Grand Lake man undergoes treatment after brush with sick bat
August 9, 2013
Late afternoon on July 23, Walt Schierioth paused to take a breather during his four-mile hike around Monarch Lake. He felt something abruptly land on his back. Then it began to crawl. Startled, Schierioth knocked it off onto a nearby rock. When he turned around, it took him a moment to realize it was a bat, dazed and struggling in the bright daylight.
"At first, it looked like a great big, dried-up maple leaf," he said. "I thought it was unusual for a bat to hit me like that, at 3:15 in the afternoon."
The animal flew across the hiking path, fell again, then died a few moments later. Schierioth used pine branches to wrap up the bat, then packed it up to take to the Forest Service office once it opened the following day. He was curious to see if there had been any reports of rabid bats in the area.
Schierioth had only minimal contact with the animal, briefly with his hand when he swatted it away, and wasn't concerned about exposure. His wife, however, was upset and nervous. She talked him into calling the Middle Park Medical Center in Granby. The medial center sent the bat in for a rabies analysis.
"After the report came back positive, I got a call again from Granby medical, requesting I come in immediately," he said.
According to the Centers for Disease Control and Prevention, the vast majority of rabies cases occur in wild animals like raccoons, foxes, skunks and bats. These animals can transmit the virus to other mammals, including cats, dogs, horses and humans. The virus infects the brain and nervous system, and almost always results in death. The disease is also preventable.
A recent Denver Post story published on July 29 reported a spike in rabies cases throughout eastern Colorado, with skunks harboring the bulk of the disease. Larimer County confirmed 40 cases of rabies this year. Prior to 2007, rabid skunks were uncommon in the state, but the diseased animals have moved west.
So far, the Colorado Department of Public Health and Environment reports that rabid skunks haven't progressed beyond the Front Range foothills.
"In areas of the mountains, bats are only rabies reservoir. We don't see it circulating in other species, such as skunks, at this time," said John Pape, epidemiologist and rabies expert at Colorado Public Health.
Still, bats have wrought their share of havoc recently. Since Jan. 1, Colorado Public Health reports 21 confirmed rabid bat cases in the state. Schierioth's encounter has not yet been added to that count, and it's not the only suspected rabies case in Grand County this year.
According to Pape, a 15-year-old tourist visiting Grand County tried to rescue a bat she found in a swimming pool in the middle of the day. The bat bit her and flew off. Although they couldn't retrieve the animal for testing, health officials determined the bat's unusual behavior signaled rabies. She underwent treatment immediately after returning home. The girl was bit just three days after Schierioth's hike at Monarch Lake.
Treatment in a rural community
After Schieroth got the call from the Granby hospital, he followed orders to rush in for treatment.
"They weren't taking any chances," Schierioth said. "I guess I learned something from it. They say it doesn't matter if it bites you or not, and by brushing it off my back like that, you only need to touch the animal to be exposed."
The Centers for Disease Control and Prevention report that rabies is most commonly transmitted through animal bites. But an infection can occur through the animal's saliva or contact with an open wound.
"If the saliva got in a eye for instance, you can be infected without the animal biting," said Jan Carrasco, registered nurse at Ground County Public Health. "It's just good to avoid contact with wild animals."
By the time Schierioth, 70, came to Middle Park Medical for treatment, it had been two days since his brush with the bat. He arrived at the hospital only to learn that presumably no hospital in Grand or Summit counties had the rabies antibodies and vaccines needed to treat the disease. Instead, Shierioth rushed to an emergency room in Steamboat Springs to receive treatment.
While Grand County Public Health and Middle Park Medical did not have supplies of rabies vaccine in stock, a call on Tuesday, July 30, to Winter Park's East Grand Community Clinic and Emergency Center, administered by Denver Health, confirmed that clinic has rabies treatment on site.
Schierioth received his initial time-sensitive antibody in Steamboat. But Schierioth will still need to receive a series of additional expensive vaccination shots throughout the month of August, which he'll likely get in Granby now that they've ordered in the treatment. As a second homeowner who spends his summers in Grand Lake, Schiertioth said he'd rather not return home to Colorado Springs for the shots. He also said he was surprised at the ordeal in getting treatment.
According to Middle Park Medical CEO Cole White, it's not uncommon for rural hospitals to be without rabies vaccinations. They have short shelf lives and are extremely expensive. Medical facilities can, however, have treatments sent overnight and still administer them to patients in a timely manner.
"That's one of the risks of living in a rural community – how many things do you keep on hand?" White said. "I believe this is the first rabies vaccination we've had requested in the 3.5 years I've been here."
Keeping rabies treatments on hand could require hospitals to absorb the cost if they expire before a patient needs the treatment. Those treatments can cost between $2,000 and $7,000. If a patient seeks help from the ER, they also pay emergency costs. In many cases, rabies treatment isn't covered by insurance, White said.
"You can see the conundrum that we're in," he said.
Larger public health divisions and hospitals can spread some of these losses among a greater number of people. "But we're a smaller organization, so to stock an expensive medication and administer it with no regard to cost, it's an irresponsible way of running a business," White said.
CDPHE's John Pape confirmed that small-town health providers don't usually have rabies treatment on hand, even in mountain areas rampant with wildlife.
"They don't administer rabies treatment as often," he said. "But it's easy to get, we can ship it within 24 hours if need be."
According to both Pape and White, 24 hours is usually ample time to administer rabies treatment. The Centers for Disease Control and Prevention call rabies exposure an "urgency," but not an "emergency." A patient's safe window in receiving inoculation varies, however, according to age, weight and a variety of other factors. Health professionals advise seeking medical consultation immediately in suspected rabies encounters.
"If exposed to a bat or rabies, contact the local health department," Pape said." Talk to the nurses there. They'll make recommendations and get specimens in for testing."
Still, so few rabies cases in Grand County may have resulted in some confusion during Schierioth's experience at Middle Park Medical Center.
"I think there's a little disconnect on this subject. Steamboat, possibly because they've had more cases, seemed more on top of it," he said. "We hope this brings some attention to the issue."
Make Pets priority
In preventing rabies infection, health professionals have two recommendations: avoid contact with wildlife and keep pets vaccinated.
Contrary to popular belief, rabid animals aren't always aggressive and foaming at the mouth. Some might appear docile, dazed and approachable. Jan Carrasco at Grand County Public Health said animals behaving abnormally are suspect.
"In the case of bats, for instance, if they're out during the day and approaching people, that's abnormal behavior for a bat. That would certainly raise some red flags," she said.
Pape pointed out that cats and dogs are especially vulnerable to exposure from sick, docile wildlife like rabid bats.
The State of Colorado has mandatory rabies vaccination laws for pets to reduce infections from wildlife and transfers to people. Unvaccinated pets with suspected exposure to rabid animals are required to be euthanized or put under a mandatory six-month quarantine.
The first three months of the quarantine must be at an isolated and secured facility permitted by the health department.
"The only way to tell if a pet's infected is to cut its head off and examine its brain at the state lab, unfortunately," said Dr. Susan Tasillo, veterinarian at Granby Veterinary Clinic.
Tasillo's clinic doesn't quarantine pets without rabies vaccinations, neither does Grand County Public Health. Quarantine costs can be prohibitively expensive for pet owners. Keeping pets current on vaccinations costs only a fraction of a quarantine.
While pet rabies protocols in the state are severe, Dr. Tasillo noted strict regulations are important in preventing the fatal disease from spreading.
"It only takes one animal moving over the divide and getting over here, it could come as an outbreak," she said. "That's why vaccination is required for pets, and advised for horses and other animals in a petting zoo."
Bats not on radar
After enduring a series of painful antibody shots injected right into his muscles, vaccines resulting in flu-like symptoms — and more to come — Schierioth notes the irony of being exposed to a grave health risk caused by a critter so small he initially mistook it for a maple leaf.
While he typically hikes alone, Schierioth takes extra precautions to ensure his safety and avoids contact with all wild animals. He said depending on the hike and where he's at, he carries a bear bell, a snakebite kit, bear spray, an air horn and trekking poles. He pays attention for signs of dangerous animals, like moose and mountain lions.
"I'm all prepared for that, but I wasn't prepared for the bat."