8 ms·

Given that the symptomatic rabies leads to death in 100% of cases currently, wouldn’t it make sense to try a version of this in those few cases when someone in

by graeme 3y ago

Given that the symptomatic rabies leads to death in 100% of cases currently, wouldn’t it make sense to try a version of this in those few cases when someone in North America does get rabies? They already tried the experimental Milwaukee protocol even though it wasn’t clinically established (and in fact didn’t work)

marcodiego 3y ago
> rabies leads to death in 100% That is not true anymore. There are two known protocols with a small chance of working but which have already saved about a few dozen lives. They are called "the Milwaukee protocol" and "the Recife protocol" after the cities they were developed.
- drunkendog 3y ago
  Not sure about the Recife protocol, but it's pretty much accepted now that the Milwaukee protocol doesn't work[1][2] - the initial case may have been some other encephalitis mimicking rabies. [1] https://journals.lww.com/pidj/fulltext/2015/06000/the__milwaukee_protocol__for_treatment_of_human.34.aspx https://journals.lww.com/pidj/fulltext/2015/06000/the__milwa... [2] 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 https://www.cambridge.org/core/journals/canadian-journal-of-...
  - logicchains 3y ago
    Your second link is an error 404, page not found.
    - IvyMike 3y ago
      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 https://www.cambridge.org/core/journals/canadian-journal-of-...
      - littlestymaar 3y ago
        How did you get that “the initial case may have been some other encephalitis mimicking rabies.” from that paper? AFAICT The paper questions the hypothesis that the 2 additional survivors had rabies, but not the first patient.
        IvyMike 3y ago
        You may want to reply to drunkendog so they see your question.
        littlestymaar 3y ago
        Oh I didn't pay attention that you weren't the original poster of that link, thanks for pointing that out!
  - Enginerrrd 3y ago
    Back when I was a paramedic, I HAD a rabies patient that survived using the Milwaukee protocol. It doesn't work very well... but it does seem like it occasionally works.
    - LegitShady 3y ago
      That's amazing.
  - littlestymaar 3y ago
    How did you get that “the initial case may have been some other encephalitis mimicking rabies.” from the decond paper paper? AFAICT The paper questions the hypothesis that the 2 additional survivors had rabies, but not the first patient.
littlestymaar 3y ago
> They already tried the experimental Milwaukee protocol even though it wasn’t clinically established (and in fact didn’t work) It worked for the first patient on which it's been tried though! Which is still an objective win even if it wasn't particularly successful afterwards.
- drunkendog 3y ago
  The first patient might not actually have had rabies.
  - deleted 3y ago
    [deleted]
  - littlestymaar 3y ago
    I don't think there's much doubt on that actually, the diagnostic was confirmed by CDC analysis and antibodies were found.
deleted 3y ago
[deleted]
ryeights 3y ago
>(and in fact didn’t work) This review [1] cites 11 documented survival outcomes of the Milwaukee and related Recife protocols. Is there a basis to your claim? [1]: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7670764/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7670764/
jjtheblunt 3y ago
towards the end of the article, they say it makes sense to test in India because they get large numbers of advanced rabies cases whereas north america supposedly gets zero.
- graeme 3y ago
  Yes. My point was it sounds like we’ll delay it for years for testing. But 59,000 people die of rabies each year and each case is almost certainly fatal. So it seems we should speed up distributing this. If rabies patients start surviving then we know it works. At that point we can test exactly how much it works. But meanwhile why wait?
anon291 3y ago
The Milwaukee protocol is not particularly good. It has a low survival rate. However considering the normal survival rate is zero... It's a lot better I mean.. you can't say it doesn't work if it led to the first ever documented case of rabies survival. That's amazing.
karaterobot 3y ago
Once again, every single comment is picking apart the least important aspect of a comment. Though it works a small percentage of the time or not, the Milwaukee protocol is evidently not nearly effective enough, thus necessitating this research into a cure. Your question stands: why not test it? There's precedent for testing unproven drugs on humans in extremis, so it's not that. As a halfhearted stab in the direction of an answer: I assume they will try it in human rabies victims in a later phase, they're just testing it in mice first.
- bsder 3y ago
  > Your question stands: why not test it? Because there are so few late stage rabies victims that you simply can't get the data? By and large in the US, people know the protocol--get bitten by a strange animal, head to the ER and get ready for rabies shots. And it almost always works. Apparently, the US never had a post-treatment death until one 84-year-old man with an immune deficiency (and a bunch of other health issues) died of it. It's not clear anything would have worked for him. https://www.unmc.edu/healthsecurity/transmission/2023/04/04/rabies-patient-becomes-first-fatal-case-in-us-after-post-exposure-treatment-report-says/ https://www.unmc.edu/healthsecurity/transmission/2023/04/04/... Basically, the only people who die of rabies are those who missed that they got bit or those who were dumb enough to refuse the vaccine. And there just aren't that many of them.
  - gambiting 3y ago
    >>Because there are so few late stage rabies victims that you simply can't get the data? In India, estimated 20k(!!!) people die of rabies each year. Surely that's enough to warrant human testing. https://www.who.int/india/health-topics/rabies https://www.who.int/india/health-topics/rabies
    - contravariant 3y ago
      I think there are some ethical issues with trying to find those people and not treat their disease before it is too late, most of the testing will consists of preventing people from becoming good test subjects. I'm not saying it's bad, but it will be expensive and may fail to yield much result (as far as testing the cure goes).

by graeme 3y ago

marcodiego 3y ago

> rabies leads to death in 100% That is not true anymore. There are two known protocols with a small chance of working but which have already saved about a few dozen lives. They are called "the Milwaukee protocol" and "the Recife protocol" after the cities they were developed.

drunkendog 3y ago
Not sure about the Recife protocol, but it's pretty much accepted now that the Milwaukee protocol doesn't work[1][2] - the initial case may have been some other encephalitis mimicking rabies. [1] https://journals.lww.com/pidj/fulltext/2015/06000/the__milwaukee_protocol__for_treatment_of_human.34.aspx https://journals.lww.com/pidj/fulltext/2015/06000/the__milwa... [2] 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 https://www.cambridge.org/core/journals/canadian-journal-of-...
- logicchains 3y ago
  Your second link is an error 404, page not found.
  - IvyMike 3y ago
    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 https://www.cambridge.org/core/journals/canadian-journal-of-...
    - littlestymaar 3y ago
      How did you get that “the initial case may have been some other encephalitis mimicking rabies.” from that paper? AFAICT The paper questions the hypothesis that the 2 additional survivors had rabies, but not the first patient.
      - IvyMike 3y ago
        You may want to reply to drunkendog so they see your question.
        littlestymaar 3y ago
        Oh I didn't pay attention that you weren't the original poster of that link, thanks for pointing that out!
- Enginerrrd 3y ago
  Back when I was a paramedic, I HAD a rabies patient that survived using the Milwaukee protocol. It doesn't work very well... but it does seem like it occasionally works.
  - LegitShady 3y ago
    That's amazing.
- littlestymaar 3y ago
  How did you get that “the initial case may have been some other encephalitis mimicking rabies.” from the decond paper paper? AFAICT The paper questions the hypothesis that the 2 additional survivors had rabies, but not the first patient.

littlestymaar 3y ago

> They already tried the experimental Milwaukee protocol even though it wasn’t clinically established (and in fact didn’t work) It worked for the first patient on which it's been tried though! Which is still an objective win even if it wasn't particularly successful afterwards.

drunkendog 3y ago
The first patient might not actually have had rabies.
- deleted 3y ago
  [deleted]
- littlestymaar 3y ago
  I don't think there's much doubt on that actually, the diagnostic was confirmed by CDC analysis and antibodies were found.

deleted 3y ago

[deleted]

ryeights 3y ago

>(and in fact didn’t work) This review [1] cites 11 documented survival outcomes of the Milwaukee and related Recife protocols. Is there a basis to your claim? [1]: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7670764/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7670764/

jjtheblunt 3y ago

towards the end of the article, they say it makes sense to test in India because they get large numbers of advanced rabies cases whereas north america supposedly gets zero.

graeme 3y ago
Yes. My point was it sounds like we’ll delay it for years for testing. But 59,000 people die of rabies each year and each case is almost certainly fatal. So it seems we should speed up distributing this. If rabies patients start surviving then we know it works. At that point we can test exactly how much it works. But meanwhile why wait?

anon291 3y ago

The Milwaukee protocol is not particularly good. It has a low survival rate. However considering the normal survival rate is zero... It's a lot better I mean.. you can't say it doesn't work if it led to the first ever documented case of rabies survival. That's amazing.

karaterobot 3y ago

Once again, every single comment is picking apart the least important aspect of a comment. Though it works a small percentage of the time or not, the Milwaukee protocol is evidently not nearly effective enough, thus necessitating this research into a cure. Your question stands: why not test it? There's precedent for testing unproven drugs on humans in extremis, so it's not that. As a halfhearted stab in the direction of an answer: I assume they will try it in human rabies victims in a later phase, they're just testing it in mice first.

bsder 3y ago
> Your question stands: why not test it? Because there are so few late stage rabies victims that you simply can't get the data? By and large in the US, people know the protocol--get bitten by a strange animal, head to the ER and get ready for rabies shots. And it almost always works. Apparently, the US never had a post-treatment death until one 84-year-old man with an immune deficiency (and a bunch of other health issues) died of it. It's not clear anything would have worked for him. https://www.unmc.edu/healthsecurity/transmission/2023/04/04/rabies-patient-becomes-first-fatal-case-in-us-after-post-exposure-treatment-report-says/ https://www.unmc.edu/healthsecurity/transmission/2023/04/04/... Basically, the only people who die of rabies are those who missed that they got bit or those who were dumb enough to refuse the vaccine. And there just aren't that many of them.
- gambiting 3y ago
  >>Because there are so few late stage rabies victims that you simply can't get the data? In India, estimated 20k(!!!) people die of rabies each year. Surely that's enough to warrant human testing. https://www.who.int/india/health-topics/rabies https://www.who.int/india/health-topics/rabies
  - contravariant 3y ago
    I think there are some ethical issues with trying to find those people and not treat their disease before it is too late, most of the testing will consists of preventing people from becoming good test subjects. I'm not saying it's bad, but it will be expensive and may fail to yield much result (as far as testing the cure goes).