Such Lazy Blogging (with Rabies!)

I continually have fleeting visions of actually writing something substantive about public health in this blog, but even those visions are subject to my highly-restricted attention span. However, I have found some public-health worthy news to share with you today. It does not, however, really approach the criteria for substantive.

I subscribe to a ludicrous number of public health-related emails, among them the CDC's MMWR Weekly Report, DHS' Daily Infectious Disease Report, NIH press releases, Kaiser Health News, the Robert Wood Johnson Foundation's Public Health News Digest, and of course, Pro-Med. Most mornings I wake up to all of them in my email inbox, and promptly delete them in my pre-shower haze that is comprised of 65% lethargy and 30% contempt for anything producing noise, and 5% ill-will towards my dog for being so happy that I'm awake. I used to read, or at least quickly browse, almost all of these publications. I suppose without John Swartzberg's prodding to share current events in my Principles of Infectious Disease course, they take a backseat to more pressing matters, like making coffee, walking my dog, and whatever came from Netflix that week. Sometimes I even study.

But I digress... I had the opportunity to check one of my Pro-Med emails during a particularly dry lecture today and found this noteworthy headline, "RABIES - CHINA: (GUANGXI) COUNTERFEIT HUMAN VACCINE". Apparently, 8 people have been arrested in China's Guangxi Zhuang region for selling over 1,200 fake rabies shots, which caused the death of one child, and were administered to over 1,000 others. No other harmful effects have been reported by those who received the shots. Pro-Med linked to this article for reference.

China has a notoriously high rate of rabies infections, second only to India. Rabies vaccine is typically adminstered as post-exposure prophylaxis (PEP), which means it's given after a suspected infection. Why doesn't everyone get it beforehand? Well, because you have to get 4 shots, and they hurt something fierce. It's the sort of thing you really only want to experience if absolutely have to. China will likely do the vaccine counterfeiters one better and simply execute them, since that's their preferred approach dealing with any crimes remotely serious.



If, like me, you're from the east coast, you generally think of raccoons a primary reservoir for rabies. Stumbling about in the daytime, refusing to not tear through your trash, and even refusing to yield when you throw logs at them when you're camping. Well, on the west coast, the primary reservoir are bats. What's even better is that many people get infected without knowing it because a bite from a bat can be so minuscule that you don't even notice it. The incubation period for rabies can be well over a month, depending how long it takes for the infection to travel to your central nervous system. However, once it arrives there and severe symptoms occur, you're about 99% likely to die, after progressing through fever, malaise, depression, violent movements, hydrophobia, hallucinations, and eventually coma. I think hydrophobia would be the worst part, I really love swimming.

So, those vaccine swindlers in China are likely to die, or least fester in a prison camp in a remote sector of the Tibetan Plateau for quite some time. But I still have unanswered questions: (1) what on earth was in the fake vaccine? (2) What sort of cold-hearted bastard picks rabies as the vaccine to counterfeit? Why not go for something a little less 'life-or-death', like a flu shot? Or maybe some fake Viagra? (3) And finally, and perhaps most importantly, this story makes no sense! People only get rabies vaccines if they have a suspected exposure to it, usually an animal bite, likely a dog in the case of China. If over 1,000 people got this FAKE vaccine, and still didn't die of rabies, and 99% of untreated cases die... then what gives?

I have a few of plausible hypotheses:

1. People in China are getting bit by dogs all the time, but none of them actually have rabies.
   
2. This fake vaccine wasn't as fake people think it is.
   
3. The folks in China are just a hardy bunch, apparently they've got the anti-rabies gene.
   
4. China doles out pre-exposure rabies vaccine for some reason.
   

If I find out, I'll report back....