Rabies: The shots don’t hurt much, but paying for them might

Karen L. Lynch never felt the animal’s bite.

She had rushed to a dark corner of her sister’s northwest Fresno backyard to rescue her two Polish lowland sheepdogs. One of her dogs, Maggie, had been bitten and was hiding under a chair. Lynch yanked the animal off her other dog.

The animal, possibly a raccoon or a possum, scurried away.

Blood dripping down her arm, Lynch carried her frightened dog, Molly, back to the house. An examination under a porch light showed Lynch had a deep bite on her right hand; Molly didn’t have a scratch.

Lynch, 57, a Fresno attorney, had been enjoying a family get-together when the attack happened. Her brother, Michael Lynch, a Fresno doctor who specializes in travel medicine, washed the wound. He told her to go to the hospital. She needed rabies shots.

Lynch took Maggie to the veterinarian emergency hospital, then heeded her brother’s advice and sought care for herself. It was impossible to know if the animal had rabies, and she couldn’t take the risk if it did. She needed the shots as a precaution.

Rabies, a disease caused by a virus, has been found in bats and skunks in Fresno County. Untreated rabies is virtually 100 percent fatal.

“It’s such a horrible, horrible disease and such a horrible death that we just couldn’t take the risk,” Michael Lynch said.

The series of rabies shots Lynch got in July three years ago surprisingly did not hurt much – and unlike in the past were not given in her stomach – but they were costly and not easy to get outside a hospital.

Care costs thousands

Treatment after a potential exposure to rabies consists of one dose of human rabies immune globulin and four doses of rabies vaccine over a 14-day period. The immune globulin and the first dose of rabies vaccine need to be given very soon after the bite or scratch. The additional doses of rabies vaccine are given on the third day after the first shot and on days seven and 14.

Each year, Fresno County receives about 1,000 reports of dog bites and about 100 reports of cat bites that lead to the animals being quarantined for 10 days to rule out rabies. Last year, the county had 19 reports of bites by wild animals.

Human cases of rabies in the United States are rare – from one to three are reported each year – and that largely is because of animal control and vaccination programs, the federal Centers for Disease Control and Prevention says. But about 80 to 100 unvaccinated dogs and more than 300 cats a year have rabies, usually infected by wildlife. Last week on World Rabies Day, people were reminded of the need to vaccinate their pets.

In the United States, about 40,000 to 50,000 people are vaccinated against rabies each year, the CDC says. Cost for the treatment varies, but it is not cheap. A course of rabies immune globulin and four doses of vaccine given over a two-week period typically exceeds $3,000, according to the CDC. That’s a bargain, however, for the cost per life saved from rabies, which ranges from $10,000 to $100 million, the federal health agency says.

Fresno County Department of Public Health staff says the price for a 2-milliliter vial of immune globulin is $662, and a person typically needs more than one vial. The county doesn’t have a supply. It hasn’t offered post-exposure rabies shots since budget cuts forced the closure of the health screening and prevention program in 2008, said Dr. Ken Bird, the county’s health officer. “We provide pre-exposure rabies prophylaxis to our laboratory staff who do the test for rabies on animals brought in for testing,” Bird said.

The CDC recommends pre-exposure treatment for people who have frequent contact with rabies virus or potentially rabid animals, such as veterinarians and their staff, but a 2000 study said a survey of California animal workers found few had been vaccinated. The Central California SPCA has not seen a need to have staff vaccinations, said spokesman Walter Salvari, since the organization has not seen a case of rabies in about 30 years.

Brenda Mitchell, president of the board of Fresno Humane Animal Services, said her agency doesn’t have a policy requiring vaccination, but it is considering one for its animal control officers. But cost could be a reason why few animal workers are vaccinated, she said. Rabies shots for a dog or cat cost a few dollars, she said. “But for humans, it is so expensive.” A pre-exposure series of three shots costs about $900. Many insurance plans do not cover it.

Lynch went to the emergency department at Saint Agnes Medical Center to get her initial rabies shots. It was night when she was bitten and her doctor’s office was closed, but that wouldn’t have mattered: Doctors don’t keep the expensive immune globulin and vaccine in stock.

The emergency department bill for Lynch to get immune globulin shots, a first rabies vaccine and a tetanus shot: $25,509.50. The price of the immune globulin drove up the bill – Lynch got 10 vials of immune globulin, for which the hospital charged $21,324.90.

“I was taken aback,” Lynch said. “I want people to know the cost.”

Lynch had insurance, which had negotiated rates with the hospital. The company knocked $23,089.50 off the hospital bill, and her portion of the total charges came to $2,250.89.

Emergency room prices are driven up by the costs of running a department around-the-clock, by inadequate government reimbursements, unfunded legislative mandates and the costs of uncompensated care, Saint Agnes spokeswoman Kelley Sanchez said.

Seldom, if ever, does an insured patient pay the full charges, she said. Saint Agnes also does not collect full charges from patients without insurance, she said. Rabies immune globulin, for example, would be discounted by 40 percent, she said.

Other hospitals operate the same way. “There is no set hospital charge for rabies treatment because no two cases are exactly the same,” said Mary Lisa Russell, spokeswoman for Community Medical Centers. “The hospital’s costs, and ultimately the charges, will vary depending on the amount of drugs used, whether surgery was needed, time in the hospital and other factors.”

Doctors don’t have vaccine

After getting the immune globulin and initial rabies vaccine, Lynch thought she was done with the emergency department. She called her doctor to get the follow-up rabies shots, but her doctor didn’t have the vaccine and suggested Lynch go back to the hospital.

Lynch was dumbfounded. “I was running out of time,” she said. She needed a shot in the next couple of days.

It isn’t surprising that her doctor didn’t have the vaccine, said Bird, Fresno County’s health officer. Hospitals are about the only places that stock it. And it’s fortunate they have it. Over the years, there have been shortages, he said, but he is not aware of any supply problems lately.

Lynch balked at going back to the emergency department, which would be another hefty bill and a lengthy time sitting in the waiting room. Finally, her doctor suggested she go to her brother, who gives travel immunizations.

Michael Lynch didn’t have the seldom-called-for vaccine either. It costs about $300 per shot, and he couldn’t afford to keep it on hand. The only thing he could do for his sister was order the vaccine, he said. “I had it FedExed.”

The three shots Lynch got in her arm ended up costing her brother. Her insurance company refused to pay for them, Michael Lynch said. “I ended up writing it off.”

Karen Lynch said she felt guilty and paid the bill.

She had better luck with her sister’s home insurance company, which had a $1,000 no-fault medical payment. It took some time to convince the company that she had a hospital bill for thousands of dollars, she said. “The insurance adjuster said, ‘There’s no way your bill was that high,’ but I faxed the bill to him, and he sent a check for $1,000.”

This story was originally published October 3, 2016 at 12:30 AM with the headline "Rabies: The shots don’t hurt much, but paying for them might."