People who survived rabies, a disease with 100% mortality–Dr. Maha Ahmed

Dr Maha Ahmed, working as a medical officer in Capital Hospital (CDA Hospital) of Islamabad, Pakistan says, “Rabies is a fatal disease, with a mortality rate of 100%. Once signs and symptoms of rabies appear, nothing much can be done but there are only six patients from all around the world, who have survived rabies after developing its signs and symptoms”. Who are these lucky people and how they survived? This is what we are going to discuss in this article.
Unlike many other viruses and bacteria, Rabies virus doesn’t spread via blood. It spreads when an animal that can transmit rabies, bites a human. The rabies virus is present in the saliva of the rabid animal. The virus when introduced into the wound of the patient attaches itself to the nerves and starts travelling to the central nervous system. When it reaches the brain, it stimulates and causes generalized inflammation of the brain, damages it and this is the point of no return. The patient starts showing the signs and symptoms of rabies. When signs and symptoms appear then the only management is to give cool, calm, honourable and less painful death to the patient.
The virus travels at the speed of few centimetres per day and it causes fatal disease when it reaches the central nervous system. So if we kill this virus before it can gain access to the brain then the disease can be prevented. One way to do that is immediate post-exposure vaccination course and anti-rabies immunoglobulins infiltration of the wound. Rabies virus usually takes 7 to 10 days to reach the central nervous system and this duration also depends on the location of the bite, if the animal has bitten on the face then such individual is more likely to get Rabies much earlier than a wound that is inflicted on the foot or hand. So We have time, if we know that the patient is bitten by a dog or any animal that can transmit rabies then he should be vaccinated as soon as possible. After vaccination, the body of the victim takes 7 days to prepare antibodies and once antibodies appear in his blood they start killing the virus.
Now, the post-exposure vaccination works only if it is done soon after the animal attack. It doesn’t work after the onset of symptoms. Now is there any way to save a patient life who has started showing the signs and symptoms of rabies? Unfortunately, there is nothing much in our hands to save such a patient’s life. Analgesics, Benzodiazepines and other muscle relaxing drugs just help to keep the patient calm and lead to a less painful death.

The Milwaukee Protocol

But in 2004, doctors heard that a very-high-risk experimental procedure had been done on a patient of Rabies by Dr Rodney Willoughby. Dr Rodney was a paediatrician in Milwaukee and is of the view that our immune system is completely capable of killing the rabies virus but only if had enough time to do so. He made a protocol which was named as Milwaukee protocol. According to Milwaukee protocol, a patient who has already got the signs and symptoms of rabies is put on an artificially induced coma, so that his brain becomes extremely less active that prevents the brain from damaging the whole of the nervous system. During this comma, the body fights against the virus, makes antibodies and kills the virus and once all the viruses are killed, the inflammation subsides and patient recovers. This manoeuvre, called Milwaukee protocol was applied on 51 patients of Rabies until September 2014, out of these 51 patients only 6 had recovered significantly and other showed extreme neurological deficits.
So for those patients of rabies who have developed its signs and symptoms, Milwaukee protocol is a hope. From all around the world there are only six people who survived Rabies and these six people were managed according to the Milwaukee protocol.
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Reference:

The Readers Digest, Edition: September 2014, Diagnosis Rabies

Special Thanks:

Dr. Maha Ahmed, Medical Officer and Post-Graduate Trainee under supervision of Dr. Siddique Akbar Satti Head Department of Medicine, CDA Hospital Islamabad, for this worthy contribution.

Date: 15 * Oct * 2014