November 25, 2004 Girl Is First to Survive Rabies Without a Shot By ELISABETH ROSENTHAL Wisconsin teenager is the first human ever to survive rabies without vaccination, the Centers for Disease Control and Prevention said yesterday, after she received a desperate and novel type of therapy.
Last month, doctors at the Children's Hospital of Wisconsin in Wauwatosa, a suburb of Milwaukee, put the critically ill girl into a drug-induced coma and gave her antiviral drugs, although it is not clear which, if any, of the four medicines contributed to her surprising recovery. Dr. Charles Rupprecht of the disease control agency called the recovery "historic." But even the doctors who took care of the girl said the result would have to be duplicated elsewhere before the therapy could be considered a cure or a treatment. "You have to see this therapy repeated successfully in another patient," said Dr. Rodney Willoughby, the associate professor of pediatrics who prescribed the cocktail of medicines for the sick girl, Jeanna Giese, 15. "Until then, it is a miracle." Jeanna, of Fond du Lac, was bitten by a bat at a church service on Sept. 12. She did not visit a doctor and so was not vaccinated, as is standard medical practice for such an exposure. "As society has developed, people have forgotten the folklore about don't play with stray animals, or stay away from bats," Dr. Willoughby explained. The bat drew blood, he said, but the bite was quick and small, so Jeanna thought she had just been scratched. Her fellow churchgoers assumed that only healthy bats could fly, so they picked it up after it flew into a window and threw it out the door. On Oct. 18, she was admitted to the hospital with fluctuating consciousness, slurred speech and other symptoms typical of full-blown rabies. Rabies is caused by a virus in secretions, like saliva, from an infected animal. The vaccine, which stimulates antibodies to the virus, eliminates the chance of getting the disease if it is administered within days after the initial exposure. Once symptoms develop, generally after a few weeks, the shots are much less effective. They are useless when the rabies is advanced, so doctors opted in Jeanna's case for the experimental treatment. Only a handful of people have recovered after developing even the earliest symptoms of rabies, and all of those were given the vaccine. The technique of inducing comas has been used by neurologists in patients with large brain injuries from infection, injury or stroke. But it had not been tried for rabies. Jeanna's doctors said they would not disclose which medicines they had used until publishing their findings in a medical journal. Dr. Willoughby said he had tried to induce the coma in part because evidence suggested that rabies did not permanently damage any brain structure. Instead, death comes because the virus seems to cause temporary dysfunction of brain centers that control critical functions like breathing and swallowing. While rabies kills tens of thousands of people in Asia, Africa and Latin America, it is rare in developed countries. Even if Jeanna's treatment proves successful in a second patient, it is not clear how widely it could be used in poorer parts of the world, since it requires an intensive care unit, with all its high technology. Still, Dr. Willoughby said he expected Jeanna to make a good recovery. She is already responding perfectly to questions by pointing to a message board or nodding her head. Her father, John Giese, said he was grateful to the doctors and their novel treatment, but added that prayer had made the crucial difference. "The day after we found out, I called on everyone we knew for prayer," he told The Milwaukee Journal Sentinel this week. "We believe a lot of that snowballed and it really made a difference." http://www.nytimes.com/2004/11/25/national/25rabies.html?pagewanted=print&position= --- URG-L Pour quitter URG-L, envoyez un message a la liste ([EMAIL PROTECTED]) avec, COMME SUJET, le mot REMOVE (rien d'autre).
