A menace in india: Stray dogs are captured in New Delhi during an anti-rabies drive

When Jeanna Giese, a 15-year-old girl from Fond du Lac in Wisconsin, US, recovered from rabies early this year, she became the first person in medical history to have survived the infectious disease. Conventional wisdom says that unless immunised, nobody can escape the fatal attacks of this virus.

Jeanna apparently owes her life to a novel drug therapy. It was devised by Rodney Willoughby Jr, a doctor at the Children’s Hospital in Wisconsin, in a desperate bid to save her life. Although the treatment initially plunged the girl into a week-long coma, it eventually helped her immune system recover from the initial shock brought about by the virus and fight back the bug.

Last October, the teenager was rushed to the hospital with rapidly worsening symptoms ? unsteady gait, double vision, fatigue, etc. She had been bitten by a bat the previous month, but didn’t seek any medical attention. In case of such animal bites, you are supposed to get an anti-rabies shot along with an immune globulin (a blood product).

Even though the case raised the possibility of a rabies infection, doctors at the hospital, including Willoughby, were loathe to believe that she had rabies, simply because it is extremely rare in the US.

Rabies is most prevalent in India, killing at least 20,000 people every year. In the US, bat-bite is the principle cause of rabies, whereas in India street dogs cause the majority of the infections. However, unless animals are infected themselves with rabies, there’s no chance of passing on the virus.

Though thousands of animals develop rabies in the US each year, hardly one or two people get the disease. Which is why physicians attending Jeanna thought she had been suffering form some neurological disorder.

However, soon after she was admitted in the hospital, Willoughby, a paediatric infectious disease specialist, found that she was salivating profusely, pointing the needle of suspicion towards rabies. Analysing her spinal fluid, the doctors, on the second day, detected traces of rabies virus. Her condition gradually deteriorated and on the fifth day of onset of symptoms, Jeanna was put into a breathing tube in the intensive care unit to prevent an aspiration pneumonia.

The doctors led by Willoughby decided not to administer the rabies vaccine or anti-rabies immune globulin on Jeanna, apprehending an aggravation of the disease. Medical literature as well as virologists at the Centers for Diseases Control (CDC) told them that there was no history of survival in rabies unless people get an anti-rabies shot.

Willoughby knew that the virus is notorious for damaging the nerves and the brain. It affects the muscles and when throat muscles begin to function abnormally the patient can’t swallow foods properly. He or she refuses water ? the most dreaded condition called hydrphobia. Gradually heart and other internal organs give in because nerves connected to them fail to work. Heart failure, coma and other complications follow in the final stages.

Willoughby’s study of recent scientific advances offered him only a glimmer of hope from a research at the Pasteur Institute in Paris which had shown that ketamine?an anaesthetic?could be effective against viruses which had shapes similar to rabies.

So Willoughby decided to give Jeanne ketamine along with a sedative to induce a deep coma. The idea was that the treatment would stabilise the excited state of rabies-affected nerves and muscles and then the doctors would administer strong antiviral drugs to maim the viruse.

But the entire drug regimen was experimental; it had never been tried on any animals, let alone humans. So the doctors had to counsel Jeanna’s parents about the risks involved. They agreed to go in for it because when there is a history of 100 per cent fatality you can take any risk whatsoever.

The radical procedure was adopted and the patient went into coma; this saved her brain from the ravages of rabies. Meanwhile, strong antivirals like amantidine and ribavirin were administered. It took three months to cure Jeanna from rabies, except that she had problems like slurred speech or unsteady gait.

When Willoughby reported the case to the New England Journal of Medicine last month the medical fraternity was taken by storm. “There is every reason to celebrate any miracle,” Willoughby told Know-HOW in an e-mail message. “But it is not science until it can be replicated by other doctors.”