Non-vaccine treatment for rabies getting notice

Wisconsin girl makes progress, but two others die

Medicine

July 01, 2005|By Knight Ridder/Tribune

MILWAUKEE - An untested rabies treatment used by doctors in 2004 to save Jeanna Giese, the world's only unvaccinated survivor, has already been administered to others infected with the virus.

The strategy used by the team of eight specialists from Children's Hospital of Wisconsin was published in the New England Journal of Medicine, but requests to duplicate the protocol began coming in after her survival was reported in November.

A patient in Germany received a modified version and died of medical complications after 56 days. The treatment was also unsuccessful in another patient in India. The New York Times reported this week that the 14-year-old boy, who had been bitten by a rabid dog, died last week.

However experts warn that Jeanna's case is isolated and may not be the blueprint for future rabies treatment.

"There is no way to determine what specific factors were responsible for the good outcome in this patient," said Alan C. Jackson, a rabies expert and a professor of medicine at Queen's University in Kingston, Ontario. "We can only speculate and further assess the usefulness of the drugs used for the treatment of this patient."

Jeanna was bitten by a bat Sept. 12 at a church in Fond du Lac, Wis., after picking the creature up by its wings. Her mother, Ann Giese, thoroughly washed the small wound on her left index finger with peroxide afterward. However, Jeanna did not receive medical treatment immediately after the bite.

Rabies is a viral disease that can be warded off with a vaccine before symptoms appear.

While the virus kills only a handful of Americans each year, it is far more common in developing countries such as Bangladesh and India.

Jeanna was diagnosed with rabies Oct. 19 and within two days entered a medically induced coma.

Her parents had been given the option of hospice care for their daughter or allowing the doctors to take a more aggressive approach based on an untested strategy that involved the use of four drugs: ketamine and midazolam to protect her brain and amantadine and ribavirin to fight the rabies virus. Ketamine also helped to fight the rabies virus.

John and Ann Giese didn't hesitate.

"I guess when you're told that your daughter is pretty much on death's door, you want them to do anything they can, no matter what," Ann Giese said. "It's scary but I think you just put all of your trust in the doctors, that they'll be led in the right direction."

"We believe that God gave them the knowledge and their will to do the best they could do," John Giese said. "We just believe we got the right doctors."

Rodney E. Willoughby Jr. was among the doctors who devised the strategy. He says that he had no concerns about using such heroic measures because he thought "it was the right thing to do."

"Obviously, coma is dangerous stuff, but my main concern was running into a medical complication, which would cause her to be damaged, including brain damage, or that she would die," he said.

Jeanna, now 16, has made a remarkable recovery. But no one knows how long it will take her to fully recover or if she'll have any long-term effects from the illness.

Since returning home from the hospital on Jan. 1, Jeanna has gradually regained strength, progressing from a wheelchair to walking with a walker to walking for periods on her own. She was able to return to classes at her high school, where she was a sophomore, and by fall should be caught up with her classmates.

"She amazes me how she handles it," Ann Giese said. "She's really strong."

She said her daughter sometimes is frustrated that she can't do things she used to do, "but she gets over it and does what she can and tries for the next step."

"It's really a landmark event that this girl has done so well," said Thomas Bleck, a professor of neurology and a director of the Neuroscience Intensive Care Unit at the University of Virginia.

Bleck, who was not involved in Jeanna's care, said her case has likely inspired a different approach to rabies treatment.

"The real problem, if they'd tried it and it didn't work, would be if it deterred people from trying to treat people again," he said.

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