How to: Survive rabies without really trying

This is an awkward sort of "How To" post because nobody really knows the answer. Here's the rather bleak reality: Rabies is not, typically, something you live through. If you think you've been exposed, you can get a life-saving vaccine. But, if you miss that window, and symptoms start to appear, your chances of survival are pretty much nil.

There are exceptions. We've talked before here about the Milwaukee Protocol, a medical intervention that some doctors think has allowed a handful of people to escape death. But the Milwaukee Protocol is not a simple thing. It involves hospitalization, as doctors put the affected person into a coma. Basically, they reboot the system. And it might not be as effective as we think it is. Five people have gotten the Milwaukee Protocol and survived. Thirty-two others received the treatment and still died. There's a lot of effort that goes into the Milwaukee Protocol, and it might be wasted effort.

Then there's this: In 2009, a teenage runaway walked into a Texas hospital, exhibiting symptoms of rabies—a diagnosis that was later confirmed. She didn't get vaccinated before symptoms started. She never got the Milwaukee Protocol. Instead, she recovered on her own and left the hospital hale and healthy three weeks later.

That's not supposed to happen in humans.

The Austin American-Statesman has a fascinating story about this case. At the heart is a big mystery. The young woman cut off contact with hospital researchers shortly after she was discharged from the hospital. She was homeless—in fact, she'd probably contracted rabies from a bat while camping in a cave. There's a very good chance that we may never know why she survived when so many others don't.

Veterinarians know that not all animals die after exposure — usually from a bite — to the rabies virus, which is carried in saliva and other bodily fluids. Much depends on how much of the virus is transmitted, the severity and location of the bite, and the immune system of the bitten animal.

"Abortive rabies is not unusual in research animals — it happens spontaneously all the time," Rupprecht said.

Rupprecht said the blood of certain human populations — maybe 1 percent of raccoon hunters, for example — also tests positive for rabies antibodies, indicating they have been exposed to the virus without becoming acutely ill. In the Amazon, where indigenous tribes are at daily risk of rabies from vampire bats, "it could be in the 10 percent or more range," he said.

The rabies vaccine, injected in a series of five doses, prevents onset of the disease if given soon enough after exposure. About 35,000 people receive the expensive shots — the series costs about $1,600 — in the U.S. each year. Seldom do more than a handful of people die from rabies in a year. But once rabies symptoms appear, the vaccine is no help.

"We don't have poster children. In our field, 99.9 percent of our cases are in the ground," Rupprecht said.

Read the rest of the article at the Austin American-Statesman

Image: White-Shouldered Bat, a Creative Commons Attribution Share-Alike (2.0) image from wilsonb's photostream

Via GrrlScientist


  1. I just finished getting my rabies vaccination series on Saturday. I was deeply stupid, and tried to pet a dog with a soup bone outside a coffee shop. By the time I’d finished cleaning up my knee in the bathroom, the dog had been taken away by its owner. There’s only been one human case of rabies in Massachusetts since 1935 (someone who got bit by a bat), and the annual count  of canine rabies cases in MA is statistically zero…but if this particular dog had missed getting its shots, and gotten into a fight with a raccoon the week before, the first symptom I got would be a death sentence.

    So after terrifying myself with Google, I went to the hospital, and got eleven shots on my first visit (five directly into the wound), then went back for three more shots over the next two weeks. The doctor and nurses were universally rueful — the first nurse who heard the dog was missing paused, gave me a pained look, and said, “That’s too bad.” (Which terrified me more.) Fortunately, they use small-gauge needles now, and no longer have to inject the stomach directly. Also fortunately, I have health insurance now, so the total cost to me was a $20 co-pay.

    If anybody has any bats they need caught, lemme know. I’ll do it bare-handed.

    1. Last summer, my bro’s girlfriend got bit by a dog and the owner ran off, but the hospital (in Toronto) advised against getting the vaccine. They figured since it was an owned, healthy-looking dog, getting vaccinated might be riskier than the bite itself – she decided to forgo the dozen shots! No foaming, yet.

      1. have you kept tabs on the gf, especially when there is a full moon? sleep with one eye open, bro

    1. More likely a bat bridge or bat building then, rather than a cave. There are a couple of bridge colonies in Houston, but none of them are as big as the Congress Bridge colony in Austin. 

      1. Austin’s Congress Bridge bat colony – 1.5 million, Houston’s Waugh Bridge bat colony – 250,000.  The bridge in Houston is the only bridge colony in Texas that stays year round.  The colony in Austin leaves for the winter.    

        Maybe you thought that was impressive.  How about this: just to the NW of San Antonio is Bracken Cave, home to the largest colony of bats in the world: 20 million.  Which also, not surprisingly, is the largest concentration of mammals in the world.

  2. Was the survivor known to drink Sterno squeezings?

     (This is always to be the first thing to pop into my head  any time there’s a medical mystery afoot. )

  3. So four possibities:
    1. she had immunity
    2. she has a genetic abberation that allowed her to survive (did she ultimately survive?)
    3.  Maybe similar to the Sickle Cell / Malaria / Syphilis trifecta  (where one or more diseases at least mask the others).. she probably had another disease that counteracted (AIDS+rabies? Taxoplasmosis+rabies?  prion vs. retrovirus who wins?) 
    4. Dumb luck.

    1. Don’t forget the obvious # 5:

      Maybe the death sentence from rabies is grossly exaggerated

      1.  Not so much. Because occasionally people (like this girl) do show up at a hospital already showing symptoms. And they die. All of them.

        It’s not like it’s been decades since the last time there was an untreated rabies case and we have been passing on a rumor of fear ever since. Doctors watch people die of this every year.

      2. Don’t be ridiculous StaceyG. Go read a reputable medical journal about the subject and educate yourself. You sound like HIV conspiracy theorists who denounce anti-retrovirals. 

    2. She probably had some prior low-level exposure which conferred an inoculative effect. She was homeless, and might have had exposure through bat-shit or transient dogs. Rabies might be the sort of thing that wouldn’t normally kill a human unless that human had been raised and kept in a hygienic environment, away from rabid stimuli.

      Or, yeah, it could be some other thing. I’ll have the needle, please.

  4. PatientX, the mysterious young lady being homeless and living in possibly squalid conditions probably had an immune system that was already on high alert and working steadily so that could have indeed been a factor.

  5. Maybe the hospital realized they weren’t going to get any insurance monies for a homeless patient they realized had a 100% mortality rate, so they trumped up some paperwork and saying she was “hale and hearty”. 

    Afterwards they realized that discharging a patient that miraculously survived Rabies invited an awful lot of questions, so she’s been difficult to get ahold of.

    That’s an awfully cynical  view, though.

    1. I think it would be highly unlikely that, if this was the case, the hospital would have gone through the trouble of writing up her case for widespread publication in the CDC medical archive. 

      Also: People dying of rabies can’t really just get up and leave. They couldn’t have just shown her the door. She wouldn’t have been able to make it that far. 

  6. People do on very rare occasions clear viruses that are otherwise incurable such as HIV so I’m not surprised that some very small number of people survive rabies infection. Most are probably like those raccoon hunters, they probably received a mild case that their immune systems took care of before the virus got to their brain to start causing symptoms. That the girl was symptomatic and survived is what I find interesting.

    1. Look, as I suggested to StaceyG, I’ll do the same for you Sheryl. Please read reliable information on this subject written by medical experts. People don’t just “clear viruses that are otherwise incurable”. The likelihood is so small as to be inconsequential. When people test HIV+ and then later test HIV-, what has probably happened is they are the lucky .001 percent that receive a false positive result, or they did a standard anti-body quick test too soon for anti-bodies to be detected. The should follow that up with a comprehensive bloodwork analysis that actually reveals the virus itself. In the case of people like your raccoon hunters, there have been recorded incidences of people not seeking treatment for suspicious animal bites, who survive without symptoms for a long while but then eventually die when the rabies virus comes out of dormancy. If you get Rabies, consider yourself dead. Okay? 

  7. Well, considering that natural selection works on viruses as on any other living being, and that for a virus, producing “more offspring” usually necessitates not killing its host, or at least doing it more slowly, then in the normal course of events viruses should become milder. At the same time, resistance should evolve in the affected populations (and indeed has evolved in some wild species, as mentioned in the article).
    But this requires large-scale interaction between the virus and the host – so the fact that there are so few cases of human rabies is conspiring against our survival rates and this particular adaptation :-(

    1. The reason for this persistent situation is basically that our large, fragile brains are highly vulnerable to viral encephalitis, which is the primary cause of death in rabies infections. The differential in baseline lethality between non-human host species and human populations is so high that the virus hasn’t been able to jump the gap and adapt to survive and propagate in human groups.

    1. Oh don’t get me wrong, I like bats.  They eat insects, which I dislike more than them.  However, when they get inside you house it makes for a nerve racking experience (in my case twice now).

    2. You are far more likely to catch rabies from a dog than a bat.

      It’s certainly true that most bats don’t have rabies, but that statement is flat wrong. Rabies has been virtually eliminated in household pets in the US. From the CDC: “Wild animals accounted for 92% of reported cases of rabies in 2010. Raccoons continued to be the most frequently reported rabid wildlife species (36.5% of all animal cases during 2010), followed by skunks (23.5%), bats (23.2%), foxes (7.0%), and other wild animals, including rodents and lagomorphs (1.8%).” Pets are the other 8%.

      Since 1995, 35 of the 49 human rabies fatalities in the US were from bats, compared to 12 from dogs.

      The only two human cases of rabies reported in 2010 were both from bats.

      It’s true that most bats are healthy, but the trouble is they’re much harder to catch and test than other animals. It’s also possible to be bitten by a bat and not know it — the one Massachusetts fatality since 1935 didn’t know he’d been bitten. That’s usually not true of dogs.

      I did a bunch of research after I got bit. :) I adore bats too, but I want to set the record straight. Interesting note: possums’ body temperature is too low to support the rabies virus, so possum bites are worry-free.

      1.  Exactly right.  I’m part of a small bat rehab. organization and I can attest first hand to seeing people bitten by bats and seeing no physical evidence of the bite.   Most bats teeth are so tiny, you might not even feel the bite.

        The best advice for rabies prevention pre exposure is avoidance.  If you see a bat on the ground, look up “bat rehabilitation” in Google.  Most of the time, they’ll come pick up the bat for free.  If they are unable, call animal control.  Under no circumstances should anyone ever touch a bat if they don’t have rabies vaccination.  It will just result in the bat being tested (aka killed).  Keep your pets away from them too.

  8. I’ve always wondered why the vaccine is available for cats and dogs, but not for humans, considering how fatal the disease is and you can be infected without knowing it.

    1.  It is. My wife who works in a shelter was required to get it after being hired. It needs to be boostered if you actually do get bitten though.

    2. Vaccines all carry some inherent degree of risk of negative reaction. Therefore they’re only recommended when the risk of the disease outweighs the risk of the vaccine. Because most people will not come into contact with the disease and the vaccine can be given prophylacticaly post-bite, there’s not really much reason to take on the cost and risk of vaccination unless your risk of contact with the disease is atypically high.

  9. There a case in Turkey or some place like 15 years ago where people were harvesting grapes, and workers sleep in the vineyards at night.  A rabid dog came through and bit like  30 people. Treatment was not available. Something like 4 people lived despite being bitten. 

  10. I saw a doctor after being bitten by a dog several years ago. He advised that the chances of getting rabies from a domesticated dog (the dog was being walked by someone when it bit me) was low so I didn’t get any shots.  The cost would have been around $1200.

    (Why didn’t we just quarantine the dog to be sure it didn’t have rabies?  The owner and the dog ran off immediately after the attack and i never found them again.)

    He did quote me the factoid that bite wounds from genuinely rabid animals are 70% less likely to result in rabies if the wound is washed out immediately afterward.

  11. “About 35,000 people receive the expensive shots — the series costs about $1,600 — in the U.S. ” 

    In Brazil, my wife was once bitten by a stray cat and a doctor immediatelly indicated the rabies treatment since they could not monitor the cat. Only public hospitals in Brazil carry the vaccine. The whole treatment was free.

  12. Last summer I woke to find a bat chilling on the ceiling of our hallway.  It was my wife’s birthday.  She looked at me and calmly said, “the best birthday present you can give me is to get that f*cking bat out of my f*cking house now.”  My dog really wanted to help, but I got him out of the house right away.  In retrospect, I thought to myself, “why did I exclude the one member of the family who is 1) actually vaccinated against rabies, and 2) enthusiastic about catching this effer?”

    Because we had no idea if it had been in any of the bedrooms overnight, my wife and I and our two young kids all got the whole series of shots.  Pain in the ass.  Literally.

    Bonus PSA: Here’s how I caught it: If it’s not stationary, wait for it to land, place large bowl over it, slide piece of cardboard between ceiling and bowl, run outside like you’re carrying plutonium, release in least-favorite neighbor’s yard.

    1. You know, you could have kept the bat in the bowl and taken it to animal control to be tested. That would have been simpler than all of you getting rabies shots.

  13.  “We made calls to the numbers she gave us, but she’s dropped off the grid.” – Why exactly can’t we get some police and private detectives after her?  Seems like the potential benefits – curing rabies – outweigh the financial costs by far, and that this might be the exception to the rule in the case of patient confidentiality. 

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