief Answer:
Detailed answer below

Detailed Answer:
Hello and welcome back,

I understand that the vaccine is very expensive. There are programs that may offer support in case the vaccine is needed and the patient is not insured or is underinsured: https://www.cdc.gov/rabies/medical_care/programs.html

There are bite and non-bite exposures that are at high risk. You have not given many details of the exposure you had but the following link will give you detailed information to understand if your exposure was high risk or not. https://www.cdc.gov/rabies/exposure/animals/bats.html

Yes, many patients have raised WBC count but not all, so this should never be used as a guide towards the use of prophylaxis. The links I have sent will guide you to access more information on tests and the decision to have prophylaxis but as a rule of thumb, any high-risk encounter should warrant PEP (post-exposure prophylaxis).

I hope this answers your query.
I remain at your disposal in case further medical assistance is needed.

Regards,
Dr. Antoneta Zotaj,
General and Family Physician


Above answer was peer-reviewed by : Dr. Arnab Banerjee
doctor
doctor
Answered by Dr. Dr. Antoneta Zotaj (0 minute later)
Brief Answer:
Detailed answer below

Detailed Answer:
Hello and welcome back,

I understand that the vaccine is very expensive. There are programs that may offer support in case the vaccine is needed and the patient is not insured or is underinsured: https://www.cdc.gov/rabies/medical_care/programs.html

There are bite and non-bite exposures that are at high risk. You have not given many details of the exposure you had but the following link will give you detailed information to understand if your exposure was high risk or not. https://www.cdc.gov/rabies/exposure/animals/bats.html

Yes, many patients have raised WBC count but not all, so this should never be used as a guide towards the use of prophylaxis. The links I have sent will guide you to access more information on tests and the decision to have prophylaxis but as a rule of thumb, any high-risk encounter should warrant PEP (post-exposure prophylaxis).

I hope this answers your query.
I remain at your disposal in case further medical assistance is needed.

Regards,
Dr. Antoneta Zotaj,
General and Family Physician


Above answer was peer-reviewed by : Dr. Arnab Banerjee
doctor
default
Follow up: Dr. Dr. Antoneta Zotaj (1 hour later)
I know it’s not an accurate way to diognose. However, are you saying that most people’s WBC count was elevated as well in incubation phase even when they weren’t experiencing any symptoms but when the infection was just present in their body.
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Follow up: Dr. Dr. Antoneta Zotaj (0 minute later)
I know it’s not an accurate way to diognose. However, are you saying that most people’s WBC count was elevated as well in incubation phase even when they weren’t experiencing any symptoms but when the infection was just present in their body.
doctor
Answered by Dr. Dr. Antoneta Zotaj (15 minutes later)
Brief Answer:
Detailed answer below

Detailed Answer:
Hello and welcome back,

The information on WBC count in patients with rabies is very scarce as this is not a key test in diagnosis or follow up. Theoretically, the presence of the virus in the blood may cause increased WBC count in both the incubation period and during the infection. The incubation period is the time the virus is multiplying and trying to overcome the immune response of the host. Thus, the host is reacting to the infection even though the patient has no symptoms.
Practically, not all patients get increased WBC count.

There is no data available to say what exact percentage of patients get high WBC but is acknowledged that many do.

I would recommend you not to decide based on this examination. It really does not give any clue on how you should proceed further. It is not a reliable way to judge the need for vaccination.

I hope this answers your query.
I remain at your disposal in case further medical assistance is needed.

Regards,
Dr. Antoneta Zotaj,
General and Family Physician


Above answer was peer-reviewed by : Dr. Arnab Banerjee
doctor
doctor
Answered by Dr. Dr. Antoneta Zotaj (0 minute later)
Brief Answer:
Detailed answer below

Detailed Answer:
Hello and welcome back,

The information on WBC count in patients with rabies is very scarce as this is not a key test in diagnosis or follow up. Theoretically, the presence of the virus in the blood may cause increased WBC count in both the incubation period and during the infection. The incubation period is the time the virus is multiplying and trying to overcome the immune response of the host. Thus, the host is reacting to the infection even though the patient has no symptoms.
Practically, not all patients get increased WBC count.

There is no data available to say what exact percentage of patients get high WBC but is acknowledged that many do.

I would recommend you not to decide based on this examination. It really does not give any clue on how you should proceed further. It is not a reliable way to judge the need for vaccination.

I hope this answers your query.
I remain at your disposal in case further medical assistance is needed.

Regards,
Dr. Antoneta Zotaj,
General and Family Physician


Above answer was peer-reviewed by : Dr. Arnab Banerjee
doctor
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Follow up: Dr. Dr. Antoneta Zotaj (2 hours later)
Can walk in physicians do saliva tests to diagnose?
default
Follow up: Dr. Dr. Antoneta Zotaj (0 minute later)
Can walk in physicians do saliva tests to diagnose?
doctor
Answered by Dr. Dr. Antoneta Zotaj (9 hours later)
Brief Answer:
No test can confirm or exclude rabies before onset of symptoms- your doctor will need to discuss with the local public health authorities related to your case.

Detailed Answer:
Hello and welcome back,

Saliva test and other tests for rabies are very specific tests and are not ordered very often so it may happen that not all labs may be able to such tests.

You may see your doctor and discuss with him, it would be best if someone from public health would be consulted as they are equipped with the needed information on local statistics and latest recommendations and may give you a better guide as what should be done now, weeks after non-bite exposure to bates. As a rule, testing should be coordinated with the local health department so your doctor should contact them.

This is a portion that I took from literature:

1. contact state or local public health authorities and Centers for Disease Control and Prevention for assistance in rabies testing(2, 3)

2. no diagnostic test can confirm rabies infection prior to onset of clinical symptoms and negative test results do not exclude rabies(1, 4)

I hope this answers your query.
I remain at your disposal in case further medical assistance is needed.

Regards,
Dr. Antoneta Zotaj,
General and Family Physician
Above answer was peer-reviewed by : Dr. Nagamani Ng
doctor
doctor
Answered by Dr. Dr. Antoneta Zotaj (0 minute later)
Brief Answer:
No test can confirm or exclude rabies before onset of symptoms- your doctor will need to discuss with the local public health authorities related to your case.

Detailed Answer:
Hello and welcome back,

Saliva test and other tests for rabies are very specific tests and are not ordered very often so it may happen that not all labs may be able to such tests.

You may see your doctor and discuss with him, it would be best if someone from public health would be consulted as they are equipped with the needed information on local statistics and latest recommendations and may give you a better guide as what should be done now, weeks after non-bite exposure to bates. As a rule, testing should be coordinated with the local health department so your doctor should contact them.

This is a portion that I took from literature:

1. contact state or local public health authorities and Centers for Disease Control and Prevention for assistance in rabies testing(2, 3)

2. no diagnostic test can confirm rabies infection prior to onset of clinical symptoms and negative test results do not exclude rabies(1, 4)

I hope this answers your query.
I remain at your disposal in case further medical assistance is needed.

Regards,
Dr. Antoneta Zotaj,
General and Family Physician
Above answer was peer-reviewed by : Dr. Nagamani Ng
doctor
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Follow up: Dr. Dr. Antoneta Zotaj (52 minutes later)
Okay. Is it highly likely that if it did bite me say while asleep, that I would’ve felt something sharp and noticed the bite awake as an area that would be red itching/stinging or swelling right after the fact? And would not heal properly. It’s been 6 weeks I’m sure by now I would have noticed an obvious bite correct?
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Follow up: Dr. Dr. Antoneta Zotaj (0 minute later)
Okay. Is it highly likely that if it did bite me say while asleep, that I would’ve felt something sharp and noticed the bite awake as an area that would be red itching/stinging or swelling right after the fact? And would not heal properly. It’s been 6 weeks I’m sure by now I would have noticed an obvious bite correct?
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Follow up: Dr. Dr. Antoneta Zotaj (1 hour later)
Also. Would a physician be able to look at my body and determine if I had been bitten?
default
Follow up: Dr. Dr. Antoneta Zotaj (0 minute later)
Also. Would a physician be able to look at my body and determine if I had been bitten?
doctor
Answered by Dr. Dr. Antoneta Zotaj (1 hour later)
Brief Answer:
It will be very unlikely to notice the wounds now

Detailed Answer:
Hello and welcome back,

Bat bites may be in some cases not painful and some of them may have small teeth and cause very small wounds that may not be noticed by the patient. This is why if a person woke up in the morning and noticed a bat in the room this is considered high risk even though he may not have noticed wounds.

It is now 6 weeks and it would be almost impossible for a health worker to identify the bite sites now. Even soon after a possible event, a careful examination is needed in some cases as the bites may not be big noticeable wounds.

I hope this answers your query.
I remain at your disposal in case further medical assistance is needed.

Regards,
Dr. Antoneta Zotaj,
General and Family Physician
Above answer was peer-reviewed by : Dr. Yogesh D
doctor
doctor
Answered by Dr. Dr. Antoneta Zotaj (0 minute later)
Brief Answer:
It will be very unlikely to notice the wounds now

Detailed Answer:
Hello and welcome back,

Bat bites may be in some cases not painful and some of them may have small teeth and cause very small wounds that may not be noticed by the patient. This is why if a person woke up in the morning and noticed a bat in the room this is considered high risk even though he may not have noticed wounds.

It is now 6 weeks and it would be almost impossible for a health worker to identify the bite sites now. Even soon after a possible event, a careful examination is needed in some cases as the bites may not be big noticeable wounds.

I hope this answers your query.
I remain at your disposal in case further medical assistance is needed.

Regards,
Dr. Antoneta Zotaj,
General and Family Physician
Note: For more detailed guidance, please consult an Internal Medicine Specialist, with your latest reports. Click here..

Above answer was peer-reviewed by : Dr. Yogesh D
doctor
Answered by
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Dr. Dr. Antoneta Zotaj

General & Family Physician

Practicing since :2004

Answered : 4435 Questions

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Hi There, I Was Talking To A Doctor On Here

Hi there, I was talking to a doctor on here regarding exposure to a bat 6 weeks ago with no bites to be felt or seen. I did not get the rabies shot however he wanted me to still get it 6 weeks later. The only one available to be is the RabAvert (Dose day 1, 7, 21, 28) It is the preventative shot he told me it would help with past exposure. I also got my CBC count done to see if my white blood cells were elevated showing if my body was fighting an infection or not and all results were normal, he then told me that if even if I had rabies in my blood, my results would remain normal? Ive had 8 doctors tell me otherwise, that my WBC would be elevated during incubation period as well and that WBC are not subject to symptoms but to the infection inside your body. The other doctor told me that all that information was false. Basically Im trying to ask if I need the RABAvert preventative vaccine at 6 weeks time after exposure or if my blood results tell me that I am healthy and do not need it? I have also seen 2 GP in person that said that my blood work would have been abnormal so I dont need the vaccine. WHat do I do? Someone smart please help!