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Published Date: 2012-01-06 17:56:35
Subject: PRO/AH/EDR> Rabies - USA (02): (MA) bat, human
Archive Number: 20120106.1002196

RABIES - USA (02): (MASSACHUSETTS), BAT, HUMAN
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Date: Thu 5 Jan 2012
Source: Boston Herald.com from Cape Cod Times [edited]
http://www.bostonherald.com/news/regional/view/20120104rabies_victim_in_critical_condition/srvc=home&position=recent

A Cape man diagnosed with rabies last week is alive and fighting the deadly virus, according to health officials. As of Tue 3 Jan 2012 morning, the unidentified Barnstable man, in his 60s, remained in critical condition at a Boston hospital, said Barnstable Health Director Thomas McKean Tuesday evening.

The diagnosis last week confirmed the 1st human case of rabies in Massachusetts in more than 75 years. State health officials also confirmed on Tuesday [3 Jan 2012] that the man contracted the virus from a species of _Myotis_ bat. The small, brown mammals are common in Massachusetts, said state Department of Health spokesman John Jacob. The man's wife has been released from the hospital following precautionary vaccinations and was staying with friends, McKean said. The man was apparently bitten in the couple's Barnstable home months before exhibiting symptoms.

The Barnstable man is the 4th confirmed human infected by the rabies virus in the United States in 2011, according to statistics from the Centers for Disease Control in Atlanta. A rabies diagnosis is usually considered fatal; however, a treatment developed in the last decade has helped cure a handful of patients. The "Milwaukee protocol" is a pioneering medical procedure in which doctors sedate patients into a coma-like state to give them time to build antibodies to fight the virus. The procedure was developed by Dr. Rodney E. Willoughby, a professor of pediatrics at the Medical College of Wisconsin in Milwaukee. It was 1st used successfully in 2004 to save a Wisconsin teenager from the almost certainly fatal virus. She was the 1st person to survive infection without prior immunization, and since then, 5 more have also been saved.

The treatment raises a patient's survival rate from near zero to 20 to 25 percent, Willoughby said. Rabies is a neurological virus which kills by disrupting commands from the brain to vital parts of the body, including diaphragm and heart. There is no signature death from rabies, rather patients eventually drown in their own saliva or blood, suffer a fatal abnormality in their heartbeat or lose the ability to breathe normally, Willoughby said.

Through his early work with the virus, Willoughby noticed that a patient could produce the antibodies necessary to fight off the infection, if they just could survive long enough to do so. To accomplish that, doctors implementing the Milwaukee protocol must administer a cocktail of sedatives, including ketamine and benzodiazepine, then wait for the body to fight back. "Essentially, you sit around and stay out of trouble and wait for the body to make the proper immune response," Willoughby said.

So far, the procedure has saved 6 patients worldwide. The 1st was Jeanna Giese of Fond du Lac, Wisconsin. She was 15 when she was bitten on the finger at church. Her parents treated the wound and thought nothing more of it, said her mother Ann Giese. After several weeks, though, the teen began showing the symptoms of rabies, vomiting, fatigue and double vision. Doctors tested Giese for a host of other diseases before finally arriving at the rabies diagnosis. "They said, 'She has rabies; there's really nothing we can do but put her in a dark room and let her die,'" Ann Giese said. The family opted instead to try Willoughby's experimental treatment, and after months of treatment, Jeanna Giese was able to leave the hospital. Today, Jeanna Giese, now 22, is flourishing. In June [2011], she graduated from Lakeland College and is working at the humane society in Fond du Lac. She's always wanted to work with animals, and her battle with rabies has only broadened her enthusiasm, Anne Giese said. "She has more respect for them than ever," she said.

[Byline: Steve Doane]

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[We must hope that the Massachusetts patient will become the 7th person to survive rabies virus infection as a result of treatment according to the "Milwaukee Protocol." - Mod.CP]

[For the HealthMap/ProMED map of Barnstable, Massachusetts, USA see http://healthmap.org/r/1CfO. - Mod.MPP]

A HealthMap/ProMED-mail map can be accessed at: http://healthmap.org/r/1vdg]

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