Old-time fears of rabies eased after vaccines became widely available in the 1940s and '50s to protect domestic animals and humans from the virulent virus, but a cyclical resurgence under way in Kansas proves the disease remains a formidable foe.
Fifteen people now are receiving post-exposure rabies shots that average $900 per series at Lawrence Memorial Hospital.
Among those receiving the shots are a Baldwin woman, Cheryl Smith, her husband and their four children, who had a rabid puppy, and a Baldwin area farmer who had a rabid cow.
Dr. Donald Abels, medical director of the LMH emergency department, said no medical treatment existed for people who contracted the disease and did not get the protective shots.
"It's probably safe to say it's a very high mortality rate likely to be fatal," he said.
AS OF TUESDAY, Kansas State University posted a count of 78 confirmed rabies cases in wild and domestic animals in Kansas for the year to date a dramatic increase over previous years that experts anticipate will continue for some time.
Deborah Briggs, assistant professor in KSU's department of veterinary diagnosis, has been tracking the outbreak. She said clues that foretold its coming emerged last year and became irrefutable by the end of January. Twenty-two cases were confirmed from Jan. 1 to Jan. 30 alone, she said, and the year-to-date figure of 78 represents 15 more than were documented in all of 1991.
The predominant carrier is skunks and many of the cases are in northeast Kansas.
Briggs said as of Tuesday, seven of the confirmed cases were in Douglas County, 21 in Shawnee, 10 in Sedgewick, two in Jefferson, five in Osage, and four in Franklin. None had been confirmed yet in Leavenworth County. Among animals involved, in addition to skunks, are dogs, cows, raccoons and bobcats.
BRIGGS EXPLAINED the increased numbers of infected skunks simply were coming into contact with more domestic animals, which in turn led to more human exposure.
Skunks can harbor the virus from two weeks to 18 months before they get sick, she said, noting "that's why it stays endemic in that population." The last rabies outbreak peaked in 1981-'82, and before that, in 1971-'72.
Dr. Mark Marks, president of the Douglas County Veterinary Medical Assn., which has been trying to alert the public to the danger, said veterinarians in the group "are a little bit frustrated by a lack of concern about the problem" locally.
He said skunks now were nearing the end of their annual breeding season and the breeding process presented a prime opportunity to spread the virus. One infected male can infect a female, he noted, and she can infect her entire litter which may be sick but not show signs of the disease for 18 months. An average skunk litter is four to five kits; by early summer, they'll be moving about on their own in search of food and able to spread the disease even further.
DR. W.W. WEMPE, a longtime Lawrence veterinarian, said he, too, was concerned about the outbreak.
"In the 50 years I've been in practice, lacking a couple of months, I've never seen anything like this in Kansas," he said. "I never seen it where prospects looked as bleak."
He noted there seemed to be so many obviously infected skunks that people weren't even bothering to send the heads to KSU for verification any more.
In this area, he said he knew of one case involving a skunk that got into a pen and attacked some dogs and another involving a skunk that chased a man and his wife into their home. Both skunks were shot.
"Any time you see a skunk that's attacking people or animals, it's rabid," Wempe said, adding he thought the many road-kill skunks in evidence were another sign of the problem.
"It's seeded around," he said. "I suspect by summer, we'll see more of it."
KSU'S BRIGGS performs fluorescent antibody tests on animal heads that are sent to KSU for clinical documentation of rabies.
Tuesday alone, she said, her lab tested 45 heads, ranging from dogs and cats to rats, raccoons and even a ewe. Pieces of the creatures' brains are treated for the test, she explained, and if the rabies virus is present, the brain tissue gives off a fluorescent glow.
That's what happened to tissue taken from the Smith's puppy's brain. Since the pup's report came back positive Feb. 5, the Baldwin family has discovered firsthand the trauma rabies can inflict despite protective vaccines.
Mrs. Smith, her husband, and their children, 5-year-old Nicole, 4-year-old J.J., 2-year-old Jessica, and 18-month-old Ariel, have one shot left to take in the post-exposure rabies series of six or more shots.
She showed the last injection site on 2 -year-old Jessica's small thigh as she explained how difficult it was to determine her family's jeopardy and make the decision to begin the se97 2 36 0$$*> 2 37( (($re so small, they have been frightened by the shots, which make their arms and legs sore. Only Nicole is old enough to get hers in her arm; the younger children's thighs are used.
"It was scary," Mrs. Smith said. "The kids do not like it. The first couple of times, it was really, really stressful."
Mrs. Smith's concerns were compounded because the puppy possibly exposed members of three other families to the virus in the week her family had it. Those families posed a number of questions to her that she could not answer.
She said she discovered that ``people doctors'' had less experience with the disease than veterinarians, and as a consequence, her veterinarian, Dr. Shawn McCoole of the Baldwin Hilltop Animal Health Center, became her most trusted source of information on how the virus operated.
McCOOLE SAID it was difficult for himself and other veterinarians to give advice to people about rabies jeopardy, other than to urge them to consult their own physicians, but he understood Mrs. Smith's concern and confusion.
"If the life of a child is at stake . . . ," he said.
Now, many members of the other families who handled the pup, none of whom wished to be identified, also are getting the shots, Mrs. Smith said. Not all have health insurance, though, and some have been seeking special assistance to help pay the anticipated bill. Mrs. Smith said she expected her family's shots to be covered by their insurance policy.
She added that the Lawrence friend from whom they received the puppy, who also is getting the shots, had no idea of its rabid condition.
The pup's mother, a stray dog, had her litter of two in the friend's barn. Although the other puppy died, Mrs. Smith said she presumed it succumbed to a birth defect.
THE SMITH'S puppy, however, appeared fat and healthy, although Mrs. Smith said in retrospect it never played like most puppies do and it had a worrisome vaginal discharge.
"It wanted to sleep," she recalled, "so I let it sleep with me."
At 6 weeks of age, the pup was too young to be vaccinated and it wasn't running a fever. Recommended rabies vaccination dates for pups are at 3 months, again a year later, and annually after that.
When the Smith puppy began to fall into its water bowl and acted "confused," she took it to McCoole, who immediately suspected rabies.
That was Jan. 31. The next day, the vet, who is protected from the disease by a series of pre-exposure rabies shots, advised that the pup be euthanized and its head sent to KSU for Briggs' test.
Mrs. Smith agreed. On Feb. 5, McCoole called her back. The test was positive.
THE VETERINARIAN said such young puppies didn't usually have rabies because of the virus' incubation period.
Although the disease can be transmitted from a mother to her babies prior to birth, he said he didn't think that was the case with the pup. Its mother eventually was caught and euthanized, and her brain tissue tested negative for rabies.
Probably, McCoole said, the pup was bitten by a rabid skunk while it was in the Lawrence barn.
He also treated a cow that he suspected was bitten in much the same way as the puppy.
"We get a lot of calls about strange behavior," he said, "but (with rabies) it's really variable how the disease is clinically presented.
"Look more for extreme changes in behavior."
THE FARMER, who also did not want to be identified, noticed Feb. 21 that his cow was mooing a lot and couldn't seem to eat or drink.
He consulted McCoole, who again suspected rabies. By Feb. 26, the cow was euthanized. Her foamy slobber was everywhere in the isolation pen.
The farmer and his wife hauled the cow's head to Manhattan for the test, which was positive.
Because he washed out the cow's water tank with his bare hands, the farmer is now taking the post-exposure rabies series at LMH also, but his wife, who was in the pen with the cow but didn't touch her or the slobbers, is not.
She said she hoped she'd made the right decision about the shots. "It's in the back of my head `Am I OK?'"