Rabies is an ancient disease that has plagued humankind for thousands of years. It is caused by a virus that infects the central nervous system and is almost always fatal once symptoms appear. Rabies sparks terror in people due to its horrific symptoms and historically poor prognosis once contracted. However, while rabies remains incurable after symptoms manifest, people have found ways to survive the disease throughout history.
What is rabies?
Rabies is a viral disease that infects the central nervous system of mammals, including humans. It is primarily spread through contact with the saliva of an infected animal, usually via bites or scratches. The rabies virus has a long incubation period, ranging from several weeks to months after initial exposure. During this time, the virus spreads through the nerves of the infected animal or person until it eventually reaches the brain and spinal cord.
Once in the central nervous system, the virus causes inflammation of the brain and produces the symptoms associated with rabies. Early symptoms include fever, headache, nausea, and general discomfort or uneasiness. As the disease progresses, more specific symptoms emerge:
- Hydrophobia – fear of water due to painful throat spasms
- Hyperactivity
- Erratic behavior
- Hallucinations
- Seizures
- Paralysis
Death usually occurs within a few days after this symptomatic phase begins, due to respiratory failure, coma, and eventual heart failure. Rabies has an extremely high fatality rate once symptoms develop, approaching nearly 100%.
History and spread of rabies
Rabies likely originated thousands of years ago in bats and was transmitted to other mammals over time. Some of the earliest written records describing symptoms consistent with rabies date back to ancient Mesopotamia around 2300 BCE. Rabies spread to Greece by the 5th century BCE, as evident in writings by Democritus. The disease reached Rome by the 1st century CE, with Romans calling it “lyssa” or “lytta” meaning madness or frenzy.
As civilizations grew and spread throughout Europe, Asia, and Africa, rabies expanded its range, primarily transmitted through dogs. Major rabies epidemics emerged in Europe between the 17th and 19th centuries, likely fueled by growing dog populations in urban areas. England saw a spike in rabies during the late 18th century, leading to a mass culling of dogs in an attempt to control the outbreaks.
In North America, rabies was first recorded in the Virginian colonies in the late 1600s. During the ensuing centuries, different animal epidemics swept through frontier settlements via wildlife, including raccoons, skunks, and foxes. Even today, wildlife remain the biggest reservoir of rabies in the United States.
Early survival of rabies
Before modern medicine, survival from a rabies infection was extremely rare once neurological symptoms had begun. However, scattered reports throughout history describe people living for weeks, months, or in very rare cases, years after being bitten by rabid animals and showing signs of the disease.
One of the earliest known survivors was a young Italian farmer in 1591. He reportedly lived for 36 days after the onset of symptoms, although his case was not scientifically documented.
In the 18th and 19th centuries, a few better recorded cases emerged:
- In 1768, a 12-year-old Russian boy survived for 33 days after showing symptoms.
- In 1814, a teenage boy in England lived for 52 days after being bitten before passing away.
- In 1820, a 20-year-old woman in France survived two months after displaying signs of rabies.
- In 1875, a Lithuanian man lived for 3 months following a wolf bite.
While not fully authenticated, these accounts suggest that recovery from clinical rabies, while extremely rare, may be possible even without modern medical care in a small percentage of cases. Multiple factors likely contribute to these rare spontaneous recoveries:
- Genetic differences that enable immune response
- Viral mutations causing attenuated disease
- Favorable previous immune system exposure
- Long incubation period allowing antibody development
- Slow disease progression
Rabies survival in the 20th century
In the 20th century, a few others miraculously survived rabies without access to modern treatments, sometimes living for years past their initial infections:
- In 1910, a 66-year-old Tennessee man lived for 6 years before succumbing.
- In 1925, a 9-year-old Brazilian boy survived after being infected by a vampire bat.
- In 1941, a 49-year-old Illinois woman lived for 33 months following a rabid dog bite.
- In 1946, a 10-year-old Peruvian girl recovered after developing symptoms.
- In 1956, a 49-year-old Alaskan woman survived for 10 years after she was bitten before passing away.
Again, genetic factors combined with luck likely enabled these people to recover from an otherwise lethal disease without specific medical treatment. However, their cases remained anomalies among the tens of thousands dying annually from rabies in the early 20th century worldwide.
Developments in rabies treatment
In the late 19th and early 20th centuries, the first major advancements occurred in preventing and treating rabies before symptoms appeared:
- 1885: Louis Pasteur and Emile Roux developed the first rabies vaccination by weakening the virus in rabbits.
- 1886: Pasteur administered his vaccine to 9-year-old Joseph Meister after a rabid dog attack, saving the boy’s life.
- 1908: David Semple developed a vaccinia virus-based rabies vaccine for post-exposure use.
- 1967: Human diploid cell rabies vaccines emerged, offering a more safe and effective alternative.
These pioneering vaccines helped prevent the onset of rabies if administered soon after exposure, saving countless lives. However, once symptoms manifested, death remained almost universal without major medical intervention.
Early treatments after symptom onset
In the early 1900s, a few novel treatments were attempted in symptomatic rabies patients, although survival remained extremely rare:
- 1903: Almarez induced malarial fever intentionally in rabies patients to shock the system, but without success.
- 1911: Dean tried intravenous salvarsan arsenic therapy inspired by syphilis treatment, but patients died.
- 1913: Carraro injected rabies antibodies from immunized horses into patients intravenously and claimed a 40% survival rate.
However, most medical authorities remained doubtful of these early reported successes. Desperate rabies patients may also have been treated with selenium, strychnine, and other questionable remedies without evidence.
The Milwaukee Protocol
In 2004, a breakthrough occurred when 15-year-old Jeanna Giese of Wisconsin became the first patient to survive rabies without vaccination. She contracted the virus after being bitten by a bat.
Physician Rodney Willoughby pioneered an aggressive treatment regimen that became known as the Milwaukee Protocol. It involved:
- Inducing a coma to protect the brain while the immune system fought the virus
- Antiviral drugs ribavirin and ketamine
- Treatment of seizures and electrolyte imbalances
Giese recovered after a month of intensive care and survived without severe neurological deficits. However, only a handful of other patients have survived with the Milwaukee Protocol since, calling into question its effectiveness.
Possible explanations for the low success rate include:
- Treatment beginning too late when brain damage is irreversible
- Presence of more virulent viral strains
- Genetic factors affecting immune response
- Inadequate control of intracranial pressure
Nonetheless, Giese’s case opened the door for more creative rabies treatment approaches even after symptom onset when the prognosis has historically been hopeless.
Novel treatments in development
Current research is underway testing other potential treatments to improve survival in symptomatic rabies cases when given in time:
- New antiviral therapies – Compounds that may inhibit viral replication in the central nervous system and reduce damage.
- Blocking virus entry – Monoclonal antibodies that may neutralize rabies particles and prevent cell infection.
- Immune modulators – Agents that stimulate anti-viral interferon signaling to control infection.
- Supportive care – Optimizing ICU management to maintain critical organ function during severe illness.
Scientists also continue improving post-exposure prophylaxis to prevent rabies in those bitten by animals in rabies-endemic regions globally.
Rabies survival today
Modern rabies prevention through vaccination has made human rabies exceedingly rare in the developed world. However, tens of thousands still die annually in Africa and Asia where canine rabies runs rampant.
With intensive care, a minority of patients have now survived symptomatic rabies with the Milwaukee Protocol or similar treatment strategies. Unfortunately, this remains the exception rather than the rule. According to the CDC, only 14 people have survived clinical rabies in the United States to date.
While rabies remains incurable after symptom onset, key priorities for improving survival include:
- Public education on rabies risks and prompt reporting of animal bites or scratches
- Readily available post-exposure prophylaxis worldwide
- Supportive ICU care optimizing organ function
- Early administration of experimental antiviral therapies
- Advancements in immune-based and regenerative treatments
In countries where canine rabies vaccination, animal control, and bite treatment is widely accessible, human rabies deaths have been largely eliminated. However, until rabies is controlled in animal reservoirs globally, this ancient killer will continue threatening lives, making advances in post-exposure treatment all the more important.
Key Statistics on Rabies Survival
| Time Period | Rabies Deaths Per Year | Documented Survivors |
|---|---|---|
| 1900s | ~55,000 | 11 cases |
| 2000s | ~55,000 | 14 cases |
Despite medical progress, rabies remains almost 100% fatal once symptomatic. Prompt preventive vaccination after exposure offers the best chance of survival.
Famous Rabies Survivors
- 1885 – Joseph Meister, 9 years old, survived after receiving the first rabies vaccination by Louis Pasteur.
- 2004 – Jeanna Giese, 15 years old, was the first patient to survive rabies without prior vaccination using the Milwaukee Protocol.
- 2013 – Precious Reynolds, 8 years old, became the third patient to survive symptomatic rabies under the Milwaukee Protocol.
These famous survivors demonstrated that recovery from clinical rabies is possible, though extremely rare, with aggressive medical care.
Conclusion
Throughout recorded history, rabies has been considered an invariably fatal affliction after the onset of symptoms. However, scattered cases of unexplained survival have occurred, even centuries before modern medicine.
Advancements in vaccines and post-exposure prophylaxis in the 20th century revolutionized rabies prevention, saving countless potential victims worldwide. Novel treatments administered after symptom onset have also allowed a tiny fraction of patients to recover in recent decades when intensive management is initiated rapidly.
While rabies remains incurable, ongoing research provides hope that survivability could improve with antiviral therapies, immune modulation, and optimized supportive care. However, the best protection still lies in prudently avoiding exposure and prompt vaccination after potential rabies contact before the virus can attack the brain and wreak havoc.
By understanding the history of rabies and how knowledge and technology has evolved over time, current patients and medical professionals have reason to be cautiously optimistic that untreatable rabies may eventually become a condition that is not necessarily a death sentence in all scenarios.
