rabies vaccine medical malpractice

[alco]

My wife was scratched at the back of her hand by our cat. The cat reached for the food she is feeding to the cat and its claw causes the scratch. There is a slight bleeding. My wife immediately go to the hospital of fear or rabies infection. The first hospital referred her to a bigger hospital where the anti-rabies vaccine is available. The doctor administered the anti-rabies vaccine and she has to come back for 3 more shots in a span of 2 weeks. My wife is terrified of injection needles and has to suffer several shots. From what I know, if you are bitten by your house pet, you quarantine the animal and observe for 10 days if it dies or get sick. If the animal dies during this period, then lab would examine if for rabies infection. If rabies is found, then the person bite victim get the shots. Nurses and doctor know that our house cat is healthy. 2 weeks passed, my wife get the last of 4 injections and our cat is healthy as usual. I tried to tell them the vaccine to my wife is unnecessary but nobody believe me. They say the doctor know better. Should the doctor know about it and advice the patient against getting the unnecessary injections? Does this qualify as medical malpractice?

[Xircal]

Definitely not medical malpractice. The Center for Disease Control recommends one immediate shot of immune globulin followed by four shots of rabies vaccine. http://www.cdc.gov/rabies/exposure/

 

So it sounds like the doctor treating you was following standard procedure even though your pet appears to be healthy.

[lopburi3]

This is what the CDC website actually says.

http://www.cdc.gov/rabies/exposure/animals/domestic.html

Domestic Animals

Cats, dogs and ferrets

If you were bitten by a cat, dog, or ferret that appeared healthy at the time you were bitten, it can be confined by its owner for 10 days and observed. No anti-rabies prophylaxis is needed. No person in the United States has ever contracted rabies from a dog, cat or ferret held in quarantine for 10 days.

If a dog, cat, or ferret appeared ill at the time it bit you or becomes ill during the 10 day quarantine, it should be evaluated by a veterinarian for signs of rabies and you should seek medical advice about the need for anti-rabies prophylaxis.

[impulse]

11 minutes ago, lopburi3 said:

This is what the CDC website actually says.

http://www.cdc.gov/rabies/exposure/animals/domestic.html

Domestic Animals

Cats, dogs and ferrets

If you were bitten by a cat, dog, or ferret that appeared healthy at the time you were bitten, it can be confined by its owner for 10 days and observed. No anti-rabies prophylaxis is needed. No person in the United States has ever contracted rabies from a dog, cat or ferret held in quarantine for 10 days.

If a dog, cat, or ferret appeared ill at the time it bit you or becomes ill during the 10 day quarantine, it should be evaluated by a veterinarian for signs of rabies and you should seek medical advice about the need for anti-rabies prophylaxis.

 

Huge difference between the USA, which is virtually rabies free in pets, and Thailand which is anything but.

 

Risk a horrible death for fear of a jab, or to save a few hundred baht?  Not a good idea.

 

The incubation period for rabies in cats can be up to a year.  I have no clue whether the cat can pass on the disease before it shows symptoms, but why chance it?

 

The 10 days probably comes from the typical time between the onset of rabies symptoms to the death of the critter, but it can be up to a year between the cat getting infected and onset of symptoms.  Typically 3-8 weeks, but up to a year.

Edited October 28, 2016 by impulse

[lopburi3]

I corrected a post claiming that CDC recommends below for pet bite - in this case there was not even a bite.

Quote

The Center for Disease Control recommends one immediate shot of immune globulin followed by four shots of rabies vaccine. 

 

[alco]

I read somewhere that rabies virus go to the saliva only when the animal is showing symptoms of rabies infection and will surely die within 10 days. During the incubation period, it is not possible to pass on the disease through saliva. In our case, it is not even a bite but a tiny scratch. But the medical authorities said that's just the same with a bite since cat often licks its claws. Just made me think that everyone in Thailand going to the hospital with cat scratch is getting a course of anti-rabies shots? That does not seem right.

 

 

Edited October 28, 2016 by alco

[Sheryl]

If this was just a scratch and the cat did not lick the scratched area or drool on it, vaccination was not indicated. The rabies virus is transmitted through saliva. However, this does not  remotely qualify as malpractice. No harm was done (in fact, your wife now has some immunity and should she subsequently be bitten by a stray dog etc would need no or fewer injections depending on how long afterwards it occurs).

 

If it had been a bite, which it evidentally wasn't, relevant factors to consider re rabies risk are (1)  has your cat had been regularly vaccinated for rabies and (2) Is the cat allowed to go outsides?

 

An unvaccjnated cat which is allowed to go outside, even though it is your pet, could be bitten by a rapid animal and carry rabies even before it appears sick.

 

 

 

[Pib]

Why in the world would you say "medical malpractice" because the hospital recommend rabies injections to play it safe and especially since the wife is so concerned about rabies.   Just because a pet is a  "house pet" in Thailand does not mean it couldn't have gotten rabies from some critter biting it outside....I assume you do let it outside sometimes.   Thailand is by far not a rabies-free country...far from it.   Lots of stray animals, people who don't vaccinate their house pets, etc. 

 

Maybe a bigger question is why didn't you have the cat vaccinated against rabies and keep the vaccination up to date....if you do that you can let your cat bite, scratch the wife all day and night without fear of getting rabies.   Getting your pet vaccinated/protected is a lot cheaper than hospital bills for a series of rabies injections.   Pet vaccinations are cheap and sometimes free.

 

I got those series of rabies injection about three years ago when I saved a dog from drowning in a canal in my moobaan...although I did my best to avoid getting bit he did bite my hand (one of his canine teeth completely punctured through my hand like a nail) just as I tossed him up on the canal-side to safety.   Gosh knows if someone owned the dog because he staggered off as he came really close ot drowning...but he didn't look like a house pet as he was pretty bony.  So off the local hospital to get the hand cleaned and bandaged and the series of rabies injects over 4 weeks....a total of 5 shots I think....all in the arm....none of this in the stomach stuff like they use to do a long time ago.  That "nice guy" event cost me about Bt6,000 in hospital bills including all the shots and a couple of bandage changes.

 

P.S. I keep all my house pets up to date with vaccinations to extend their life and protect the family.

Edited October 28, 2016 by Pib

[Issangeorge]

I was recently bit or scratched, it happened so fast not sure which, by a stray cat. I went to the hospital and told the doctor I had rabies shots twenty years ago. He said then I didn't need them. I felt 20 years was a long time ago so insisted on having them. The first time I had a tetanus shot, rabies shot, and a regime of antibiotics, total cost ฿179. A month later I had ti go back for a second rabies shot, ฿42, in six months I get the third and final. They cause very little pain and are cheap, to me it's a no brainer to get them.

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[alco]

http://www.americanhumane.org/fact-sheet/rabies-facts-prevention-tips/

 

Why a 10-Day Quarantine?

• In almost all states, an animal that has bitten a human or another domestic animal must undergo a mandatory 10-day quarantine period. Some states require that this quarantine be carried out in an approved animal control facility, while others may allow the quarantine to be carried out at the owner’s home.
• The quarantine is set at 10 days because a rabies-infected animal can only transmit the disease after clinical signs have developed AND once these signs have developed, the animal will die within 10 days.
• If the animal lives beyond the 10th day, it can be said with certainty that it was not shedding the rabies virus at the time that the bite occurred.
• If the animal dies before the 10th day, it can be tested for rabies. If the test is positive, a human bite victim will still have enough time to receive post-exposure vaccinations and prevent the disease.

 

 Our house pet are kittens, vet told us they should at least be 3 months old to get the vaccine. Different people, different opinion. I just thought medical professionals should know the facts. "medical malpractice" is a wrong word I used, should be something like "misinformation" but my English is not perfect. Except that my wife is terrified with needles with tears on her eyes every time she had the shots, no other harm done to my wife and more importantly she now have peace of mind.

[NancyL]

It's appalling that the OP doesn't keep his pet's vaccinations up-to-date.  If anyone is practicing "malpractice" it's him.

 

What if his pet had bitten someone outside his family?  He is a very irresponsible person.

[lopburi3]

Did you read above that vet said pets were too young to receive shots?

[alco]

I am not very good at conveying ideas in writing but one thing i'm trying to point out is doctors overdoing it. Our case is not even a bite but a tiny scratch by a kitten. It made 3 red lines at my wife's hand no more than 1 cm long. No blood dropped, not sure you called that bleeding. But doctor still administer full course of anti-rabies vaccine. It is not against my wife's will to get the shots but it definitely hurt her. And if the doctor told her its not needed she will happily believe. I tried to explain to everybody that we quarantine the animal for 10 days but either they don't understand me or they don't care. Cost is never an issue, we did not pay anything for the shots, all covered by health card. In a similar manner that when you go to a doctor here for some health problem, they will give you many different drugs for all the symptoms you enumerated. You end up taking about 6 different medicines for say a common cold.

[Sheryl]

This is in part a cultural thing - Thai doctors assume that anyone coming in to see them wants treatment i.e. medication and will be unhappy if it is not provided. The idea of paying for a doctor's professional opinion alone is not well understood here. In fact. doctors who have their own private clinics will often not even have a consultation fee, charging solely based on the treatment given (which means that in order to be paid they have to treat).

 

Most Thais (for that matter, most people anywhere) would not go to the doctor over a tiny scratch from a kitten. Doctor assumed that since she did, this meant she wanted treatment.

 

It is also assumed that patients will equate the quality of care with the number of medications given - and in fact,. some Thai people do. I've had doctors/nurses  look embarrassed and apologize to me for giving "only one medicine"!

 

Doctors who trained and worked in a Western country are different in this regard,  but tend to be available only in Bangkok, Chiang Mai  and some major teaching hospitals.

 

 

[ghworker2010]

OP must be american using the word 'malpractice'. This is thailand. what are you going to do? sue the hospital....

 

Next time keep your pets vac's up to date and stop whinging