Trip Like I Do? No Thank You! (Why Luck is Not Enough When it Comes to Rabies Prevention)
"'She is truly a fighter.' That's what doctors are saying about the little girl who survived rabies without a vaccine, the third person in the U.S. to do so."
So started a CBS News piece extolling a California girl’s near-miraculous recovery after coming down with rabies last month.
The article, titled, "Rabies miracle? California girl survives dread disease without vaccine," is currently making the rounds among the vet-set. And for good reason. Not only are we typically attracted to salacious stories about zoonotic diseases (like anyone else among the medically-inclined might be), we’re also always on the lookout for cautionary tales about rabies.
Why? Because we veterinarians harbor a very healthy respect for this disease. But the same isn’t always the case with some of the humans we have to deal with. Case in point: Last week’s cat rescuer who refused to go to the hospital for vaccines after being bitten by a parking lot feral.
So anytime we can point to a rabies horror story ... we will. Even this one. Though this eight year-old from Willow Creek, California recovered even without receiving the recommended post-exposure vaccines (after an adverse interaction with a feral cat outside her school in April), she did suffer mightily for it.
First came the flu-like symptoms at the end of May, accompanied by a bumpy road to diagnosis. Then came the drug-induced coma and two weeks in the ICU, where she received anti-viral medications throughout her stay. I’m sure it wasn’t pretty.
Nurses at the hospital thought her survival chances were slim, when she arrived at the pediatric intensive care unit. "None of us thought she would leave the PICU," Krystle Realyvasquez, a nurse who cared for Precious, said in the statement. "When she did it was unbelievable."
Out of PICU, but still in hospital. And still suffering the ravages of a highly preventable condition. With post-exposure vaccines, prevention of rabies is extremely effective; close to 100 percent. Without it, almost all victims die.
So how did Precious’s case slip through the cracks sans vaccine? Because by the time she sought medical attention it was too late for the vaccination to be effective. The better question is … why?
Was it (a) because Precious minimized the importance of her interaction with a feral cat and didn’t tell her family; or (b) because her family minimized the importance of her interaction with a feral cat and didn’t tell her doctor; or, perhaps, (c) because our culture is so blinded by the rarity of rabies in "first-world" settings that it minimizes adverse interactions with cats and dogs, not adequately educating the public — or sometimes its human medical community — as to its true risks?
Regardless of who omitted to follow up on a cat bite, possibility (c) is almost certainly at play in the U.S. today. Take this doctor’s statement as an example of where we are with this disease in the U.S.:
[Precious’s] doctors were shocked that they found rabies."Rabies was not on my list," Dr. Theresa Vlautin, her pediatrician at [University of California at Davis’s] Children's Hospital, told The Sacramento Bee. "It's very, very rare to get rabies in a human — there about 30 cases in the world."
Well, not exactly, Dr. Vlautin. It’s more like 55,000. And those are just the dead ones.
But who’s counting?
You know I hate to criticize our sister profession (especially when it’s obviously being practiced at the highest levels, as it surely must be at UC Davis Children’s), but it’s still shocking to me the degree to which rabies gets so soundly smothered by the rug we’ve collectively swept it under.
Just because it’s not in our face 24/7 like it is throughout so much of the world doesn’t mean it’s not just about the scariest disease you’ll ever encounter. That is, unless you’re charmed enough to spend a full two weeks of your time in Hell tripping to a medically induced coma.
A fighter? I’m sure. But let’s face it: Precious was lucky much more than she was anything else.
Dr. Patty Khuly