Radiolab: Rodney Versus Death
This podcast which talks about the 15 year old girl, Jeanna, who became the world's first known survivor of rabies (without vaccination) and the protocol that was developed from her treatment. I highly recommend it; the science behind it is really fascinating and it's only 30 minutes.
It explains rabies in simplest terms- how it travels from a bite wound site into your nervous system, and its neurologic manifestations, including behavior changes, convulsions, inability to drink, and eventually complete system shut down. The actual physiology of the disease is not very well known.
Dr. Rodney Willoughby at Children's Hospital of Wisconsin, in a last-ditch effort, developed a treatment which essentially put the patient in a coma to "ride out" the disease. Once Jeanna arrived to Children's, Dr. Willoughby started going through dozens of case reports, and began to hypothesize that rabies causes excito-toxicity. In other words, there is no physical damage to the brain, but the neurons become overstimulated, and therefore shut down because they are overwhelmed. He suggested putting Jeanna in a coma to allow her immune system time to fight the virus.
Such a treatment had never been done, or even formally considered/suggested, and Dr. Willoughby discusses the ethical dilemma of potentially "locking the patient in," or causing brain damage but having the patient remain in a coma, leaving her "trapped" in her body. With the fatality rate of rabies being 100%, Dr. Willoughby was more concerned with this notion, saying he might "be doing worse than death."
The treatment worked, and they named it The Milwaukee Protocol. It has since been implemented for others infected with rabies, but its efficacy has come under question. The role of immune system is discussed and critics of the protocol suggest that this patient had the ability to fight the disease regardless of implemented treatment. According to an article by New Scientist, only six of the 35+ who have undergone treatment have survived.
Here are some links discussing the protocol:
Critical Appraisal of the Milwaukee Protocol for Rabies: This Failed Approach Should Be Abandoned
The "Milwaukee protocol" (MP) hope does not succeeds for rabies victim
This is a very interesting, new method on treating rabies considering the daunting consequences that can happen when someone is in a coma. My question is why did the researchers/doctors defer to this method of curing rabies, other than the traditional vaccines, when the success rate is so low? Is the recovery more manageable or better when undergoing a coma than the vaccines and it's just the ethical issue of whether doctors should risk putting their patient in a coma?
ReplyDeleteI looked at a website that has extensive detail on what a person should do if they are bitten by a rabies-infested animal and this website was fairly detailed with different solutions to different types of rabies which is why I ask the question of why they changed their protocol.
http://www.southernnevadahealthdistrict.org/health-care-providers/rabies-protocol.php
Hi Morgan! This protocol was implemented for someone who was outside the window for receiving the vaccines. If they are not vaccinated within a matter of days (or even hours) and symptoms have already set in, the vaccine is useless. Sorry that wasn't clear in my initial post!
DeleteMelanie, this blows my mind! I can see what Morgan is saying. It definitely is a touchy approach but nevertheless, it worked! I do not know the specifics of rabies and how they overstimulate the neurons but couldn't an antagonistic approach been used to block or destroy the neurotransmitters in order to prevent them from the overstimulating effects? I am sure the mechanism is much more complicated but I figured this method could have been used before such a drastic procedure.
ReplyDeleteAlso, were there any follow-ups with the others in which this method was utilized? It would lend a lot of credibility as well as a strong push in the right direction if this procedure demonstrated the same positive outcome in the others. I couldn't imagine it being easy to recommend this approach. Unfortunately, the Milwaukee protocol also contains other suggestion such as ketamine infusion and amantadine; all of which are controversial (Zeiler & Jackson, 2015). So unless strong evidence is there, I definitely foresee a lot of barriers that need to be overcome before it becomes a viable choice. Anyhow, Let's hope for more research! I believe this to be very interesting and promising for the field of medicine.
http://dx.doi.org.dml.regis.edu/10.1017/cjn.2015.331
This is fascinating! Thanks for the links to your sources; it was interesting to learn that genetic variability plays a role in the chances of survival amongst rabies victims. Do you think that the initial recipient of the Milwaukee Protocol treatment was genetically resistant, or that the treatment just has a very low success rate? There is a new rabies antibody being developed, SII RMAb (https://academic.oup.com/cid/article/4159363/Comparison-of-a-novel-human-rabies-monoclonal), which sounds promising, especially as it is a cheaper alternative to HRIG.
ReplyDelete