This is probably a dumb question, but if we eliminate the hydrophobia caused by rabies, would it increase the survival rate of active rabies?
This is probably a dumb question, but if we eliminate the hydrophobia caused by rabies, would it increase the survival rate of active rabies?
I've been learning some about rabies and learned about rabies causing hydrophobia. This is just a theory, I'm not saying I know anything about this topic to be knowledgeable, but if we could get someone with rabies to not fear water, could they survive?
No. You can fix the dehydration relatively easily by just giving the person liquid intravenously.
But the primary way rabies kills you is liquifying your brain, which is independent of how hydrated you are.
No. Rabies is destroying neurons, causing the symptoms. The hydrophobia is not literal fear of water (like phobias so often aren't) but a result of your brain being fried to the point where you have issues swallowing. If it were an issue of hydration, just IV fluids would be a given, and you would probably want IV access anyway.
Not a doctor or anything, though.
The "cure" for rabies is to treat it with a vaccine prior to symptoms appearing. The rabbies vaccine is 100% effective and you will not become symptomatic if you treat soon after the bite. The Milwaukee protocol has been tried and it's a last ditch effort for people who didn't get the vaccine shortly after the bite and are now showing symptoms. They don't even know if the Milwaukee Protocol is what prevented death or if the people it worked on were somehow resistant to rabies.
Why can't we just get a rabies vaccine when we're kids, or every few years, like most other vaccines? Why does it have to be after the bite event?
Because unless you're living and working in a high risk environment, there's no need for a human to go get a rabies vaccine because they can just avoid mammals that are acting strangely. It's not like it's airborne, you have to get a penetrating bite from a symptomatic animal to get it, so when that happens you just go to the doctor. You'd still likely get the vaccine even after a bite even if you had been previously vaccinated.
The Milwaukee Protocol is a treatment plan that is essentially a more advanced version of what you’re asking. The patient is put in a medically induced coma and then given antivirals and IV fluids, which avoids the issue of hydrophobia.
It got a lot of press because one person survived on it (a big deal given that rabies is a death sentence once symptoms appear) but this success hasn’t been reproduced with other patients. A paper on the protocol has a remarkably blunt title: Critical Appraisal of the Milwaukee Protocol for Rabies: This Failed Approach Should Be Abandoned.
and didnt they use it on that girl that survived cause she didnt report the bite until it was too late, so it was either try something dangerously crazy like Mulwaukee Protocol, or just die miserably?
I guess whether this protocol should be abandoned, rather than iterated on to improve its chances of success, to me, depends on the effect the coma has on the patient's quality of life while the protocol is attempted. It's arguably more humane to put someone in a medically induced coma while they're still sane. If the protocol fails, the patient is at least not conscious while their brain is deteriorating.
I'm gonna go watch House.
One thing that has since come out about rabies is that it's "100%" fatality rate is actually slightly overstated. Populations have been found with biological evidence of widespread rabies infections in apparently-healthy adults that never showed symptoms, for example: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7017994/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7077287/
Last I heard experts talking about this, it seemed like we're not really sure what that means. Maybe there's some immunity or suitability in these populations we have not born witness to and studied.
There are also absolutely more than 1 people to have been confirmed to survive rabies. The numbers are very small, but I know there's at least one other from the middle of the 19th century. https://www.sciencenews.org/article/first-rabies-survivor-boy-1971-cure-vaccine
As always, a lot we don't know about this disease. It is very possible that the Milwaukee Protocol is not the reason that girl survived -- hell, it might've even done overall harm -- because an n of one is just not science. She may have had a random, purely lucky medical quirk that meant she would've survived anyway. We really cannot know.
Science Journalism doesn't quite do its diligence on this subject. It REALLY likes to report about the fringe science/only one known survivor. Water is quite a bit muddier than that.
It seems like this would be the most humane way to “treat” it, but maybe I’m missing something?
Unlikely. Rabies kills by infecting brain cells. This means they're converted into virus factories instead of doing brain things. That also causes swelling as an immune response, which further damages the brain. Both of these result in coma and death. Eliminating hydrophobia and increasing water consumption would not really help treat an infection (at least any more than treating any infection, which is to say, not very much on its own).