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Summer 2020 - Vaccines

Rabies: A Patient’s Perspective

image of patient with horse

JEANNA GIESE-FRASSETTO was only 15 years old when her life permanently changed following a chance encounter with a bat. The Fond du Lac, Wis., resident was attending Sunday mass with her family when the winged creature began circling the church. An usher hit the bat with a prayer book, sending it crashing to the floor, stunned. A passionate animal lover, Giese-Frassetto rushed to pick it up by its wings and take it outside where she could set it free. “It began screeching, and as I went to throw it into a bush, it sank its fangs into my left finger,” she recalled.

Once home, her parents cleaned the superficial wound and did not consider additional medical treatment. Three weeks later, Giese-Frassetto began displaying signs that something was seriously wrong, including fatigue, double vision, vomiting and tingling in her left arm. By the time she was rushed to the hospital where she was officially diagnosed with rabies, it was too late to administer an anti-rabies vaccine. Her parents were told the devastating news that she had only hours to live.

Rabies is a vaccine-preventable viral disease that spreads from animals to humans. In both animals and people, the rabies virus travels to the brain, where it reproduces and then travels back through the nerves into other parts of the body. Eventually, the virus reaches the salivary glands, where it produces the telltale symptom referred to as “foaming at the mouth.” Rabies eventually kills by compromising the brain’s ability to regulate breathing, salivation and heartbeat. According to the World Health Organization (WHO):1 Dogs are the main source of human rabies deaths, contributing up to 99 percent of all rabies transmissions to humans; infection causes tens of thousands of deaths every year, mainly in Asia and Africa; 40 percent of people bitten by suspect rabid animals are children under 15 years of age.

The WHO fact sheet emphasizes that timing is critical when it comes to rabies postexposure prophylaxis (PEP) treatment. In the United States, PEP consists of a regimen of one dose of immune globulin and four doses of rabies vaccine over a 14-day period. Rabies immune globulin and the first dose of rabies vaccine should be given as soon as possible after exposure.

Giese-Frassetto was fortunate, to say the least. Rodney Willoughby, MD, a pediatrician and infectious disease specialist at the Children’s Hospital of Wisconsin in Milwaukee, made a bold decision not to give up on her, despite the odds. After consulting with various books and drawing on his own expertise, he devised an impromptu plan of action credited with saving her life. It would later be dubbed the “Milwaukee Protocol.”

The treatment plan began with putting the teen into a medically induced coma to isolate her brain and give her immune system an opportunity to kick in and fight the virus. In addition to inducing the coma, doctors gave her the antivirals ribavirin and amantadine, tapering them off when tests showed her immune system was, in fact, kicking in. A week after beginning the experimental treatment, doctors slowly brought Giese-Frassetto out of the coma; she had survived, but the road to recovery would be a difficult one. She spent 11 weeks in the hospital, taking as many as 17 pills a day and embarking on a rigorous rehabilitation program. For approximately six months after her release, physicians also gave her a compound called tetrahydrobiopterin that is chemically similar to the B-complex vitamin folic acid and known to boost production of serotonin and dopamine, the neurotransmitters needed to perform motor, speech and other routine bodily functions. “I felt lucky to be alive, but I was frustrated, isolated and desperate to go home. The whole left side of my body was affected, I had balance issues, and my speech was badly impaired. It was so slow to begin with that I despaired that I’d never recover.”

Giese-Frassetto’s rehabilitation initially included physical, occupational and speech therapy, as well as tutoring to help her keep up with schoolwork. Years later, she also incorporated equine therapy to assist with balance issues. Although difficult, her recovery has been remarkable.

It’s been well more than a decade later since that fateful morning mass, and Giese-Frassetto’s life has since been marked by more celebratory milestones, including college graduation, marriage and motherhood. But, rather than distance herself from the most difficult yet defining experience of her life, she’s used it as a platform to educate others, sharing her experience as a public speaker, volunteering for animal rights groups and even serving as an ambassador for the Global Alliance for Rabies Control. “I feel so grateful for my survival and the life I’ve had since the bite. I don’t take anything for granted.”

References

  1. World Health Organization. Fact Sheet on Rabies. Accessed at www.who.int/news-room/fact-sheets/detail/rabies.
Trudie Mitschang
Trudie Mitschang is a contributing writer for BioSupply Trends Quarterly magazine.