Rabies historical perspective

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Overview

Rabies is a disease that has been classically associated with infected animals, mainly dogs. The first written record was from approximately 1930 BC when the owner of a dog with symptoms of rabies was told to take preventative measures against bites. If a person died from being bitten by a rabid dog, the owner was fined heavily. Although dogs are viewed as the main culprit of rabies, rabies is also associated with animals such as possums, skunks, and more importantly, bats.

Historical Perspective

People have known about rabies for a long time, although the virus itself was not seen under the electron microscope until the 1960s. Rabies in animals was reported in early Babylonian, Greek, and Roman records. Rabies was likely brought to the Americas when settlers first came from Europe, bringing rabid animals with them.

A 9-year-old boy was the first person to have received an effective shot for rabies. In 1885, Joseph Meister was bitten by a rabid dog. His parents went to the famous French biologist Louis Pasteur. They begged him to help their son. Pasteur thought that if he injected a weak form of virus from one rabid animal into another, the second animal might be able to fight off the disease. He tried this hypothesis out on Joseph. The boy survived and lived a long life. That was how people starting giving shots for rabies.

After this success. other rabies vaccines were made. In the 1950s, people who had been bitten by a rabid animal got 23 shots along the abdomen. Today, the shots are more effective and less painful. They consist of a series of 6 shots given in the arm over a 1 month period. One shot is given around the bite and the rest are given in the arm.

Rabies and Animal Quarantine

Sign at a UK port showing rabies prevention measures aimed at merchant seamen

Rabies is endemic to many parts of the world, and one of the reasons given for quarantine periods in international animal transport has been to try to keep the disease out of uninfected regions. However, most developed countries, pioneered by Sweden, now allow unencumbered travel between their territories for pet animals that have demonstrated an adequate immune response to rabies vaccination.

Such countries may limit movement to animals from countries where rabies is considered to be under control in pet animals. There are various lists of such countries. The United Kingdom has developed a list, and France has a rather different list, said to be based on a list of the Office International des Epizooties (OIE). The European Union has a harmonised list. No list of rabies-free countries is readily available from OIE.

However, the recent spread of rabies in the northeastern United States and further may cause a restrengthening of precautions against movement of possibly rabid animals between countries.

Rabies and Dogs

Rabies has a long history of association with dogs. The first written record of rabies is in the Codex of Eshnunna (ca. 1930 BC) (written prior to the Code of Hammurabi), which dictates that the owner of a dog showing symptoms of rabies should take preventative measure against bites. If a person is bitten by a rabid dog and later died, the owner was fined heavily.

Rabies and Possums

Rabies cases in the Virginia possum are spillover cases from other wildlife species such as bats, skunks and the raccoon epizootic in the eastern United States. Cases have been reported across the United States from California to New York . In New York state, the Wadsworth Center lists laboratory confirmed cases in possums 5 years out of 10 from 1989 to 1998.

Rabies and Bats

The problem of bat-transmitted rabies is found over most of North and South America but was first closely studied in Trinidad in the West Indies which had a dreadful reputation for bat rabies, which took a significant toll of livestock and humans alike. In the 10 years from 1925 and 1935, 89 people and thousands of livestock had died from it - "the highest human mortality from rabies-infected bats thus far recorded anywhere.".

In early 1931, Dr. H. Metivier, a Veterinary surgeon, established the connection between the bites of bats and paralytic rabies. In September 1931, Dr. J. L. Pawan, a Government Bacteriologist found Negri bodies in the brain of a bat with unusual habits. In 1934 the Trinidad and Tobago Government began a program of vampire bat control, shooting, netting, trapping and poisoning, while encouraging the screening off of livestock buildings and free vaccination programs for exposed livestock.

After the opening of the Trinidad Regional Virus Laboratory in 1953, basic research on bats and rabies progressed rapidly under the able direction of Arthur Greenhall, who demonstrated that at least 8 species of bats in Trinidad had been infected with rabies - particularly the Common Vampire Bat, Desmodus rotundus (which "will attack any warm blooded creature"), the rare White-winged Vampire Bat, Diaemus youngi, (which "appears to have a special preference for birds and goats"), as well as two abundant species of Fruit Bats: the Seba's Short-tailed Bat or Short-tailed Fruit Bat, Carollia perspicillata, which commonly roosts with Vampires, and the Jamaican Fruit Bat, Artibeus jamaicensis.

Non-bite transmission of rabies to susceptible animals placed in bat-proof cages in a cave with bat colonies was demonstrated by Constantine in Frio Cave, Texas, as early as 1960. In 1967, rabies virus was isolated from the air in the same cave, presumably passed by the bats urinating, potentially forming a source for infection of other susceptible animals, and presenting a hazard to researchers and spelunkers. While the risks may be low, they are deserving of further study and monitoring.

The United Kingdom, which has stringent regulations on the importation of animals, had also been believed to be entirely free from rabies until 1996 when a single Daubenton's bat was found to be infected with a rabies-like virus usually found only in bats – European Bat Lyssavirus 2 (EBL2). There were no more known cases in the British Isles until September 2002 when another Daubenton's bat tested positive for EBL2 in Lancashire. A bat conservationist who was bitten by the infected bat received post-exposure treatment and did not develop rabies.

Then in November 2002 David McRae, a Scottish bat conservationist from Guthrie, Angus who was believed to have been bitten by a bat, became the first human to contract rabies in the United Kingdom since 1902. He died from the disease on November 24 2002.

In November 2004, Jeanna Giese, a fifteen-year old girl from Fond du Lac, Wisconsin, became one of only six humans known to have survived rabies after the onset of symptoms, and the first known instance of a human surviving rabies without vaccine treatment. Giese's disease was already too far progressed for the vaccine to help, and she was considered too weak to tolerate it. Doctors at the Children's Hospital of Wisconsin in Wauwatosa a suburb of Milwaukee, Wisconsin, achieved her survival with an experimental treatment that involved putting the girl into a drug-induced coma, and administering a cocktail of antiviral drugs. Giese had symptoms of full-blown rabies when she sought medical help, thirty-seven days after being bitten by a bat. Her family did not seek treatment at the time because the bat seemed healthy. Jeanna regained her weight, strength, and coordination while in the hospital. She was released from the Children's Hospital of Wisconsin on January 1, 2005.

On May 12, 2006 Harris County Texas. U.S.A. Health Department officials reported that a teenage boy, Zachary Jones of Humble, Texas, had died of rabies at Texas Children's Hospital in Houston, Texas. Zachary had contracted the disease after a bat flew in his bedroom and bit him in his sleep. He was unaware he had been bitten and was not hospitalized until he developed symptoms several weeks later. He died at Texas Children's Hospital after an attempt to cure the disease through a drug-induced coma, similar to that of Jeanna Giese.

On November 2, 2006 a 10 year old girl in Bourbon, Indiana, U.S.A. died of rabies. The Indianapolis Star reports that she was bitten by a bat in June 2006.

In August of 2006, a 73 year old rural resident located east of Edmonton, Alberta, Canada was bitten by a bat while he slept. He ignored the bite and became symptomatic in January 2007. Diagnosed with rabies in March of 2007, he was treated with the Milwaukee protocol, but died April 26, 2007.

On August 6, 2006, 950 Girl Scouts were urged to receive rabies shots by the Girl Scouts of America. The nine hundred and fifty girls had attended a camp in Virginia, U.S.A. in July, and had reported seeing bats in their cabins. Even though infections were relatively unlikely, the G.S.A. offered to pay for the shots, at a cost of nearly two million dollars. The Centers for Disease Control reports 27 cases of human rabies caused by the bat variant rabies virus in the United States from 1990 to 2002.

Rabies and Organ Transplantion

In June 2004, three organ recipients died in the United States from rabies transmitted in the transplanted kidneys and liver of an infected donor from Texarkana. There were bats near the donor's home, and the donor had told others that he had been bitten. The donor is now reported to have died of a cerebral hemorrhage, the culmination of an unidentified neurological disorder, although recipients are said to have been told the cause of death had been a car crash. Marijuana and cocaine were found in the donor's urine at the time of his death, according to a report in The New England Journal of Medicine.

"[The surgeons] thought he had suffered a fatal crack-cocaine overdose, which can produce symptoms similar to those of rabies. 'We had an explanation for his condition,' says Dr. Goran Klintmalm, a surgeon who oversees transplantation at Baylor University Medical Center, where the transplants occurred. 'He'd recently smoked crack cocaine. He'd hemorrhaged around the brain. He'd died. That was all we needed to know'. Because of doctor-patient confidentiality rules, doctors involved with this case would not talk about it on the record, but a few did say that if no cocaine was found in the donor's blood, the E.R. doctors might have investigated his symptoms more aggressively instead of assuming he had overdosed. (Because no autopsy was done, doctors have not been able to establish whether the rabies or the drugs actually killed him.)"

In February 2005, three German patients in Mainz and Heidelberg were diagnosed with rabies after receiving various organs and cornea transplants from a female donor. Two of the infected people died. Three other patients who received organs from the woman have not yet shown rabies symptoms. The 26 year old donor had died of heart failure in December 2004 after consuming cocaine and ecstasy. In October 2004, she had visited India, one of the countries worst affected by rabies worldwide. Dozens of medical staff were vaccinated against rabies in the two hospitals as a precautionary measure.