Published November 17, 2008
A 15-year-old boy from Brazil who contracted rabies from the bite of a vampire bat is recovering after doctors used a novel treatment developed at Children's Hospital of Wisconsin.
"This is wonderful news," said Rodney Willoughby Jr., a pediatric infectious disease specialist at the hospital and the Medical College of Wisconsin.
Willoughby supervised a team that used the same type of treatment protocol in 2004 to save the life of Jeanna Giese, a Fond du Lac teenager. At the time, Giese was the only person known to have survived rabies without having been vaccinated.
The case is one of only three known cases worldwide in which a person survived a confirmed rabies infection, the Brazilian health ministry said in a statement.
The survivors were all children and all were treated with what is referred to as the "Milwaukee protocol," according to Willoughby and the health ministry.
The 15-year-old who lives in Recife, the capital of the northeastern state of Pernambuco, was bitten in mid-September by a bat while he was sleeping. He survived the rabies virus after a month in the hospital. His recovery was announced Friday by the Pasteur Institute in Brazil.
Recife is the hometown of Willoughby's wife. He had met doctors there in 2005 and spoke to them about the protocol at Oswaldo Cruz University Hospital, where the boy was treated.
Physicians there closely followed the Milwaukee protocol, Willoughby said. It wasn't until after about three weeks that Willoughby, who speaks Portuguese, first began talking with doctors there about when the boy should be brought out of the coma.
"This is very optimistic because people can essentially do this by themselves without being coached by us," he said.
The boy is now responding to verbal commands, Willoughby said, but doctors at the hospital have not ruled out possible damage to his motor functions.
His case, another involving an 8-year-old Colombian girl and that of Giese all involved close versions of the same treatment: A regimen of drug therapies and a medically induced coma to protect the brain while the virus attacked the body.
The approach had never been used until Giese arrived at Children's Hospital in 2004 with blurred vision, slurred speech and periods of unconsciousness.
Like Giese, the Colombian girl had not been vaccinated for the rabies virus. The Colombian girl died last month of unrelated causes, according to El País, a Colombian newspaper. She was first treated about a month after being bitten by a cat.
The 15-year-old boy had been vaccinated, but the rabies had progressed while his body was developing his immune response, Willoughby said.
Previously, five people in the world were known to have survived fully developed rabies who had been vaccinated. The boy is the only survivor where the virus was detected before treatment.
The presence of the rabies virus and the boy's recovery are important, Willoughby said, because "there are a lot of skeptics out there and one of the arguments made is that people who survived, including Jeanna, did not have the rabies virus in them."
"The argument is that they were clearing (the virus) themselves. In this case, he had the virus."
The treatment used by Willoughby and his team at Children's has invited criticism, including a paper this spring in the Transactions of the Royal Society of Tropical Medicine and Hygiene, which concluded there was no evidence the cocktail of drugs used in the Milwaukee protocol played a key role in Giese's recovery.
"The fact of the matter is that there has been heavy rear-guard action against this approach," Willoughby said.
The repeated success shows the protocol works, he said.
In addition to the first case with Giese, Willoughby said that doctors worldwide have used variations of the procedure 17 times, with some doctors using the protocol more closely than others. Doctors aren't required to follow it exactly, but Willoughby counts all attempts.
The important point is that people become vaccinated for rabies, Willoughby said.
"You should get your shots," he said.
An estimated 55,000 people die each year from rabies around the world, according to the American Veterinary Medical Association.
One or two people die each year in the United States, the association said.