There have only been three cases of persons beating a rabies infection in the United States. Most recently, the girl with a unique name, Precious Reynolds, conquered the infection with help from physicians, nurses and therapists at UC Davis Children’s Hospital.

Jean Wiedeman, associate professor of pediatric infectious diseases in California explains:

“Precious received superb care from everyone at UC Davis Children’s Hospital, and we were enveloped with support from the CDC and the state encephalitis group from the moment we learned she was infected. From the very beginning, Precious had a very rapid, robust immune response to her infection, which is a significant contributor to why she survived. She is truly a fighter.”

While it is not known how she became infected, public health officials suspect Precious may have encountered a feral cat near her elementary school. Because pets and farm animals typically are inoculated against the disease, exposure commonly comes from a bat, skunk, fox or other wild animal.

Normally, infected persons receive post-exposure prophylaxis (PEP), a series of antiviral inoculations administered following infection. Rabies is virtually always fatal without PEP. Precious’ survival was extremely rare.

The virus affects the central nervous system, ultimately causing encephalitis, or acute inflammation of the brain, and normally is fatal. Very early symptoms of rabies in people include fever, headache, and general weakness or discomfort.

Wiedeman was fearful when the case came into the facility:

“You’re aware that the child has a minimal chance of survival, that the protocol has been applied worldwide in 25 cases with only four survivors. You’re not going to the family with good news if you’ve got a diagnosis of rabies. It’s heartbreaking. I was very encouraged that with her diagnosis she continued to interact. She was right there until we deepened her coma significantly. She could respond to you and had brisk pupillary responses throughout the coma. There were subtle signs that she was performing well given her diagnosis.”

As the disease progresses, more specific symptoms appear and may include insomnia, anxiety, confusion, slight or partial paralysis, excitation, hallucinations, agitation, hyper salivation (increase in saliva), difficulty swallowing, and hydrophobia (fear of water). Death usually occurs within days of the onset of these symptoms. Basically you go mad.

According to the Centers for Disease Control and Prevention, people who have never been vaccinated against rabies previously, post exposure anti-rabies vaccination should always include administration of both passive antibody and vaccine.

The combination of human rabies immune globulin (HRIG) and vaccine is recommended for both bite and nonbite exposures, regardless of the interval between exposure and initiation of treatment.

People who have been previously vaccinated or are receiving preexposure vaccination for rabies should receive only vaccine.

In 2004, American teenager Jeanna Giese survived an infection of rabies unvaccinated. She was placed into an induced coma upon onset of symptoms and given ketamine, midazolam, ribavirin, and amantadine. Her doctors administered treatment based on the hypothesis that detrimental effects of rabies were caused by temporary dysfunctions in the brain and could be avoided by inducing a temporary partial halt in brain function that would protect the brain from damage while giving the immune system time to defeat the virus.

After thirty-one days of isolation and seventy-six days of hospitalization, Giese was released from the hospital. She survived with almost no permanent sequelae and as of 2009 was starting her third year of university studies.

Sources: The New England Journal of Medicine, UC Davis and Centers for Disease Control and Prevention

Written by Sy Kraft