Few People Survive Rabies

Jeanna Giese is the first person known to survive clinical rabies infection without standard treatment.

In 2004, while attending church, a bat fell to the floor. Jeanna, age 15, picked it up, carried it outdoors and released it. In the process she was bitten on the left index finger. The bite was cleaned with hydrogen peroxide, but no medical care was sought.

The Centers For Disease Control (CDC) MMWR (Morbidity and Mortality Weekly Report) for December 24, 2004 states, “Persons bitten by a potentially rabid animal should immediately 1) wash the wound thoroughly with soap and water, 2) capture the animal (if this can be done safely by avoiding direct contact) and submit it for testing or quarantine, 3) contact local or state public health officials, and 4) visit a physician for treatment and evaluation regarding the need for PEP. Persons should not handle or keep bats as pets and should keep bats away from living quarters and public places.

PEP, or postexposure prophylaxis, usually includes immune system stimulation and/or modulation. In Jeanna’s case such treatment was not employed because a month passed before Jeanna became ill, and she was six days into her illness before anyone mentioned the bat bite. By that time Jeanna’s own immune system had responded with antibodies that could kill some of the virus.

Instead, Jeanna’s physician, Dr. Rodney Willoughby, Jr., along with his colleagues at Children’s Hospital of Wisconsin and the Medical College of Wisconsin, devised a concoction of medications to administer to her. Treatment was supplemented with a medically-induced coma, part of routine therapy in symptomatic patients.

While ten humans have survived rabies infection, the previous five survivors all had routine PEP. CDC is careful to point out that the treatment Jeanna received is unproven and her single case does not mean that every patient following that regimen will recover.

Why is Jeanna Giese in the news today? As a 21-year-old biology major she just graduated from the Lakeland College campus in Sheboygan, WI. While she still has some difficulty with running and balance, those are her only reported sequella.

What is now being called the Milwaukee protocol has been used to save more human rabies victims. It has been used thirty-three more times, and four victims have lived. Only one, however, like Jeanna, had no classic immune-modulating therapy. Two of those four have since died during rehabilitation, and the two other survivors live in Qatar and Brazil.

The CDC gives this advice to keep one’s self safe from rabies: Rabies in humans is preventable with proper wound care and timely and appropriate administration of PEP before onset of clinical disease. PEP is recommended for all persons with a bite, scratch, or mucous-membrane exposure to a bat, unless the bat tests negative for rabies. When direct contact between a human and a bat has occurred and the animal is not available for testing, PEP should be administered when a strong probability of exposure exists. However, if a bat bite is unrecognized or if the significance of exposure is underestimated, medical intervention might not be sought and appropriate treatment not administered. Once clinical signs of rabies are evident, a progressive and usually fatal encephalitis ensues.

Jeanna wants to work with animals. She doesn’t even mind working with bats and says, “I definitely think they’re misunderstood.”

See you Tuesday, Dr. Randolph.

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