The Girl Who Survived Rabies

June 14, 2011 2:37 PM

Recently, 8-year-old Precious Reynolds became the sixth person in history to survive rabies without a vaccine. A few years back, Extraordinary People put out a documentary (1 2 3) on the first person to beat the only viral disease that hides itself completely from one's immune system.
posted by gman (56 comments total)

My grandfather's brother was the last recorded human death from rabies in Massachusetts, in the mid 30's. He was bit by a stray dog on Wakefield Common. Because his mother was a cold, stern, casually mean New England stereotype, he was afraid to tell his parents and it cost them a son.

Until I saw this, I didn't realize that the mortality rate wasn't exactly 100% for untreated patients. Very lucky girl if you discount contracting rabies in the first place.
posted by Mayor Curley at 2:53 PM on June 14, 2011 [9 favorites]

I can't help but feel that news like this will only fuel the anti-vaccine movement.
posted by Sangermaine at 2:59 PM on June 14, 2011 [4 favorites]

The Precious Reynolds thing also prompted a nice post today on Scienceblogs.com's blog ERV called Another rabies survivor. The young woman who survived in 2004 with the induced coma method described in the link just graduated from college, apparently.
posted by Decimask at 3:01 PM on June 14, 2011 [1 favorite]

Well, she was treated, but not with prophylaxis. She was put in a medically-induced coma and given supportive therapy to keep her alive and preserved while her immune system fought off the virus.

Speaking of which, what's this about rabies hiding itself from the immune system? I'm not up for watching a 45-minute documentary and there's nothing about it in the first link or in the Wikipedia article on the virus. I Googled around a bit but didn't find anything more specific than what the OP wrote, other than that its ability to hide has something to do with its ability to infest the CNS. Can anybody shed some light on this?
posted by Scientist at 3:04 PM on June 14, 2011 [4 favorites]

As an update to that documentary, Jeanna Giese, the Wisconsin girl who prompted the creation of the Wisconsin protocol has graduated from college.

Even so, it's important to note that the current treatment only has a limited chance of working, on the order of 16%. On the other hand, I take issue with the documentary's claim that rabies has become "endemic" in the wild animal population. It's only so by comparison with the domestic animal population, and perhaps from the perspective of rabies-free Great Britain.
posted by dhartung at 3:10 PM on June 14, 2011

Scientist: Speaking of which, what's this about rabies hiding itself from the immune system? I'm not up for watching a 45-minute documentary and there's nothing about it in the first link or in the Wikipedia article on the virus.

Here, I've cued it up for you.
posted by gman at 3:29 PM on June 14, 2011

Having instantly obtained expertise via Wikipedia... apparently rabies is special in that the virus resides and reproduces inside of nerve tissue. Most nerve tissue is located in the brain (duh) but anti-viral immune cells cannot cross the blood-brain barrier. The virus entering the brain is what causes the cranial swelling which is near-invariably fatal. The preference for nerve tissue is also why it's symptomless for months; the immune system does fight it, so the virus travels slowly through the nerve system (instead of rapidly via blood) until it reaches the brain, where it reproduces uninhibited and rapidly causes death.
posted by mek at 3:45 PM on June 14, 2011 [2 favorites]

Jeanna Giese is the girlfriend of one of my friends. It's a terrifyingly small world sometimes.
posted by Slinga at 3:49 PM on June 14, 2011

Precious "Rabies" Reynolds has an awesome potential career as a prize-fighter.
posted by hermitosis at 4:00 PM on June 14, 2011 [14 favorites]

dhartung, you said, "I take issue with the documentary's claim that rabies has become "endemic" in the wild animal population. It's only so by comparison with the domestic animal population, and perhaps from the perspective of rabies-free Great Britain".

Can you elaborate on what you mean? It sounds like you're saying that it is technically incorrect to say that statistically the rabies rate is rising amongst the "wild" animals, but I couldn't understand your point about comparisons.

Out of curiosity, what's the survival rate for an animal with rabies? Does the virus incapacitate the host, and if so, how long before that occurs? It sounds like a brutal infection, but one that makes spreading difficult since it kills the host presumably so quickly?
posted by scunning at 4:06 PM on June 14, 2011

Precious "Rabies" Reynolds has an awesome potential career as a prize-fighter.

Especially because she's resistant to brain damage.
posted by justsomebodythatyouusedtoknow at 4:10 PM on June 14, 2011 [5 favorites]

Rabies is in many ways the prototype for zombie movie virus infections. Essentially 100% fatal, it first enters your blood stream through the insane biting, clawing, and attacking of those already infected. As the virus hides and reproduces within your nervous system, it in turn drives you insane, pushing you to bite, scratch and claw the next victim.

About all that is missing is a tweak to the timeline of its life cycle speeding it up and a secondary side effect causing hunger specifically for brains.
posted by Muddler at 4:11 PM on June 14, 2011 [16 favorites]

Back in 2009 Michigan had its first death from rabies since 1983.

A friend of mine, a former biology teacher who now works in the county morgue as a lab tech, was assigned to remove the brain from the deceased, nobody advised, insisted, recommended, ordered, or suggested that she might want to wear some protective gear, or a mask or respirator as she fired up the saw to take the skull off.

Afterwards, after the fine blood spray in the air settled down, they did insist she go through the series of shots.
posted by tomswift at 4:20 PM on June 14, 2011 [5 favorites]

This was posted by me earlier, regarding an encounter with a rabid animal:

When I was working in Canada, I left a NYC girlfriend at my remote house, while I was at the office. I get a panicked call, "A racoon is trying to get in the house and attack me!"

Silly NYC girl, right? I come back home later in the day, and all the doors to the house are covered in splashes of hair and blood, where this thing had thrown itself at the doors violently and repeatedly. And the trail of blood ended where it climbed up a porch support onto the roof, and was presumably waiting to jump down on someone.

Now I feel guilty for not rushing back home sooner.
posted by StickyCarpet at 4:21 PM on June 14, 2011 [4 favorites]

Middler, the movie's called [Rec].
posted by gottabefunky at 4:21 PM on June 14, 2011

Of tangential interest: "Precious" is an example of a "virtue name" — very common among the New England Puritans who had names like Thankful, Perseverance, Deliverance, Chastity and Piety. Although the practice pretty much faded by about 1800, some virtue names became mainstream and are still used, including Hope, Faith, Joy, Blythe, Bonny, and (less often) Prudence, Patience, Constance, and (recall the TV show) Felicity.
posted by beagle at 4:22 PM on June 14, 2011 [2 favorites]

"Precious Reynolds" even sounds like a Chuck Palahniuk character.
posted by rokusan at 4:27 PM on June 14, 2011 [3 favorites]

nobody advised, insisted, recommended, ordered, or suggested that she might want to wear some protective gear

Was this her first time using the saw? I always wore a rain coat after my first time.
posted by ryanrs at 4:28 PM on June 14, 2011

A friend was bitten by a feral cat once. She refused to have it killed or have the shots (it didn't seem particularly crazy). We did name the cat Rabies. Her kittens were named Plague, Ebola and Malaria (all were trapped, spayed/neutered, and released). Plague would sit on your lap from time to time but the others stayed wild. The end.
posted by Glinn at 4:29 PM on June 14, 2011 [11 favorites]

I can't help but feel that news like this will only fuel the anti-vaccine movement.

The sort of people who are in an anti-vaccine movement are the sort of people we do not want to give vaccines to. Society wins in the long run.
posted by Renoroc at 4:31 PM on June 14, 2011

I had rabies shots when I was 5, after I was bitten by a stray cat in the desert. It sucked. They never found the cat, and for months afterward my dad kept a wrist-rocket by the back door and would shoot ball-bearings at any cat that he saw in our yard.

Good times.
posted by hermitosis at 4:31 PM on June 14, 2011 [3 favorites]

The sort of people who are in an anti-vaccine movement are the sort of people we do not want to give vaccines to. Society wins in the long run

Even if you accept that premise, it's wrong for two reasons:

(1) A lot of the anti-vax movement is about not vaccinating their kids. Those children have no say in the matter, and may be very different kind of people than their parents (kids often are).

(2) Herd immunity is important for a lot of reasons. One example is people who cannot receive vaccines for legitimate medical reasons (impaired immune system, etc); these people benefit from everyone else being vaccinated. If too many people opt out, the herd immunity doesn't work.
posted by wildcrdj at 4:41 PM on June 14, 2011 [30 favorites]

Thanks for pulling that out, gman! Still a bit mystified as to how its presence in the central nervous system renders it effectively invisible. Perhaps the immune system is simply reluctant to destroy the host cells, since they are so vital to bodily function and basically irreplaceable?

I am also reading (here, first paragraph final sentence) that oral herpes uses a similar method of retrograde axoplasmic flow (wherein it uses the flow of cytoplasm from the axon [the nerve's transmitter] toward the nerve body as a means of apparently climbing upward toward the brain) in order to infest its host. Perhaps this immune-system invisibility is not totally unique?

I'd still love to know why exactly the rabies virus becomes hidden once it enters the central nervous system. If anyone wants to drop a knowledge bomb on me, that'd be awesome.
posted by Scientist at 4:45 PM on June 14, 2011

I would hazard a guess that it has something to do with the blood-brain barrier...
posted by Zalzidrax at 4:50 PM on June 14, 2011

I can't help but feel that news like this will only fuel the anti-vaccine movement.

It might, because the anti-vaccine people are irrational, but I don't think this would make an anti-vaccine case for anyone who was thinking straight. If you get bitten by a rabid bat, you can take a vaccine, or you can wait and get rabies and try this treatment. The vaccine is sort of unpleasant but almost 100% effective. This treatment involves being put in a medically-induced coma, which gives you a 20% chance of surviving long enough to undergo years of rehabilitation and live with probable brain damage. This is great for people like Precious Reynolds, who didn't know she'd been infected, but I don't think anyone with a choice would choose it over a couple of shots.
posted by craichead at 4:58 PM on June 14, 2011 [1 favorite]

Do we really need to talk about the anti-vaccine movement again?
posted by Scientist at 5:02 PM on June 14, 2011 [10 favorites]

to remove the brain from the deceased, nobody advised, insisted, recommended, ordered, or suggested that she might want to wear some protective gear, or a mask or respirator as she fired up the saw to take the skull off.

Color me surprised by this. I had thought that breathing protection was standard practice while skull sawing because of concern about various nasties that can get aerosolized and inhaled. Am I misinformed?
posted by Forktine at 5:22 PM on June 14, 2011

Out of curiosity, what's the survival rate for an animal with rabies?

Bats are a reservoir species, carrying the virus while remaining symptomless. I once heard a bat expert on the CBC say that bats obviously don't carry rabies because they are so small and would surely be killed off too quickly to spread the virus around. Seems being an expert ain't all it's cracked up to be.
posted by Dodecadermaldenticles at 5:31 PM on June 14, 2011

Growing up, we were told that lone bats seen flying during daylight hours were probably rabid. This article seems to back it up. So not all bat carriers are asymptomatic.
posted by murphy slaw at 6:08 PM on June 14, 2011 [1 favorite]

A friend of mine, a former biology teacher who now works in the county morgue as a lab tech, was assigned to remove the brain from the deceased, nobody advised, insisted, recommended, ordered, or suggested that she might want to wear some protective gear, or a mask or respirator as she fired up the saw to take the skull off.

Afterwards, after the fine blood spray in the air settled down, they did insist she go through the series of shots.

I would have thought protective gear would have been standard practice in using a saw that cuts through bone.

I remember in 5th grade (1988), a surgeon who only worked on feet(podiatrist?!?) spoke in my class for career day and talked about how he wore a mask, and lab goggles when performing surgery because of this.

Shouldn't that former biology teacher have taken universal precautions anyway? I mean even Scully did this...and she always lost her gun.
posted by hal_c_on at 6:17 PM on June 14, 2011 [1 favorite]

During my first autopsy, I didn't have to wear any protective gear besides an apron.

Those were simpler, more innocent times.
posted by adipocere at 6:33 PM on June 14, 2011

It might, because the anti-vaccine people are irrational

I used to think this as well. Then I met one in the wild. She's an otherwise sane, reasonable, and thoughtful human being. I go to a playgroup with her and while she kind of boggles my mind in a "People really DO this?!" kind of way, she's not totally bats. We were discussing a girl with a potential case of Lyme disease and she piped up that if her son had a bullseye rash, she'd want the antibiotics immediately - even though she's generally against them.

I can totally, TOTALLY see her allowing her son to get a rabies vaccine if there was cause for one, even though she's rejected the routine vaccines as "Western medicine going too far."

Anyhow - isn't it more germane to the situation that vaccinating animals has largely prevented the need for humans to be vaccinated in the first place?
posted by sonika at 6:53 PM on June 14, 2011

> I used to think this as well. Then I met one in the wild. She's an otherwise sane, reasonable, and thoughtful human being. I go to a playgroup with her...

I was going to post some GRARR, but really, let's not make this an antivax thread. I'm sure we'll have another one soon enough.
posted by Decimask at 8:09 PM on June 14, 2011

"the anti-vaccine people are irrational"

"Anti-vaccine people" actually are individual human beings, each with a slightly different perspective and reasoning for same. Lumping together and then dismissing people who disagree with your position on something makes YOU, if not irrational, certainly very close-minded, intolerant, and inflexible.
posted by parrot_person at 8:20 PM on June 14, 2011

Anti-vaxxers are certainly individual human beings with different perspectives and reasonings for their position. All of those reasons are irrational and lead to real human death and suffering, though, so it's certainly fair to lump them all together as irrational.
posted by Thoughtcrime at 8:28 PM on June 14, 2011 [9 favorites]

"Anti-vaccine people" actually are individual human beings, each with a slightly different perspective and reasoning for same. Lumping together and then dismissing people who disagree with your position on something makes YOU, if not irrational, certainly very close-minded, intolerant, and inflexible.

The NAZIs were individual human beings who I'm sure had reasons and a perspective too.
posted by humanfont at 8:45 PM on June 14, 2011 [4 favorites]

Lumping together and then dismissing people who disagree with your position on something makes YOU, if not irrational, certainly very close-minded, intolerant, and inflexible.

I'm rather close-minded, intolerant, and inflexible on how objective scientific results should be analyzed.
posted by hal_c_on at 8:51 PM on June 14, 2011 [6 favorites]

More like Godwon, amirite?
posted by adamdschneider at 9:09 PM on June 14, 2011 [1 favorite]

So.....rabies is the Zombie Apocalypse? Really???



I've had my shots....
posted by pearlybob at 9:54 PM on June 14, 2011

Christ on a crutch, take it down a notch.
posted by cortex at 10:25 PM on June 14, 2011 [2 favorites]

she's not totally bats

ISWYDT.

scunning: The video said "Rabies is all but forgotten in the First World -- but it is making a dramatic comeback." This claim is false fearmongering. There were four human cases of rabies in the United States in 2009 (in 2007, there was just one; the most recent year with no cases was 1999). The second claim is that "Rabies has reached epidemic levels among wild animals." While there have been some increases, and some spikes, overall the numbers collected through state public health monitoring have been fairly steady (and you have to consider reporting biases). The third claim (in the middle) is that there is a "new super-strain" of rabies. There is a new strain that has made the interspecies jump to skunks and spreads epizootically from skunk to skunk instead of just to individual skunks from individual bat bites. It's a bit Alex Jones to call this a "super strain" though and rabies like any virus is constantly adapting to new conditions.

One thing that would be accurate to say is that rabies had been in recession in very many parts of the US until a raccoon epidemic in the 1990s spread it around again. But that's already some years ago and human cases have not spiked.

(I follow this because I had a close encounter with a bat a couple of years ago and had to undergo post-exposure prophylaxis. Now I'm a bit of a rabies bore in the right circumstances.)
posted by dhartung at 10:34 PM on June 14, 2011

I read a book about the history and efforts to eradicate rabies once. The descriptions of infected patients was terrifying. Here is a list of Furious rabies symptoms:

• aggressive behaviour, such as thrashing out or biting
• agitation
• hallucinations – seeing or hearing things that are not real
• delusions – believing things that are obviously untrue
• excessive production of saliva
• high temperature (fever)
• excessive sweating
• the hair on their skin stands up
• a sustained erection (in men)

posted by unliteral at 11:59 PM on June 14, 2011

Are there any estimates how many animals actually have rabies? I grew up in a city and every wild animal from sparrows on up were to be feared and definitely NOT inspected or befriended in any way because "it could have rabies!" It's really cramped my nerd style because to this day I might want to poke at a dead thing with a stick but I hear my father in my head, telling me that rabies shots involve multiple vaccines around your abdomen...
posted by autoclavicle at 1:27 AM on June 15, 2011

Furious rabies symptoms:

How about hydrophobia? Where did I learn that from? Was that from Seinfeld? Does this count as a scientific cite? I kinda liked the ending better on Curb Your Enthusiasm. Costanza...you so crazy.
posted by hal_c_on at 3:29 AM on June 15, 2011

How about hydrophobia? Where did I learn that from?

Probably "Old Yeller." However, if you're lucky enough to not have seen it, spare yourself. My mom is in her early 60s and lists that as the most traumatic film that she was ever subjected to despite having seen it once, 50 years ago.
posted by Mayor Curley at 3:39 AM on June 15, 2011

Moving things back to the actual article...

There is no specific medication to fight rabies - the body will kill it off eventually, if it can survive long enough.

This used to be true of a wide variety of diseases, particularly before the introduction of antibiotics, and still is true to a certain degree with some. Dysentery for example, is sometimes left to run its course, as if you don't die, you get better in a week. The actual bug won't kill you, but you get so dehydrated that without acute rehydration therapy, you'll almost certainly die within a week or so. Like with pneumonia and influenza, the real danger is not directly from the actual disease, which the body can identify and fight pretty effectively, but that the resulting symptoms will overwhelm the body before it has a chance to recover. If you can keep the patient alive, they'll usually get better on their own.

This is different from, say, ebola, cancer, or a poison, all of which actually cause direct damage to organ systems. Those things will kill you, or at the very least will have more-or-less permanent effects, just by the very action of the disease.

The trick with rabies, it seems, is that because it attacks nervous tissue and ultimately the brain, keeping people alive long enough to fight the virus is really difficult. The brain is both incredibly plastic and incredibly fragile, i.e. it's amazing how much punishment it can take without any noticeable effects, and how little trauma it can take to really screw things up. It seems that the main risk is from swelling. I wonder if removing part of the skull might not serve to alleviate some of the pressure?
posted by valkyryn at 4:28 AM on June 15, 2011

Rabies is in many ways the prototype for zombie movie virus infections.

If memory serves me right, in Max Brooks' World War Z, the symptoms made some confuse the initial zombie outbreaks with rabies. In response, a pharmaceutical company developed an actual working cure for rabies that, sadly, did nothing against the actual zombie infection, but did lead to a false sense of security in the United States that allowed the outbreak to spread unchecked.
posted by Gelatin at 7:30 AM on June 15, 2011

Of tangential interest: "Precious" is an example of a "virtue name" — very common among the New England Puritans who had names like Thankful, Perseverance, Deliverance, Chastity and Piety. Although the practice pretty much faded by about 1800, some virtue names became mainstream and are still used, including Hope, Faith, Joy, Blythe, Bonny, and (less often) Prudence, Patience, Constance, and (recall the TV show) Felicity.

Tangentially to the tangent, Pratchett uses this idea a few times in Discworld, but my favorite is a character named Legitimate: "Can't blame a mother for being proud."
posted by kmz at 8:00 AM on June 15, 2011 [1 favorite]

I've recently gone through post-exposure rabies prophylaxis, due to a bat exposure.

Rabies shots have a bad reputation, owing, I think, to the fact that there used to be no vaccine, just post-exposure immunoglobulin injections, which were given in the abdominal muscles.

I had 4 large rabies immunoglobulin (RIG) shots in the upper glutes, one small RIG shot in a deltoid, and then a 4-shot vaccine series in alternating deltoids over the next two weeks (last shot was yesterday). None of these were more than momentarily unpleasant; blood draws, for instance, are much worse, and I'd honestly rather go through that ten times than go through one Pap smear.

Rabies shots are, by the way, effing expensive -- I have insurance to cover it, but it's thousands of dollars.

Are there any estimates how many animals actually have rabies? I grew up in a city and every wild animal from sparrows on up were to be feared and definitely NOT inspected or befriended in any way because "it could have rabies!" It's really cramped my nerd style because to this day I might want to poke at a dead thing with a stick but I hear my father in my head, telling me that rabies shots involve multiple vaccines around your abdomen...

Birds don't carry rabies. In general, small animals like chipmunks and squirrels don't. Bats, skunks, racoons, cats and dogs do. One major reason to avoid any wild animal that wants to be "friends" with you is that abnormal behavior is a major symptom of rabies -- thus, a nocturnal animal found in the daytime, or a wild animal which allows you to approach, has a higher likelihood of being rabid than the general population.

Poking dead things with sticks should be totally safe. Rabies is actually quite hard to transmit -- you need exposure to fresh wet saliva. There are reports of "unexplained" or "aerosol" transmission from bats, but these cases are extraordinarily rare, and only get attention because rabies itself is so extraordinarily rare in countries with well-developed canine vaccination programs.
posted by endless_forms at 9:19 AM on June 15, 2011 [1 favorite]

In re. poking dead things with sticks: http://www.health.state.mn.us/divs/idepc/diseases/rabies/risk/specimens.html

Skunks and bats are the wild mammals most commonly found to be rabid in Minnesota.

Bats should be captured and tested for rabies if there is any chance that physical contact with the bat occurred. These situations include bat bites and also situations in which contact with a bat cannot be reasonably ruled out, such as finding a bat in the room of a previously unattended child, or waking up to find a bat in the room.

Large rodents (beavers, woodchucks, muskrats) and marsupials (opossums) have occasionally been found rabid in other regions of the U.S. Testing of these species should be considered if the animal is showing signs consistent with rabies and an exposure has occurred.

Any domestic or farm animal (dog, cat, ferret, cow, horse, sheep, goat, pig, llama) with a clinical diagnosis of rabies made by a veterinarian should be tested immediately. In some situations involving human exposure to dogs, cats or ferrets, rabies testing may be indicated in the absence of clinical signs of disease.

Testing of small rodents (hamsters, gerbils, guinea pigs, mice, rats, squirrels, voles, gophers), insectivores (moles and shrews), and lagomorphs (hares and rabbits) for rabies is generally not indicated. Although many thousands of people report being bitten by these animals each year in the U.S., no case of human rabies has been documented from bites of these species.

posted by endless_forms at 9:24 AM on June 15, 2011

How about hydrophobia? Where did I learn that from?

I saw rabies with hydrophobia in an episode of House. I could not find any scientific evidence suggesting it's common, but I think it was an early season, so probably it really did happen, once.
posted by jeather at 9:40 AM on June 15, 2011

Rabies is in many ways the prototype for zombie movie virus infections.

I was wearing my In Case of Zombies shirt while grocery shopping once, and the cashier loved it so much that he felt the need to share with me the theory that he and his friends discuss (regularly, and in great detail) about how the zombie apocalypse is caused by a mutated strain of the rabies virus.
posted by antifuse at 11:18 AM on June 15, 2011

Oh man, if we're talking about awesome previously common now rare disease presentation on House, nothing beats the plague in Season 1.
posted by sonika at 12:56 PM on June 15, 2011

the cashier loved it so much that he felt the need to share with me the theory that he and his friends discuss (regularly, and in great detail) about how the zombie apocalypse is caused by a mutated strain of the rabies virus.

Embrace it...because its this sector of the working class that will know what to do when the time comes.

And the time will come.

Rabies, though...yeah, no. People can be scientists or zombie killers...definitely not both.
posted by hal_c_on at 12:04 PM on June 16, 2011

Rabies, though...yeah, no. People can be scientists or zombie killers...definitely not both.

Wait a sec, Batman is a scientist, so if Batman battles zombies....
posted by Muddler at 12:56 PM on June 16, 2011

How about hydrophobia?

Hydrophobia is a common symptom of late stages of rabies, such that they were considered one and the same for centuries. (It results from paralysis of the swallowing muscles.)
posted by dhartung at 10:16 PM on June 16, 2011