Diagnosing Rabies

Perhaps you remember the Walt Disney classic Old Yeller” in which a frontier family’s dog contracts “the hydrophobie” from fighting a rabid wolf. Who could forget the tear-jerker scene where, after telling his mama “He was my dog… I’ll do it,” young Travis ends Yeller’s suffering.

Although it is a vaccine-preventable disease, rabies still poses a significant public health problem in many countries in Asia and Africa where 95% of human deaths occur even though safe, effective vaccines for both human and veterinary use exist.

Nearly half of those bitten by suspect rabid animals are children under 15 years of age. Although the efficacy and safety of modern cell culture vaccines have been recognized, some countries still produce and use nervous tissue vaccines, which are less effective.
World Health Organization » Health topics » Rabies

In many parts of the world, vaccination, testing and treatment are prohibitively expensive. In rural communities rabies isn’t reported. It’s deadly, why bother? is the logic. Keep the victim as comfortable as possible while you wait for the inevitable.

The very experimental Milwaukee Protocol is marginally effective. Patients come out of it with severe neurological damage and needing months of rehab.

Currently, if a human is bitten the doctors test the animal that bit them. The test – and this is gruesome – requires that the animal’s head be sent away for testing. The test is to look for lesions on the brain, and if there are no lesions, oh well.

They’ve come up with a new test that can diagnose human rabies from skin cells that I hope will someday replace decapitation as the diagnostic procedure of choice.

The number of human deaths due to rabies is currently underestimated to be 55,000 deaths per year. Biological diagnostic methods for confirmation of rabies remain limited, because testing on postmortem cerebral samples is the reference method, and in many countries, sampling brain tissue is rarely practiced. There is a need for a reliable method based on a simple collection of nonneural specimens.
Dacheux, Laurent et al. A Reliable Diagnosis of Human Rabies Based on Analysis of Skin Biopsy Specimens. Clinical Infectious Diseases 2008; 47:1410–7

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