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Comment by bsder | Hacker News Reader

> Your question stands: why not test it?

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.

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>>Because there are so few late stage rabies victims that you simply can't get the data?

In India, estimated 20k(!!!) people die of rabies each year. Surely that's enough to warrant human testing.

https://www.who.int/india/health-topics/rabies

I think there are some ethical issues with trying to find those people and not treat their disease before it is too late, most of the testing will consists of preventing people from becoming good test subjects.

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).

Treating them is the point. Find people who's too late to get the old rabies shot and give the new treatment to them. The difficult part is control group but that's always the difficult part. Without control group they can probably just compare statistics with the past...

I don't think you really need a control group for something with a well established nigh 100% fatality rate.

The fact that 20K people die to a disease that has a set of proven, relatively inexpensive treatments tells me that 20K people already can't get to a medical facility.

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.

I have unfortunately seen some heartbreaking videos where it's children who got it. Some for sure can't get access to medical care in the rural areas, but sometimes the kids might not even know.

Post exposure vaccination alone is not sufficient to prevent death for all cases. Immunoglobulins (HRIG) must also be administered. HRIG is not commonly available in many developing countries or rural areas. This is why preexposure vaccination is recommended for vulnerable groups (children) when traveling to such areas.

> 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.

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)

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