Is Rabies Really 100% Fatal?

Jeanna Geise was only 15 years old when she became the world's first known survivor of Rabies without receiving any vaccination. Her miraculous survival has not only challenged a time-honored scientific fact, but has also brought about a new method of Rabies treatment, known as the Milwaukee Protocol. It had long been thought that Rabies is 100% fatal in humans who are not vaccinated. However, to the surprise of the medical world, Jeanna showed that fatal the virus can be beaten sans vaccination.

First, a little background info on Rabies is required to understand the full impact of Jeanna's case. Rabies is an ever present virus; found on all continents except for Antarctica, rabies kills over 55,000 people each year. Fortunately, rabies is 100% preventable in humans thanks to the Rabies vaccine (first created by Louis Pasteur). The vaccine can be administered at two different times: given pre or post rabies exposure. People who are at a high risk of encountering rabies or rabid animals, such as veterinarians or laboratory workers, should receive the pre-exposure vaccine as a preventative measure. Post-exposure vaccination is recommended for all persons, even those previously vaccinated, who have come into contact with suspected rabid animals. But, in order for the post-exposure vaccine to work, it must be administered before the onset of symptoms. If not, an infected person is expected to live only seven days after the appearance of symptoms.

Rabies is transmitted through contact with the saliva of an infected animal. On September 12, 2004, Jeanna was bitten on the left-index finger by a rabid bat she tried to rescue at her church. Her mother proceeded to wash her wound (which is advised by WHO) but did not know that her daughter needed to be vaccinated. Thus, once Jeanna began exhibiting symptoms, her fate was sealed in the eyes of the medical world. At first, rabies induces flu-like symptoms such as weakness, fever, headache, and overall discomfort. Jeanna became extremely fatigued on October 13 and by the next day was experiencing double vision. The infamous Rabies symptoms - excessive salivation, hydrophobia (the fear of water due to difficulty swallowing), hallucinations, agitation - typically appear "just days before death." Jeanna was rushed to the Children's Hospital of Wisconsin on the 18th of October with slurred speech, fever, and vomiting. A skin sample from her neck was analyzed by the CDC and tested positive for Rabies. Jeanna's future was grim. Dr.Willoughby, a pediatric infectious disease specialist at the hospital, had read up on Rabies medical literature upon Jeanna´s arrival. Luckily for Jeanna, his readings inspired a radical new idea to take hold in his mind. He determined that Rabies neither kills by "destroying neurons or causing inflammation in the brain," but instead, causes excitotoxicity, which overstimulates the brain and causes the cells to die. Dr. Willoughby also concluded that the human immune system can fight off the virus if given enough time before Rabies reaches the person´s brain. Jeanna's survival was a matter of time; her brain had to be protected before Rabies infiltrated it. Dr. Willoughby assembled a team of experts to discuss his theorized treatment plan, which later became known as the Milwaukee Protocol. To save Jeanna´s brain and allow time for her immune system to work, the protocol called for her to be put into a coma. The idea of inducing a coma left doctors wrestling with the possible side effects. Even if they did save her life would Jeanna be left severely disabled once she woke up? The difficult decision was left to her parents who agreed to proceed with the never-before tested protocol.

Doctors administered a variety of drugs to Jeanna: ketamine to ward off Rabies and protect her brain, midazolam to "complement" ketamine and lessen its tendency to cause hallucinations, and two antiviral medicines named ribavirin and amantadine. Six days after first receiving the concoction of drugs, a spinal tap revealed that Jeanna's body was producing rabies antibodies - a good sign of her body´s recovery! After Jeanna was taken out of her coma she was placed in rehabilitation to relearn how to talk, stand, walk etc. Today, despite her doctors' previous worries, Jeanna is "pretty much normal," according to Dr. Willoughby, and recently graduated from college. Lasting side effects from her battle with rabies includes trouble with running and balance, and speaking more slowly than before becoming infected.

The Milwaukee Protocol, which was first tested on Jeanna, is now recognized worldwide as a means to possibly save unvaccinated rabies patients. But despite the amazing recovery Jeanna experienced, the method has stirred up some controversy in regards to its effectiveness. Out of 41 patients who have so far received the Protocol only 6 have survived. So why do some patients survive while others don't ? Some scientists are skeptical whether the actual Protocol is the factor allowing patients to live. New research has shown that humans may be able to survive Rabies without vaccination or treatment after all. A study done in Peru (were Vampire Bats, a known Rabies carrier, are common) lead by Amy Gilbert of the U.S. Centers for Disease Control and Prevention found that 7 out of the 63 people evaluated tested positive for rabies antibodies. Of those seven people only one had previously taken the Rabies vaccine. This meant that the other six had produced antibodies on their own after being exposed to the virus and had survived.

Other evidence also supports the theory that humans can survive Rabies. Not a single other documented virus has a 100% fatality rate in humans. Therefore, could Rabies really be the sole outlier we believe it to be? Even in animals who carry Rabies the virus isn´t completely fatal; 14% of dogs survive. Bats can survive too. Scientists have also brought forth the idea that maybe the six human survivors had been infected with a weakened strain of Rabies, which allowed their immune system to prevail. This is possible since different animals carry varied strains of the virus. Until more research* is done on the Milwaukee Protocol and Rabies in general, it remains unclear why some people triumph over the world's deadliest virus while others don´t. But in the meantime, if I'm ever infected with Rabies (which I'd prefer not to be) and for some reason don't receive the vaccination on time, I will definitely request the Milwaukee Protocol. A small chance of survival is better than no chance.

*Dr. Willoughby has expressed wishes to test his protocol on animals but no research has been carried out yet

References:

CDC. Rabies (2013).

Finley, D. "First unvaccinated rabies survivor shares story." MySanAntonio. June 21, 2012.

Johnson, M. "Rabies survivor Jeanna Giese graduates from college." JSOnline. May 8, 2011.

Johnson, M. and Newson, K. "Soul Survivor: a Journey of Faith and Medicine." JSOnline. June 18, 2005.

Murphy, M. and Wasik, B. "Bats Incredible: The Mystery of Rabies Survivorship Deepens." Wired. August 12, 2012.

Murphy, M. and Wasik, B. "Undead: The Rabies Virus Remains a Medical Mystery." Wired. July 26, 2012.

WHO. Rabies (2013).

Images:

Rick Wood (via JSonline).

Sanofi Pasteur (via Flickr).