Rabies 'cocktail' fails to save 6 others By Sharon Roznik The Reporter
February 18, 2007
Six attempts to use the controversial rabies cocktail created to cure Fond du Lac teen Jeanna Giese have failed.
Dr. Rodney Willoughby Jr., the pediatric infectious disease specialist who treated Jeanna in 2004 at Children's Hospital of Wisconsin in Wauwatosa, said he's had to grow thick skin to face opposition coming from world-renowned rabies experts.
"To our knowledge, four of those attempts (to cure rabies) were highly flawed," he said. "It's been tried six times now, and rabies experts continue to fight us." The experimental cocktail of drugs included ribaviran, amantadine, ketamine and midizolam, according to a Nov. 6, 2006 article that appeared in Current Science magazine.
The first two drugs were antivirals — drugs that destroy or inhibit the growth of a virus. The latter two drugs put Jeanna into a coma to disrupt communication between the brain and the body.
The now 17-year-old is the first person in history to have survived rabies without vaccine. he medical profession, especially those who worked on her case, were hopeful the reatment would be a medical breakthrough in treating the always fatal — until now — disease.
Assumptions on how the cocktail should be used and what the patient is like further complicate matters, Willoughby said. "You need to have a normal immune response," he said. "One patient had received a transplanted organ infected with rabies. In another case, the patient had severe brain damage."
The limited number of persons infected with rabies also makes it difficult to continue to test the cocktail's effectiveness.
Controversial treatment
"This is highly controversial, what we did with Jeanna," Willoughby said. "Clearly something worked, so what do we do when physicians ask me how we did it and if they can use it?"
Willoughby calls those leading the rebuttal against his rabies cocktail "cynical opponents." The most outspoken have been Dr. Alan Jackson from Queens University in Kingston, Ontario, Canada, and Dr. Thirava Hemachudha in Bangkok, Thailand.
Jackson declined to comment for this story, stating that he believes the debate about rabies therapy should take place at scientific meetings and in scientific publications rather than in the news media.
A paper Jackson published last year titled "Rabies: New Insights into Pathogenesis and Treatment," mentions that globally there are 55,000 human cases of rabies each year, largely related to uncontrolled dog rabies in developing countries. In the United States and Canada, most human cases, he said, are caused by bat rabies variants.
Jackson writes that multiple clinical trials have shown a lack of effect. Of Giese's case, he states: "It is also possible that the patient's illness and favorable outcome may have been due to the fact that she was infected by an attenuated (weakened) rabies virus, perhaps never previously isolated, rather than a result of the therapeutic approach taken."
Hemachudha, a neurologist at Chulalongkorn University Hospital in Thailand said the subject is complicated. "The debate should specifically focus on the evidence. You may realize that the rabies problem here and in India is much worse and how much disappointment we have had about this failure," he said.
Willoughby said he finds the opposition hard to address. "Opponents are saying Jeanna's virus was wimpy, or she is somehow unique or a mutant (her immunity)," Willoughby said. "What we are doing is focusing on trying to help physicians who call for help, and I believe we are very close."
'Close calls'
Two good attempts to use the drugs were made in the United States. Both were children and both were what Willoughby considers "close calls." In the case of a girl in Indiana, the infectious disease expert believes the rabies virus, tested through excreted saliva, was cleared, but the patient succumbed through complications of the disease.
In another case, an immigrant boy in California was exposed to rabies two years earlier. The rabies virus is highly specialized to exist in nerves and the brain but can "smolder" and grow inefficiently in other areas of the body, he said. "The virus can be very efficient, but on parched earth, it grows slowly," he said. Both of the recent cases are being prepared for publication. A Web site, intended for medical professionals, has been set up at www.mcw.edu/rabies to document protocol. "Two very good teams have tried hard to replicate it (Jeanna's treatment), and we haven't brought those children home," Willoughby said. "We have learned more and seen some new tricks. That's very helpful in ongoing research."
