Rabies

Content below is from #178 of the Who’d a Thunk It? Podcast

RECOMMENDATION SEGMENT

• This week I recommend… you go back and listen to my past episodes released during October!
• That’s right, I’m shamelessly recommending you listen to my own content.
  • Every October I try to keep things creepy and do a Who’d a Thunk It? FrightFEST!
  • In honor of AMC’s FearFest where they show classic horror movies all throughout the month of October each year.

NOW FOR THE MAIN EVENT

• Rabies is a viral encephalitis (a virus that causes inflammation of the brain)
  • Symptoms:
    • Fever
    • pain
    • hyperactivity
    • excitability
    • excessive salivation
    • confusion
    • hydrophobia (fear of water)
      • Rabies has sometimes been called hydrophobia due to this rare symptom
  • One of the most notable aspects of Rabies is that it can only be diagnosed by its symptoms… but by the time the symptoms appear… it is already too late.
    • If rabies is not treated before symptoms appear, it is 100% fatal*
      • * – Some VERY new treatments has lead to VERY few patients recovering from rabies after symptoms appeared, but very little is known about this treatment. I heard about it on NPR’s radio lab podcast. I’ll talk about this later on.

• Rabies has the highest mortality rate than any other disease on earth. It is 99.999% fatal.
  • Rabies is most commonly spread via a bite from an infected mammal (dogs, raccoons, cats, foxes, etc.)
  • We don’t know when or where the disease originated
    • But There was a 2012 Phylogenic analysis published in the Journal of General Biology that suggests the current canine genotype of the illness may have been predated by another genotype.
    • But the human connection and by far the most common way the illness is spread is by being bitten by a dog… as dogs have been man’s best friend longer than any other domesticated animal.
  • Somewhere between 33 and 40 thousand years ago we humans started our relationship with dogs, but dogs came into contact with the rabies virus long before that.
• Not only is rabies the most deadly and horrifying diseases, it is also one of the oldest.
  • Rabies is one of the oldest diseases ever recorded. a 2017 article in the Journal of Tropical Medicine and Infectious Diseases cited 4,000 concepts related to rabies in animals and humans.
  • The oldest being a cuneiform clay tablet found within the archeological record titled the Laws of Ishununa. It was from Sumerian and later Acadian city-state in present-day Iraq. The tablet is over 4,000 years old and says
    • “If a dog becomes rabid it makes that authority known to its owner. But he does not watch over his dog so that it bites a man and causes his death, the owner of the dog shall pay 40 shekels of silver”
    • It should be known, 40 shekels of silver is A LOT of money. During that time, an entire boat costed just 2 shekels…
  • There are also Dog incantations from this same time period that suggest these ancient people figured out the disease was in the dog’s saliva and if bitten, the person was certain to die.
• The word Rabies is from the latin word for Madness which found its origin in a sanskrit word for “to rage.”
• Ancient Scholars from all over talk about this horrifying disease
  • Aristotle, Hippocrates, Pliny, Ovid, and Cicero, and Chinese texts dating back to the 3rd century AD reference rabies
    • The 2nd-century Greek philosopher Celsus suggested cauterizing the wound when bitten. It is unclear how effective burning the spot of a dog bite was against rabies… but this remained the go-to treatment for rabies bites up until the 19th century.
    • Odd because the other treatment Celsus suggested was holding the victim underwater… for those subjected to this treatment… those that didn’t drown stilled died of rabies…. ‘
    • The only other treatment people used was prayer

• In medieval Europe, a common treatment was to place the hair of the dog that delivered the bite (sometimes after being charred) into the wound. This was a medical suggestion from Roman Naturalist Pliny the Elder.
  • This treatment is the etymology of the term “the hair of the dog that bit you.”… you know, the term that refers to an alcoholic chaser that is supposed to cure your hangover… FYI… I never found the hair of the dog to cure my hangover, but I’m sure it is more effective than the original Hair of the Dog treatment… that did Diddly Squat to cure rabies.
• While there are LOTS of historical records of rabies cases and unsuccessful treatments throughout history, not too many of them are all that interesting. The most interesting this is just how often this disease is mentioned by so many different cultures separated by both space and time.
  • Rabies is one of the scariest diseases out there and it has been scaring the crap out of us humans for as long as history has been recorded (and likely much longer than that).
• A notable historical case is that In 1996, a group of doctors at a medical conference were presented a set of symptoms for a patient referred to as EP (a writer from Richmond VA) They were asked to diagnose the patient. They concluded the patient died of rabies… EP was Edgar Allen Poe.
  • Poe died in 1849 so the diagnosis obviously can’t be confirmed, but is now the widley accepted cause of the famous writer’s death.

• Today, one of the greatest weapons we humans have against rabies is vaccines.
  • In 1881 Louis Pasteur developed a successful vaccination protecting cattle from anthrax.
    • He started to develop a vaccine for dogs to protect them against rabies.
    • He first greew the virus in rabbits then weakened it by drying the nerve tissue.
    • It took decades until comprehensive vaccination protocol programs were developed.
  • Those shots you are legally obligated to give your pets (the ones I always gripe about when we take our dog Rorschach or cat Beerus to the vet for) drastically lowered the number of rabies cases.
• In 1885 Pasteur used the vaccine on 9-year-old Joseph Meister who was mauled by a rabid dog.
  • For doing this, Pasteur could have not only ruined his career as a vaccine scientist, but could have been sent to prison as he was not a licensed physician and therefore not legally permitted to deliver vaccination to a human.
  • But considering the alternative for little Joey Meister (horrificly painful suffering and death), Pasteur went ahead with treatment.
  • Pasteur and his colleagues gave 13 inoculations in 11 days. Little Joey Meister made a complete recovery. It was a breakthrough. Quickly word spread about Joseph Meister surviving rabies (pre-symptom rabies) and patients flocked to Pasteur for treatment.
  • By the time Louis Pasteur died 9 years later, over 20,000 people had received his vaccine (post-exposure prophylactic vaccine).
  • It is important to know that the vaccine for rabies is only effective if given BEFORE symptoms appear.
  • In Pasteur’s time, it required up to 20 shots (and it is a big painful needle), but today only takes about 4 shots.
    • Secondly, if administered within 10 days of exposure, it is nearly 100% effective.

• Today the World Health Organization (WHO) estimates 59,000 people die of Rabies each year mostly in Asia and Africa.
  • While we humans can get it from many different kinds of mammals, dogs are responsible for 99% of transmission to humans due to our lives being so intertwined with dogs.
• Before Pasteur’s vaccine treatments that came along as early as 1885, if someone was bitten by a rabid animal, they were as good as dead.
  • Their only hope was that the animal that bit them was just acting funny in general and wasn’t actually rabid…
  • Then when the vaccines came along, there was hope. Get the treatment before the symptoms and there was a decent chance of survival…
  • But even after Pasteur’s vaccines, if someone exibited symptoms (which was common as most people didn’t equate a bite with rabies…) they were doomed. Like 100% chance of one of the most horrific things to plague mankind for as long as writing has existed. The Babylonians and Acadians wrote about this stuff thousands of years ago and genetic testing suggests it existed before canines.

• Well in 2004 that changed… just a little bit. And I first heard of this story on NPR’s Radio Lab podcast title Rodney Versus Death (link in CREDIT section)
  • In 2004 a girl from Milwaukee went to the hospital with flu like symptoms. Pretty quickly her symptoms were obviously not from the flu as she started to become really stiff and lots of pain.
  • When the mother of the girl told the Doc that she had been bitten by an odd-acting bat in church a few weeks back, the pediatrician went pale and said “I will be right back,” and left the room… He was confirming the information with colleagues before informing the family that their daughter was practically doomed with the most fatal disease known to man.
  • After the family was fully informed they were freaked out, but ultimately were like “Ok, so lets try any experimental treatment out there. If she is doomed to horrible pain and death… we will try anything because anything is better than that.”
  • The pediatrician found that the rabies virus works differently than most viruses. Where most viruses enter the body, multiply at the site of entry, enter the bloodstream, and spread all over the body until they find the tissue they are most suited to multiply in…
  • Rabies doesn’t do that. It enteres at the entry point (in Milwaukee girl’s case, the left index finger), then proceeds to latch onto the closest nerve. The rabies virus then slowly crawls along the nervous system at a rate of about 2 centimeters per hour.
    • So for the rabies virus to travel up the length of your finger might take a day. Up your entire arm, maybe a few weeks… it is slow… but once it reaches the brain you are screwed. it inflames the brain and starts wreaking havoc.
  • Well Milwaukee girl’s doctor started looking at the past 20 years of Rabies cases and also learned that once the victims are disected (autopsy) the victim’s brain is found intact. Not destroyed.
    • He thinks, huh, Rabies virus must not destroy the brain, it just hijacks it and kills the victim via the symptoms before the imune system can destroy the rabies virus. So he thinks: “what if I can buy the immune system enough time to get rid of the rabies virus before the patient dies?”
    • Sure enough, he enduces the Milwaukee girl into a monitored coma. For weeks she is like this, given IV and monitored closely.
  • When they wake her up, her pupils respond to light and eventually she wakes up… very slowly.
    • Milwaukee girl had lost months of memory and had to teach herself how to walk, and talk again, but she did it and is now considered 100% recoverd… the first case EVER recorded of a rabies victim who showed symptoms and survived!

• Now, that have been other studies, like this one Peruvian doctor who went deep into the heart of the Amazonian rainforest to test people who regulary come into contact with Vampire Bats. The hope to was gain insight into rabies victims that aren’t normally studied.
  • What he found was that about 7% of the population had Rabies antibodies in their system. The only way this could have happened is if some of these people had Rabies infection at some point…
  • This Peruvian doctor disputes the case of the Milawakee girl (now known as the Milawukee protocol). Peruvian doctor says the Milwaukee girl survived, not because of the Milwaukee protocol (induced coma), but because she had antibodies naturally… just how he suspects a small percentage of the population already has.
• In the end, the Milwaukee protocol has been used on about 30 people (at the time the Radio Lab pod was released in 2013… so theres been a whole decade of research since then…).
  • Out of those 30, 5 people survived… and all 5 had the naturally occuring antibodies.
  • Whether it is the Milwaukee protocol or the antibodies saving these people… one thing is for sure, before 2004, there were ZERO cases of people surviving symptomatic rabies. and Now that number is NOT zero.

• So why did I do an episode on this? Well… Rabies scares the shit out of me. It is October so Halloween is coming up and I usually do spooky themed episodes in October. I call it my Who’d a Thunk It? FRIGHT FEST!
  • And I think it would be beneficial for everyone to be afraid and aware of Rabies and the potential horrors it presents.
    • IF a person is aware of rabies and how important it is to seek medical help quickly, that means fewer people die in this horrible way that has plagued our species for as long as history was written.
  • And I am NOT the only person who is scared of rabies. Literary scholars have long suspected Rabies as the direct influence for some of the most horrifying monsters… think about it.
    • Vampires – get bit by a bat, turn into a violent monster obsessed with biting others… thats rabies
    • Werewolves – get bit by a dog (or wolf) and turn into a violent monster obsessed with feasting/biting others… thats rabies
    • Zombies – get bit by a violent monster of a human and turn into a violent monster human obsessed with biting others… Thats rabies.
• And lastly… I DO NOT CONDONE THIS OR SUGGEST ANYONE LOOK THESE UP AS THEY ARE HORRIFYING AND REAL. DO NOT WATCH THESE
• But there are tons of rabies victim videos available on YouTube. they are disturbing… even for me and I like watching messed up horror stuff.
  • The only benefit I got out of watching a few seconds of one of these hydrophobia rabies videos to research this episode… It instilled a very real and deep fear in me. Which may save me one day if I get bit by a raccoon that is rabid. Instead of brushing it off until symptoms arrive… I’ll certainly be gong to the hospital and asking for Rabies testing/treatment now.

CREDIT

• https://radiolab.org/podcast/312245-rodney-versus-death