
Utah man dies from rabies, the first in the state since 1944 - wglb
https://www.deseretnews.com/article/900041016/utahn-dies-from-rabies-a-first-since-1944.html
======
rlue
There's actually an experimental treatment for rabies that can be administered
if post-exposure prophylaxis fails (called the "Milwaukee Protocol"). It
involves a drug-induced coma followed by a cocktail of antivirals, and the
success rate is around 20% in the best case (n.b. the sample size for the
study that figure was 10).

Not that it would have helped here, when the diagnosis came at such a late
stage.

The case report for the patient treatment that pioneered the Milwaukee
Protocol—the first-ever successful treatment of a rabies patient—is worth a
skim, if you're into this sort of thing.

[0]:
[https://www.nejm.org/doi/pdf/10.1056/NEJMoa050382](https://www.nejm.org/doi/pdf/10.1056/NEJMoa050382)

~~~
SolaceQuantum
I believe it’s also associated with severe health consequences and the only
survivor has stated regretting the protocol...

EDIT: Seems I'm misinformed. Thanks for clarifying, commenters below.

~~~
AuthorizedCust
I don't see much regret: [http://www.jeannagiese.com/my-personal-
story.html](http://www.jeannagiese.com/my-personal-story.html)

~~~
crescentfresh
> I had less than 4 hours left to live. Dr. ... was not ready to let me die.
> He researched the internet and found a few key phrases that helped him
> devise a treatment

Well I guess in desperate times all treatments started somewhere, a quick goog
is probably as good as any.

------
fiblye
I've had bats slip into my house late at night several times. They're cute
little fuzzballs when I see them outside flapping around _far away from me_ ,
but hearing a "pittpittpittpattpatt" whirling above your head at night is
terrifying. My first assumption was always rabies, because why else would a
tiny animal get so close to a huge and dangerous animal like me?

A large number of stories I've heard involving people playing with small wild
mammals end with rabies. When it comes to bats, raccoons, and possums, I was
always taught to treat them as rabid because healthy ones won't ever get close
to random humans if they can help it. That this guy was letting them lick his
fingers is unimaginable to me.

~~~
enceladus_ice
Luckily, it's extremely rare for opossums to contract rabies, so keep
snuggling those scary beasts to your heart's content.

~~~
bryanrasmussen
what's the rate for opossums who get close to humans though?

~~~
braythwayt
This!

It's related to the assertion that fewer than 1 in 100 programmers is unable
to write "FizzBuz" in the programming language of their choice.

The rate may be statistically insignificant amongst all programmers, but what
is the rate amongst programmers looking for a job?

Different question :-)

~~~
MRD85
I really struggle with the concept that some programmers cannot write
FizzBuzz. I'd expect it from someone who has finished their first programming
unit.

~~~
bryanrasmussen
I've known some programmers that I expect might not be able to write FizzBuzz
in the time allotted within an interview, based on how long it has taken them
to produce code 5-6 times as verbose as needed given the simplicity of the
task at hand.

------
dahart
> They never hurt us

I guess as I understand it, it doesn’t matter if animals are normally friendly
because rabies causes them to act aggressively.

Radiolab did an episode on rabies that is absolutely fascinating. They talk
about the “Milwaukee Protocol” for treating it, which I’d never heard of
before that. It’s no longer a recommended treatment, if it ever was, but the
story really stuck with me.

[https://www.wnycstudios.org/story/312245-rodney-versus-
death](https://www.wnycstudios.org/story/312245-rodney-versus-death)

~~~
mongol
Why is it no longer recommended? Is it not the only viable way to save someone
infected to life, when the disease has progressed far enough?

~~~
durzagott
According to a study [1] it has never been a viable treatment. The treatment
has been repeated on at least 12 patients since the original case (Jeanna
Giese) and has been a failure every time.

No-one know why Ms Giese survived, but the Milwaukee protocol does not seem to
have been the reason. Or if it was, it is not repeatable on other patients.

[1] [https://www.cambridge.org/core/journals/canadian-journal-
of-...](https://www.cambridge.org/core/journals/canadian-journal-of-
neurological-sciences/article/critical-appraisal-of-the-milwaukee-protocol-
for-rabies-this-failed-approach-should-be-
abandoned/8A47C583B24B2B2E43248770F78CC35A/core-reader)

~~~
p49k
Sure, but I don't understand what the harm would be in trying the treatment
for a patient who will otherwise have a 100% chance of dying in a very short
timeframe. I mean, if the Milwaukee protocol did help the one patient, then
the treatment has a 5% success rate, which is better than 0, no?

~~~
vidarh
The harm is that these patients and their families lose the tiny amount of
time together they'd otherwise have left, because the patient is put in a
coma.

It's a difficult trade-off for a lot of high risk medical interventions to
judge the relative worth of the potential chance of survival vs. that last
remaining time, and it's certainly not a choice we can objectively make on
behalf of other people.

In this case it's not certain the protocol have helped _any_ patients. _If_ it
did help, then the success rate is so low that there are ethical issues with
overselling the potential vs. giving people that extra time together.

If a patient wants to try, I'd be all for giving them that choice. But there's
a big gap from letting a patient ask for something and promoting it as the
recommended course of action without evidence of _any_ efficacy.

~~~
greiskul
Well, are you aware of how death by rabies happens? Way better for you and
your family if you die in a coma, then to have to watch you going through it
consciously. If I had rabies in a stage where death is certain, the options I
would be looking at would be either the Milwaukee protocol or euthanasia. The
other option (doing nothing) doesn't just means death, it means painfully,
awful death.

~~~
vidarh
If people want to take that option, then I'd be fine with that. But it's not
for anyone to decide on behalf of others. If MP has no effect - and it's very
possible it's effectiveness is actually zero, as we don't know if it was what
saved Giese, - then it is wildly unethical to give unjustified hope to people,
especially when this will prevent doctors from trying to find other options
that might at least give them a chance.

------
gambiting
This explanation of how it is to die from rabies is horrific, if anyone
fancies a story that stops you from sleeping at night :P

[https://www.reddit.com/r/news/comments/9vdumn/utah_man_dies_...](https://www.reddit.com/r/news/comments/9vdumn/utah_man_dies_from_rabies_first_in_state_in_74/e9bpd2j)

~~~
LandR
There's no rabies in the UK, right?

~~~
gambiting
No, apparently it has been fully eradicated in 1922, and only deaths due to
rabies were due to bites while abroad.

~~~
pvaldes
Last death: Scotland 2002. A chiropterologist studying native bats. He had not
travelled out of UK

~~~
circlefavshape
Now chiropterologists all get vaccinated as a matter of course (source - my
wife is one).

~~~
LandR
I initially read that as chiropractor and was very confused... I obviously
need beer!

------
mrfusion
It’s fun to ask an anti vaxxer what they would do if they were bitten by a
rabid animal. You can watch cognative dissonance kick in.

~~~
tomphoolery
How would a vaccine help someone who already has rabies?

~~~
village-idiot
The vaccine is extremely effective if taken between the bite and when symptoms
occur. If treated properly and promptly, you have basically a 100% chance of
living. As symptoms begin to show up, the chance of survival drops rapidly to
0%.

~~~
aaron_m04
> As symptoms begin to show up, the chance of survival drops rapidly to 0%.

Probably even before symptoms show up, right?

------
URSpider94
There was also a fatal case in Virginia this year, a woman who contracted the
disease while traveling in India. It took several trips to the hospital before
they diagnosed it correctly, since it’s not something docs are expecting to
see. They tried the Milwaukee protocol unsuccessfully.
[https://www.cdc.gov/worldrabiesday/stories/rabies-
virginia.h...](https://www.cdc.gov/worldrabiesday/stories/rabies-
virginia.html)

------
tomatotomato37
"I had no clue," Giles said. "We would wake up in the night and they would be
walking on our bed"

I'm sorry for the family but I can't exactly say I'm not surprised. Generally
having any wild mammal hanging out where you sleep is a very bad idea.

Edit: Reworded to be less arse

~~~
spacenick88
And it's a very good idea to get a rabies vaccine shot if you find an unknown
dog in your bed at night. Like a very very good idea

------
pmarreck
> "I had no clue," Giles said. "We would wake up in the night and they would
> be walking on our bed."

Not to judge, but isn't this getting _a little_ too close with nature?

------
slr555
The practical takeaway here underscores the advice in Auerbach's authoritative
text Wilderness Medicine. If a person interacts with potentially rabid animals
and that interaction results in even the smallest scratch or contact with
saliva the victim should undergo rabies treatment and if possible have the
animal undergo necroscopy.

The odds of surviving rabies once it becomes symptomatic are negligible. They
can throw the hail Mary from the 5 yard line in a snowstorm but the chances of
winning the game with it are slim.

------
aurizon
Rabies enters a nerve cell at the bite site. It then travels along the nerve
axon to the next cell. It does not proliferate at this time. Cell by cell, via
the axon railway to the brain. It then proliferates in the brain and kills
large numbers of brain cells and causes death. If you have antibodies, they
can somehow block the axon travel. The Milwaukee treatment was a success - the
only one? Perhaps that girl had some immunity? In any event, once it hits the
brain the body starts to mount it's own immune response, and apparently the
anitivirals she was given, along with the induced coma, allowed her immune
system to overcome the rabies.

------
madeuptempacct
Rabies is one of the scariest diseases to me, because most aren't vaccinated,
it's virtually 100% lethal, and most of the time, doctors will tell you that
you don't need to be vaccinated "just in case", because the incidence is so
rare.

If you can, bring in the animal that bit you; you don't want to go through the
shots unless they are necessary, but you also don't want to die.

~~~
decebalus1
I was dumbfounded by the attitude of some of the medical personnel I had to
deal with when I was once randomly bitten by a stray dog. After I demanded to
be vaccinated at the emergency room they finally gave in but their attitude
was "the dog lives in the city, it doesn't interact with wildlife so you're
most likely fine". I told them 'most likely' doesn't make the cut for me when
we're talking about a disease with a mortality rate at 100%.

~~~
Paul-ish
It's amazing how, to doctors, what were once once meaningful life and death
scenarios just become more work or less work scenarios over time. They are
desensitized.

------
jordache
they allowed bats to walk on their beds at night? WTF

~~~
codezero
To be fair bats are pretty harmless when they aren’t infected with rabies.

~~~
mirceal
To be fair, in quite a few places bats are the main rabies infection vector.

~~~
opencl
The places where bats are the main rabies infection vector are generally
places where rabies is extremely rare[1], such as the US with 1-2 cases per
year. ~99% of human rabies cases globally are from dogs[2], unsurprisingly
these are mostly in places where dogs are not usually vaccinated.

[1]
[https://www.cdc.gov/rabies/bats/education/index.html](https://www.cdc.gov/rabies/bats/education/index.html)

[2] [http://www.who.int/news-room/fact-
sheets/detail/rabies](http://www.who.int/news-room/fact-sheets/detail/rabies)

~~~
mirceal
Yes and when a bat has a 10% chance of carrying rabies you get a rabies shot
it you come into contact with one.

Yes, the odds of you getting it are small, but the downside is that if you do
get it you’re almost guaranteed to die.

~~~
opencl
The number is probably way below 10%, but yes obviously getting the shot is
still a very good idea.

Though the other nasty thing is that getting rabies shots cost thousands or in
some cases tens of thousands of dollars in the US, which leaves a lot of
people with the choice between bankruptcy or some unknown probability of
getting rabies and the subsequent guaranteed death.

~~~
mirceal
WA state for example: between 3-10% of bats submitted for testing are found to
be rabid (this is from the DOH website). Yes, 10% is the high number in some
years.

~~~
tomjakubowski
Bats that have been submitted for testing are not likely representative of the
overall bat population.

~~~
baddox
Bats that have been submitted for testing are likely fairly representative of
the bat population that is likely to bite you.

------
kyleblarson
Note to self: don't let bats lick my hands.

------
grawprog
When I got my rabies shots to do bat work years ago i remember the nurse that
gave the shots told me the story of one of her first patients out of med
school who died of rabies. Apparently, he was actually bit a bat that flew
into his tent when he was camping and he didn't end up going to a doctor about
it until it was too late and he slowly died. This was in canada. We've had
deaths more recently than the USA from rabies.

It sounds like a horrible way to die. She gave me shit for going to work with
bats...even after getting the shots...

Rabies is pretty intense. Even after being vaccinated you still need to get a
titer shot every few years to keep your level of antibodies high enough to
fight off the virus if you're exposed to it.

------
JulianMorrison
Why is rabies vaccine so expensive as to be rationed?

~~~
zerr
That's not the case in Europe.

~~~
carlmr
It was still 210€ for 3 shots when I took it. (Germany)

~~~
stargazer-3
Yet it is fully covered by public health insurance in Germany (got my rabies
shots refunded by the TK).

~~~
carlmr
Not fully and not by all public insurers AFAIK. But the price of the
vaccination itself is still high anyway.

------
briandear
It’s interesting to me that my town, Mountain View refuses to require rabies
vaccinations or licensing for cats.

~~~
ghaff
I think that's pretty typical throughout the US.

------
prmph
So why doesn't everyone simply get vaccinated?

~~~
latestagetest
Rabies vaccine is crazy expensive and takes multiple shots. Even then you
still need immediate post-exposure treatment.

------
mylons
patient 0

~~~
warent
It's a real human, not a Hollywood film for your entertainment

------
kleopullin
This is a badly written article, journalists should have a little science
background.

"... the bats .... were carriers of a rabid and highly contagious virus."

Yes, it is a rabid virus...

"A person usually has some time before it is necessary to get the post-
exposure prophylaxis vaccination."

A friend had to handle a bat in her cabin, and she was not told she had "some
time" before the shots. If you've been exposed get your butt to the ER.

"An estimated 40,000

people in the US who might not be up-to-date on vaccinations

get preventive treatment for rabies after a bite or scratch from a dog or
cat."

Statistically 100% of peeps aren't up to date on rabies vaccines. Vets, bat
researchers, and bat house zookeepers may be up-to-date, but no one else is.

Rabies shots costs thousands of dollars, btw. Tricare, for military
dependents, doesn't charge a copay for rabies post-exposure injections. My
friend's insurance had something like $4000 copayment.

~~~
madeuptempacct
"Rabies shots costs thousands of dollars"

I assume you mean in the US. Really? I had no clue. They are like $5 in
Eastern Europe.

Edit: I _am_ referring to the post-exposure shots.

Edit 2: All of this reads like a bad joke - if our numbers are representative,
rabies treatment is 20-2000x the cost of other countries in the US. Would be
interesting to see someone play devil's advocate on this.

~~~
bhousel
Oh! I got rabies shots in 2014 after being bitten by a dog.

The course of treatment is injections 0day, 3day, 7day, and 14day. I went to
the emergency room to get these injections, at the recommendation of my
primary doctor.

Unfortunately I don't have the bills anymore, but the total cost was a bit
over $20,000, which insurance adjusted down to about $500/visit.

Basically, it would have bankrupted me if I didn't have insurance. Yes, the US
healthcare system is really this broken.

~~~
tom_b
Yep, my family had to do the same ER visit for our treatments. Immune globulin
is a blood product and I was told it is atypical for any medical center
outside of a hospital to have it available. Having to go the ER added a not
insignificant amount to our total bill, but we did only have to pay for a
single visit to the ER - our followups, we just walked in and a nurse would
give us the shot.

On the somewhat funny side, it's weird walking into an ER and being greeted by
first name and a wave . . .

~~~
bhousel
Hah yeah, it was kind of funny that by the 4th shot, the ER docs and police
there knew me as "the rabies guy".

I also was told that the immune globulin is a bit complicated because it needs
to be prepared specifically for the person's weight. So unlike off the shelf
vaccines, it requires an on duty pharmacist to actually do something before
they can give it to you, which I'm sure adds to the cost.

------
pvaldes
Another sad case of lack of scientific formation. Could be easily solved
spending 20 minutes at the schools to study basic ecology of parasites,
vectors and diseases.

Microbats shouldn't be, never, ever, manipulated with bare hands. Specially if
they seem to be sluggist or ill. Full stop. You need strong gloves, or much
better, let it to a trained zoologist or veterinary.

