Could more people survive rabies?

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A recent article by Mani et al. discusses a new trend in India: within the last 6 years, there have been six survivors of clinical rabies contracted from dogs. The authors attribute this upward trend in survival to increased access to conventional critical care facilities and more doctors trying to save rabies patients. Many of the Indian survivors have been left with severe neurological complications, but these patients survived none the less, a situation undocumented in India before 2000.  

Ever since Jeanna Giese, a 15 year old girl bitten by a bat was treated for and survived clinical rabies in Milwaukee in 2004, there has been heightened interest in developing a reliable cure for rabies.  The early optimism over the so-called Milwaukee protocol has not been followed by a high success rate, and despite alterations to the protocol during 48 further attempts to treat rabies with it, just 7 additional survivors are known.  The protocol remains highly controversial, in part because most of the survivors are not fully documented. However, data from the survivors along with those who survive longer before dying can provide data about clinical rabies that can be learned from to develop better therapies.

Reviews published in late 2015 and  last month list a total of 19 documented survivors from 1970 onwards, noting that many had partial or delayed pre- or post-exposure vaccination against rabies prior to symptoms developing. Those with bat-associated rabies and those with robust early immune reactions may also have better survival prospects.

Finally, a recent report describes a patient with a history of a bite from a dog infected with rabies who recently survived after only relatively simple hospital treatment in a hospital in Ghana. This case is one of presumptive rabies, as laboratory diagnosis was not available in this setting, but the symptoms, including hydrophobia and photophobia, were highly characteristic of rabies.

In resource poor settings, where rabies is woefully underreported, diagnoses of rabies are rarely confirmed in laboratories, and people clinically diagnosed with rabies are generally sent home to die, is it possible that more, undocumented survivors exist?  

These cases are extremely rare and do not affect the general conclusion that rabies is an almost universally fatal disease. However, as access to well-equipped medical facilities improves across African and Asia and the expertise of medical personnel in treating rabies improves, we should expect more rabies survivors with better outcomes. Studying these patients will allow us to learn from them, and thus improve our understanding of what interventions could potentially lead to successful recovery from clinical rabies.

Written by Louise Taylor, Scientific Director, GARC