A radical new rabies treatment
By Emma Teitel - Monday, August 22, 2011 - 2 Comments
For the first time people are surviving the infection without vaccinations—but is this therapy too risky?
On Sept. 12, 2004, 15-year-old Jeanna Giese bent down to pick up a wounded bat in her hometown of Fond du Lac, Wis. When the creature bit her left index finger, she treated the cut like any other (with hydrogen peroxide) and carried on with her life. But a month later, Giese was struck with double vision, slurred speech, and a fever of 102° F. Doctors tested her for several infections but each result came back negative. Finally, her mother recalled the bat bite and doctors filled in the blank: Jeanna had rabies—a viral infection that causes acute encephalitis and is almost always fatal when victims do not receive a vaccine of immunoglobulin immediately after infection.
But Rodney Willoughby Jr., a 55-year-old physician at the Children’s Hospital of Wisconsin, would challenge that notion with a radical therapy called the “Milwaukee protocol,” and Giese would become the first-known person to survive a rabies infection without receiving an inoculation. “We decided to use a strategy,” explains Willoughby, “where we would support the patient for a natural immune response to clear the infection.” Willoughby wanted to see if Giese’s immune system could, under the right conditions, overcome rabies on its own. He sedated Jeanna, inducing a coma (Willoughby has since moved to a lighter sedation), and put her on a number of antiviral drugs, believing that a dormant brain would keep her alive longer and allow the body to marshal its defences more effectively. “One in five rabies patients die of heart stoppage in the first week of treatment,” says Willoughby, “and if you sedate the brain then the brain can’t [stop the heart].” Jeanna suffered some brain damage from the sedation, but the treatment worked: her brain slept while her body fought off the disease, says Willoughby. “All we do,” he adds, referring to the most recent guidelines of his protocol, “is essentially provide you with a breathing tube and give you a couple medicines to keep you out of trouble. Then we let your immune system do what it has to do.” Willougby called his treatment the Milwaukee protocol after the city where the first treatment took place, and has made it accessible online for doctors around the world. Giese, now 21, graduated from Lakeland College in May, with a degree in biology.
In the last seven years, five other patients, from Qatar to Peru, have survived rabies after undergoing the Milwaukee protocol. The most recent success story is Precious Reynolds, an 11-year-old from northern California, who beat the infection in July. Precious attends a rural public school in Willow Creek, Calif., where the teachers and students regularly fed and played with feral cats. “It turns out Precious was the queen of the hill,” says Willoughby, who was in contact with the girl’s doctor throughout her treatment. “She handled the cats the most. That was probably the cause of exposure.”
Precious is currently recovering rapidly from the virus, says Willoughby, showing no signs of brain damage from the sedation. But not every protocol-aided survivor has been so lucky. Some suffer from “locked-in syndrome,” a condition of almost complete physical paralysis (some patients can move only an eyelid) resulting from the sedation. It’s this kind of outcome that has kept Willoughby’s innovation on the medical periphery. In fact, in many parts of the world, his methods are vehemently discouraged. “In Asia and elsewhere,” says Thiravat Hemachudha, a Thai neurologist and rabies expert, “we strongly recommend not to apply this to any of our patients.” Hemachudha argues that heavy sedation is unnecessary and dangerous—a criticism Willoughby says he is all too familiar with. “We are regularly pummelled at scientific meetings,” he says. “Critics say that our survivors are natural survivors, and would have lived even if we hadn’t done the protocol.” Another common criticism is that the method prolongs suffering and offers false hope. To date, the protocol has been used on approximately 38 patients, six of whom have survived.
Worldwide, 50,000 people die of rabies each year, a figure that makes the protocol’s success rate unimpressive to its critics. But it’s a start, argues Willoughby, especially considering the dearth of spontaneous recoveries without it. He is also quick to note that the professors he trained under in medical school were some of the first doctors to try to treat childhood leukemia—an undertaking regarded at the time with similar disdain. Like rabies, explains Willoughby, childhood cancers were once believed to be 100 per cent fatal, and not worth treating. “But they didn’t buy that,” he says of his professors. “Now, 40 years later, it’s 80 per cent survival at five years.” It seems—unlike many of his contemporaries—that Willoughby is more invested in the science of possibility than sheer probability. Or as he likes to put it, “Better six survivors than none at all.”
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Why are ever-younger adults contracting shingles?
By Julia Belluz - Monday, August 16, 2010 at 11:04 AM - 0 Comments
No longer just a disease of the elderly?
“Natalie” was about to start teacher’s college in Toronto when her left eyelid began burning and stinging. “I thought the pain was from a new eye-makeup remover I was using,” she remembers. When the irritation did not subside, she went to see her doctor. The diagnosis: shingles.
Also known as herpes zoster, shingles happen when the virus that causes chicken pox, varicella zoster, is reactivated. Long after the itchy, red bumps associated with chicken pox disappear, the virus that caused them remains dormant in the body, hiding in the nerve cells along the spinal cord. The virus can then resurface later in life as shingles—sometimes in otherwise healthy people, more often in those with weakened immune systems, such as the elderly. But shingles appears poised to become an equal-opportunity disease, infecting ever-younger adults. The reason, experts say, is that vaccines have, paradoxically, rendered an unlucky cohort more vulnerable.
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Swine flu fiasco
By Cathy Gulli - Monday, October 19, 2009 at 11:26 AM - 233 Comments
Everyone needs the H1N1 vaccine. Few plan to get it. What you need to know. What you need to do.
In a few weeks, every adult in Canada will decide if they (and their children) will get the flu vaccine to protect against H1N1. At the best of times, it seems the decision of whether or not to get the seasonal flu shot is tough to make. Only about one-third of Canadians do each year. Now, with the pandemic vaccine arriving in doctor’s offices in November, Canadians are being asked to get a second shot this fall.But will they? Probably not. A recent poll shows that, as of the first week of October, only one in three Canadians plan on getting the H1N1 vaccine, according to Harris/Decima. That’s down from 45 per cent in late August. Experts say this reflects the public’s growing apathy toward the pandemic in light of seemingly contradictory information about H1N1 (which is commonly referred to as swine flu, even though it’s a combination of flu viruses from pigs, birds and humans). People are being bombarded by “on the one hand” and “on the other hand” studies and recommendations. “There is confusion,” says Dr. Sarah Kredentser, president of the College of Family Physicians of Canada. “And I think it’s warranted confusion, because the messages keep changing.” Continue…
















