Starting Jan. 1, Alaska will no longer provide post-exposure rabies shots free-of-charge. Post-exposure prophylaxis (PEP) is used if someone has been bitten by an animal with rabies -- or if an animal is suspected to have rabies, but can't be located and tested for the fatal virus.
The state's decision to stop supplying PEP was made in July, and takes effect in 2014. While the state has provided PEP free-of-charge for decades, "budgets are tighter" now, said Louisa Castrodale, an epidemiologist with the state.
The series of shots can be ordered from private providers, and some clinics have the shots on hand, Castrodale said. It's not cheap: A full series for a 175-pound adult costs around $3,000, not including the shipping and administration of the shot, according to July's release. The shots consist of four doses given over a two-week period. Exact doses are based on an individual's weight.
Between 2008 and 2012, the state supplied PEP for 107 people, at an estimated cost of nearly $227,000. Some of these people were exposed to rabies while traveling outside the state. Others received the shots because they had been bitten by an animal, but whether it had rabies could not be confirmed.
Of the folks who were exposed to rabies in Alaska, 84 percent of the cases were located in the Yukon-Kuskokwim Delta.
The incubation period of the virus -- the time between when someone is bitten and symptoms develop -- can last weeks, or even months, so PEP is generally not ordered right away, Castrodale said. First, the suspected animal is tested to see if it is infected with the virus. The state will continue testing animals suspected to have rabies.
Transmission of the virus generally comes when an infected animal scratches or bites another animal. The virus can also be transmitted from the carrion of an infected animal.
Rabies can present itself in a variety of forms, Dr. Robert Gerlach, state veterinarian, told Alaska Dispatch in April. There is a "dumb form," when an animal acts depressed or disassociated, and may have a drooping head or be drooling from the mouth. There is also an "aggressive form," when an animal acts extremely aggressive and may attack or chew on inanimate objects.
This summer, two wolves tested positive for rabies in Interior Alaska. While the rabies virus is present along the northern and western coasts of Alaska, the cases were the first time animals had tested positive so far inland. Rabid animals have inhabited the Yukon-Kuskokwim Delta in Southwest Alaska for years.
In humans, rabies is nearly always fatal once symptoms are exhibited. The first symptoms are flu-like, such as fever or headache. Over the course of two to 10 days, the disease progresses to cerebral dysfunction and agitation, and the person may experience hallucinations and insomnia as the virus progresses into the brain, eventually causing death.