Miraculous Survivor from Rabies

Post date:2018.05.22

Rabies, a high fatal zoonosis, is transmitted by saliva through bites from infected dogs. All mammals including humans can be infected with rabies, and nearly 100% patients die if they develop rabies. Every year, approximately 50000 people die overseas, the majority in Asia and Africa. In Japan, a prevalence of rabies was recorded since Edo period. However, Japan has become an unusual country which has no incidence of rabies due to registration and vaccination of pet dogs, and extermination of homeless dogs based on the Rabies Prevention Law established in 1950. It was a great achievement, and both veterinarians and good-quality domestic vaccines played a major role.

Thus, recovery form rabies is difficult once humans develop it, however, recently, it was reported that a Brazilian boy of fourteen had survived from rabies (Jan 11, 2018, Jiji Press). Milwaukee protocol (MP) was used for treatment of this case. MP is an experimental way of treatment for human rabies and was performed on more than 50 patients, in which 6 patients recovered. In Sep. 2014, American high school student J was bitten by a bat and developed rabies. Dr. Willoughby, who was an attending doctor in Children’s Hospital of Wisconsin, performed MP based on the evidence which the brain of a patient was normal though the virus was isolated and which the virus was not isolated from the surviving patient in ICU after a few weeks. Willoughby induced a coma pharmaceutically, and then, administered antiviral drugs (ribavirin and amantadine) to kill the virus. After that, the immune system of the patient was activated and eliminated the virus with antiviral drugs. After a month, the virus was could not to be detected, and his encephalopathy was at low level. He could leave the hospital after the rehabilitation in Jan. 2015. The estimated cost of treatment would be about $800,000. It was not clarified why he could survive from high fatal rabies, however, there are various possibilities about reasons for which the administered virus might have had low pathogenicity, and which the bitten site was far from the brain, and which the immune system of the patient J might have been extraordinary strong. Anyway, he really returned alive, and the effectiveness of MP was reconfirmed through this Brazilian case. Mr. J is now studying to become a veterinarian.

This time, I introduced a recovery case although the patient was infected and developed rabies. However, humans do not always recover from rabies if MP is performed, thus, the preventive measures for rabies may be the most important for us. Countries which have no rabies like Japan are rare, therefore, we should keep rabies in mind when traveling overseas, and should not touch dogs, cats and wild animals without thinking. In 2006, two Japanese men in their 60s died of rabies after returning to Japan. The rabies is thought to be caused by bites from a dog while staying in Philippines. They saw a doctor because of a cold at first, thus, they had no recognition of rabies in spite of having been bitten by a dog. On the other hand, dog owners need to comply with the Rabies Prevention Law and carry out the vaccination every year. Now, there are many owners that do not have their dogs vaccinated because of no rabies in Japan. The vaccination rate in Japan is now below 70% although the WHO recommends 70% rate to prevent rabies from going around. Taiwan, where rabies has not been detected for a long time, confirmed that rabies expanded rapidly because of wild animals infected with it in 2013, followed by the infection to dogs. We should use that case as a lesson, and protect the health of humans in conjunction with that of animals while enforcing the vaccination of dogs. I hope to maintain the monumental achievement in measures for preventing rabies in Japan, with no similarities seen in the world.