Is the first cure for advanced rabies near?
medicalxpress.com
medicalxpress.com
They already tried the experimental Milwaukee protocol even though it wasn’t clinically established (and in fact didn’t work)
That is not true anymore. There are two known protocols with a small chance of working but which have already saved about a few dozen lives. They are called "the Milwaukee protocol" and "the Recife protocol" after the cities they were developed.
[1] https://journals.lww.com/pidj/fulltext/2015/06000/the__milwa...
[2] https://www.cambridge.org/core/journals/canadian-journal-of-...
AFAICT The paper questions the hypothesis that the 2 additional survivors had rabies, but not the first patient.
It doesn't work very well... but it does seem like it occasionally works.
AFAICT The paper questions the hypothesis that the 2 additional survivors had rabies, but not the first patient.
It worked for the first patient on which it's been tried though! Which is still an objective win even if it wasn't particularly successful afterwards.
This review [1] cites 11 documented survival outcomes of the Milwaukee and related Recife protocols. Is there a basis to your claim?
But 59,000 people die of rabies each year and each case is almost certainly fatal.
So it seems we should speed up distributing this. If rabies patients start surviving then we know it works.
At that point we can test exactly how much it works. But meanwhile why wait?
However considering the normal survival rate is zero... It's a lot better
I mean.. you can't say it doesn't work if it led to the first ever documented case of rabies survival. That's amazing.
Your question stands: why not test it? There's precedent for testing unproven drugs on humans in extremis, so it's not that.
As a halfhearted stab in the direction of an answer: I assume they will try it in human rabies victims in a later phase, they're just testing it in mice first.
Because there are so few late stage rabies victims that you simply can't get the data?
By and large in the US, people know the protocol--get bitten by a strange animal, head to the ER and get ready for rabies shots. And it almost always works.
Apparently, the US never had a post-treatment death until one 84-year-old man with an immune deficiency (and a bunch of other health issues) died of it. It's not clear anything would have worked for him. https://www.unmc.edu/healthsecurity/transmission/2023/04/04/...
Basically, the only people who die of rabies are those who missed that they got bit or those who were dumb enough to refuse the vaccine. And there just aren't that many of them.
In India, estimated 20k(!!!) people die of rabies each year. Surely that's enough to warrant human testing.
I'm not saying it's bad, but it will be expensive and may fail to yield much result (as far as testing the cure goes).
Getting to those people to a medical facility to test a new, unproven, expensive treatment simply isn't going to happen.
This is especially so since there are a vast number of diseases that are much higher priority than rabies in India.
Lots of people are dumb enough not to go to the ER following a harmless animal bite.
Maybe, if it's a bat, but lots of people won't bother (and 99% of the time, they'll be fine either way)
My point was, normal medical ethics seem to go out the window here. With most interventions, you can harm the patient, so you had best not give them anything until you test it.
But a symptomatic rabies patient is default dead. Given these results, it strikes me that we ought to move much faster through our usual phases and make it available for immediate use in centres which are symptomatic rabies patients.
If any of those patients start surviving, the drug has proven itself for general use and stats can be gathered. The control group is every prior symptomatic rabies patient: they all died.
The article made it sound like this will be something rolled out over several years. If that, as investment is required.
An estimated 59,000 people die of rabies each year globally. Each year of delay kills them. My question is should we not make this available immediately and see what happens?
It isn’t like heart disease where the patient will often live many years and so a new treatment must prove itself. Literally everyone dies of rabies if symptomatic.
How many are diagnosed before it's too late?
In the developed world where you're likely to get tested and diagnosed, we probably don't have many cases.
And you probably can't give the treatment to suspected cases.
But yes, there is little risk in testing on diagnosed patients.
I was exposed to a rabid bat a couple of weeks ago (captured, tested and confirmed to have rabies, unfortunately). While I’m not ecstatic about the cost of rabies treatment in America (it can be up to $40k a person, and 2 of us were exposed), I’m so glad we were able to get the bat tested and get in for the vaccines fairly easily.
The vaccines themselves are reasonably priced, but you have to get Human Immunoglobulin as well, which is only available at ERs and ranges from 2-12k per dose… and we needed 3 doses for each person (it’s by weight). In addition to those 3 shots, we had to get 4 vaccine shots, spread out over a 2 week period. Each shot caused symptoms. Luckily our symptoms were primarily just extreme fatigue or hot skin near the injection site, so it was not a fun 2 weeks but not the end of the world for us.
This alternative treatment sounds like it could be significantly cheaper and easier than that, and that it could possibly work in later stages, so that’s awesome to hear! I wasn’t clear from the article if they think it’ll be usable in humans once the symptoms begin though. If it’s before symptoms begin only, then it’s not much different than the current vaccine regimen other than cost/simplicity (which is still an awesome improvement, but not helpful for the people who don’t know they were exposed).
I found another one dead on the same deck a year or so later. As it wasn't white nose season, I had to dispose of it myself.
In no case neither myself or my kids had any discernible side effects. That’s interesting that was possible; considering the vagueness of early onset rabies (fever, fatigue, headache) that must have been worrying.
The worst about rabies is that it can linger for years; I heard of a case where a woman was traveling overseas and had exposure to a rabid monkey, and couldn’t get treatment for a week and then only got the vaccine, no HRIG. They told they won’t really know if it worked until 2 years, if she doesn’t die.
I strongly consider getting my family vaccinated before traveling to any place that doesn’t have ready HRIG and vax, since delay can be so dangerous. It’s a low likelihood but high consequences risk, but the vax is pretty low risk but expensive. Spouse doesn’t think it’s necessary so will have to cross that bridge.
https://m.youtube.com/watch?v=4u5I8GYB79Y&pp=ygURa3Vyemdlc2F...
Invidious: https://invidious.askiiart.net/watch?v=4u5I8GYB79Y
*There's maybe a dozen known recoveries from symptomatic rabies, ever. So, 100%.
I’m a little troubled by this outcome. Having the virus linger longer in a living host — is there chance it could mutate or exchange genetic material with another virus like an airborne one?
I don’t know how we would even measure when a human is truly cleared the virus; in mice they know because of an autopsy.
Many pets are likely to interact with wild animals that may carry rabies, but few humans are. Most humans with elevated risk of rabies are aware of it, and can get a sequence of preemptive vaccines.
Additionally, most humans bitten by an animal will consider rabies at that time, whereas few pets are able to provide a description of the animal that bit them.
Let's get a working cure for humans before we start worrying about sci-fi methods to eliminate a disease that's endemic in wild animals in many regions.