Speaker 1: Hey, they're extraordinaries. Heads up.
Speaker 2: Today's episode is about rabies, so we'll be touching on
Speaker 2: topics related to death and animal testing. Please decide if
Speaker 2: that content sounds like a good fit for you or
Speaker 2: for any children that might be hanging out in earshot.
Speaker 1: Thanks.
Speaker 2: In twenty twenty five, rabies made the news in the
Speaker 2: United States. A kidney transplant recipient had passed away from
Speaker 2: rabies and it was determined that their organ donor had
Speaker 2: had an undiagnosed case of rabies. Humans rarely transmit rabies
Speaker 2: to each other, and organ and tissue transplants are pretty
Speaker 2: much the only way it happens. But how does someone
Speaker 2: end up with undiagnosed rabies. Well, the man who would
Speaker 2: go on to become the organ donor was holding a
Speaker 2: kitten in an outbuilding when a skunk came in. The
Speaker 2: skunk approached the man, who perceived that the skunk was
Speaker 2: trying to kill kitten because the skunk was very hungry.
Speaker 2: The man knocked the skunk unconscious they're made of pretty
Speaker 2: stern stuff out in the country, and got a scratch
Speaker 2: on his shin in the process. In hindsight, he should
Speaker 2: have thoroughly washed out that wound and immediately gone to
Speaker 2: see a doctor for rabie's treatment, but he dismissed the
Speaker 2: scratch and didn't think he had been bitten. He just
Speaker 2: chalked it all up to an unfortunate interaction with a
Speaker 2: hungry but not necessarily rabid skunk. Five weeks later, he
Speaker 2: began hallucinating, he had trouble swallowing, and two days after
Speaker 2: that he appeared to have suffered a cardiac arrest. He
Speaker 2: never regained consciousness and was eventually declared brain dead. His
Speaker 2: family did report the skunk interaction, but cardiac arrest seemed
Speaker 2: a more likely cause of death. His kidney and three
Speaker 2: cornia tissue graphs were eventually given to recipients, and as
Speaker 2: you now know, the kidney recipient passed away. When it
Speaker 2: was determined that the kidney recipient had rabies. Some sleuthing
Speaker 2: determined that the organ donor had originally died of Raebe's
Speaker 2: as well. At that point, the cornea tissue grass were
Speaker 2: removed and all three recipients were given treatment for rabies. Thankfully,
Speaker 2: they all remained symptom free. This scenario where an organ
Speaker 2: donor transmitted rabies to organ and tissue recipients has only
Speaker 2: happened four times since nineteen seventy eight in the.
Speaker 1: United States, but it makes the news in the United.
Speaker 2: States because rabies deaths are so incredibly rare here, but
Speaker 2: globally they're not rare. Around sixty thousand people die each
Speaker 2: year from rabies, and many of them are children. And
Speaker 2: these deaths happened despite the fact that we have a
Speaker 2: vaccine that could save them if only it was administered
Speaker 2: soon after the initial rabies exposure. So today we're going
Speaker 2: to talk about rabies, how you can get it, how
Speaker 2: you can avoid it, the history of vaccine development, and
Speaker 2: what vaccines we have available today. Welcome to Daniel and
Speaker 2: Kelly's Rabid Uni. Hi.
Speaker 3: I'm Daniel. I'm a particle physicist, and I expected, based
Speaker 3: on childhood cartoons, to worry a lot about quicksand and
Speaker 3: rabi's when I was growing up.
Speaker 1: Hi, I'm Kelly Wiersmith.
Speaker 2: I study parasites and space, and yeah, I also thought
Speaker 2: that quicksand was going to be a much bigger problem
Speaker 2: as an adult than it ended up being.
Speaker 3: All right, Well, then my question for you today, Kelly
Speaker 3: is have you ever stepped in quicksand or had a
Speaker 3: serious concern about getting rabies.
Speaker 2: I never stepped in quicksand, although I did almost get
Speaker 2: stuck in a salt marsh once in some mud. I
Speaker 2: had a moment where I was out there by myself,
Speaker 2: and I was like, am I going to be able
Speaker 2: to get my foot out? Or is this the end?
Speaker 2: As the tide is coming in? And it wasn't the
Speaker 2: end because here I am.
Speaker 3: Well probably in that case, it's just by by boot, right.
Speaker 1: Yeah, yeah, I did lose that boot.
Speaker 3: Whatever you donated it to future archaeology is what you did?
Speaker 1: Yeah?
Speaker 2: Yes, Or I polluted that estuary with some microplastics.
Speaker 1: I'm so sorry.
Speaker 3: No, in five thousand years, some PhD student is going
Speaker 3: to write a whole thesis about the ritual processes surrounding
Speaker 3: your boots.
Speaker 2: Okay, sure, I wouldn't want to read that thesis, but I.
Speaker 1: Hope they passed.
Speaker 3: Well, what about rabies?
Speaker 2: Yeah, So when we moved to this property, there were
Speaker 2: two barn cats on the property and the woman was
Speaker 2: moving to a place that didn't have a barn and
Speaker 2: so we offered to keep the barn cats. And every
Speaker 2: once in a while they'll catch a bird. And when
Speaker 2: they catch a bird, I keep it This is the
Speaker 2: Wienersmith family equivalent of poop in the fridge. My husband
Speaker 2: is not thrilled when I do this, but I do it.
Speaker 2: And so I reached down once because I thought the
Speaker 2: birds and this was on my birthday.
Speaker 1: I reached down.
Speaker 2: I thought the cats had caught a bird, and as
Speaker 2: soon as I picked it up, I shouted an expletive
Speaker 2: because I realized they hadn't caught a bird. They had
Speaker 2: caught a bat oho and I had picked up that
Speaker 2: bat with a bear hand. And so immediately I was like, oh, no,
Speaker 2: do I need to go get a rabies vaccine? And
Speaker 2: so I called the Poison Control Center and they ended
Speaker 2: up deciding no, it's probably fine. You probably don't need
Speaker 2: a vaccine. And I was like, I don't want to
Speaker 2: hear the word probably. I want to hear one hundred percent.
Speaker 2: There is zero tant you're gonna get rabies.
Speaker 3: You're talking to a worrier here, people.
Speaker 1: That's right, you know, I did say. I was like,
Speaker 1: look at I have severe anxiety.
Speaker 2: If the answer isn't one hundred percent, I want to
Speaker 2: come in and get the raby shot. And they're like, lady,
Speaker 2: you're fine, and I was like all right, speaking your language,
Speaker 2: that's right, that's right.
Speaker 1: What about you.
Speaker 3: Well, I didn't have to worry about rabies, but growing
Speaker 3: up in northern New Mexico, you do have to worry
Speaker 3: about the plague. Oh and I remember one time seeing
Speaker 3: a dead squirrel and poking it, and then going home
Speaker 3: excitedly telling my mom how I saw this dead squirrel
Speaker 3: and played with it, and she was like, ugh, you what?
Speaker 3: Oh no, And from then on I was sure that
Speaker 3: I was going to get the bubonic plague, which existed,
Speaker 3: you know, medieval Europe and New Mexico.
Speaker 2: Yeah, well, and in like mountains in California.
Speaker 1: Oh I do, I do.
Speaker 2: But for both of these there are treatments if you
Speaker 2: catch it pretty soon. There's antibiotics for the plague that
Speaker 2: does not plague us anymore, and we have vaccines for rabies,
Speaker 2: which we'll be talking about today.
Speaker 3: Well that's why we joke that New Mexico is home
Speaker 3: of the flea, land of the plague.
Speaker 2: Oh yeah, that doesn't doesn't make me want to move there.
Speaker 3: No, No, the land of entrapment. Anyway. There's a lot
Speaker 3: of wonderful things about New Mexico, but you don't really
Speaker 3: appreciate them growing up there.
Speaker 2: As a teenager, I feel the same way about Ohio.
Speaker 2: But I guess I feel the same way as an
Speaker 2: adult about Ohio.
Speaker 1: I'm so sorry.
Speaker 3: Well, speaking of not appreciating things, I don't appreciate getting rabies,
Speaker 3: but I do appreciate our listener's curiosity.
Speaker 1: Yes, me too.
Speaker 2: And we got a request for an episode topic from Gurjeet.
Speaker 2: They wanted to know about rabies, and so I was
Speaker 2: happy to oblige because rabies is an absolutely horrible topic
Speaker 2: but also fascinating and so so that is Kelly's ven
Speaker 2: diagram of favorite things to talk about.
Speaker 3: That's right. We don't exploit true crime on this podcast,
Speaker 3: but we do talk about gooey biological pain and suffering.
Speaker 1: We do.
Speaker 2: And I came across what I thought was a fun
Speaker 2: fact while I was doing the research, which is that
Speaker 2: an old treatment that did not work. So treatment is
Speaker 2: in quotes here. An old treatment for rabies was that
Speaker 2: you would take the hair of the dog that bit
Speaker 2: you and put it on the wound, and you would
Speaker 2: hope that that would save you from actually getting the disease.
Speaker 3: Is that the origin of the phrase.
Speaker 1: That is the origin of the phrase.
Speaker 3: Now mostly used to justifyd mimosas at brunch.
Speaker 2: Yes, right, and we will see that many of our
Speaker 2: extraordinaries have an extraordinary desire to continue drinking in the morning.
Speaker 2: So let's go ahead and see what the extraordinaries had
Speaker 2: to say when we asked the phrase hair of the
Speaker 2: dog came from an ineffective treatment for what disease?
Speaker 3: Branchosis? Jesus Wow, what a good question. I'm going to
Speaker 3: be ignorance to say alcoholism.
Speaker 4: I have never heard the phrase before. Hmmm, what disease
Speaker 4: would be associated with dog hair? I'm going to say
Speaker 4: lime disease due to ticks.
Speaker 5: The hair of the dog originally refers to the prevention
Speaker 5: of rabies and is of course false. Probably has something
Speaker 5: to do with the old principle of like cures like,
Speaker 5: and a myth would spread very rapidly in an environment
Speaker 5: of wishful thinking and despair. With dog in the phrase,
Speaker 5: I'm going to go with rabies.
Speaker 3: I guess it's probably something related to tuberculosis.
Speaker 6: Basically a hangover, and it's so shameful that you have
Speaker 6: to walk home and then you find a dive bar
Speaker 6: on the way home, and you make even more terrible
Speaker 6: life choices.
Speaker 4: It might be a reference to rabies, the hair of
Speaker 4: the dog that bit you, based on magical thinking like
Speaker 4: cures like or some such.
Speaker 1: It doesn't work in these parts.
Speaker 3: It means if whiskey culls the hangover, whiskey'll salt it.
Speaker 3: But I think it refers to an old cure for abes.
Speaker 7: Since hair of the dog refers to a hangover remedy,
Speaker 7: maybe alcoholism. But for some reason, I'm thinking tuberculosis, and
Speaker 7: I don't know why, but I'm sure it hasn't always
Speaker 7: referred to that bloody mary.
Speaker 5: The next morning, I'm thinking the ineffective treatment of being
Speaker 5: hungover by drinking more.
Speaker 1: I don't know, sia is this or something right?
Speaker 2: So it seems like there was a pretty nice split
Speaker 2: here between folks who were definitely like, this has to
Speaker 2: do with alcohol, and folks who were like, yeah, alcohol maybe,
Speaker 2: but definitely rabies.
Speaker 3: As did you go down a rabbit hole and figure
Speaker 3: out if whiskey is actually good in the morning if
Speaker 3: you have hangover?
Speaker 2: I did not. I'm guessing that just delays the inevitable.
Speaker 2: But I know I didn't look into that. That was
Speaker 2: a little too far afield of the topic of the day, So.
Speaker 3: For those of you looking for a scientific reason to
Speaker 3: day drink, You're not going to find it on the
Speaker 3: show today.
Speaker 1: I'm not helping you with that. Now, that's not what
Speaker 1: I'm here for.
Speaker 3: You are here to tell us all the gooey details
Speaker 3: about rabies. So what is Rabi's anyway, other than a
Speaker 3: reason for cartoon dogs to froth at the mouth.
Speaker 2: Yeah, So Rabi's is a viral disease that we think
Speaker 2: has been plaguing us for at least four thousand years.
Speaker 2: There are these four thousand year old tablets that we
Speaker 2: found in Iraq that has a law written on it
Speaker 2: that essentially says if a dog becomes rabid and the
Speaker 2: ward authority makes that known to its owner, but he
Speaker 2: does not watch over his dog so that it bites
Speaker 2: a man and it causes his death, the owner of
Speaker 2: the dog shall pay forty shekels of silver. If it
Speaker 2: bites a slave and causes his death, he shall pay
Speaker 2: fifteen shekels of silver.
Speaker 3: Kelly, I love your old testament audiobook voice. That's awesome.
Speaker 2: Well, here you could see that for four thousand years,
Speaker 2: we've been putting dollar values on the value of human
Speaker 2: or che values on the value of human life, and
Speaker 2: we have been ranking the value of human beings. Not
Speaker 2: not a good look for humanity. But the point is
Speaker 2: Rabi's has been, you know, a thing that we have
Speaker 2: been aware of for a really long time.
Speaker 3: But in this case, is the word rabbit obviously a
Speaker 3: translation describing behavior of a dog or was it already
Speaker 3: understood that the dogs were ill and that's where the
Speaker 3: word rabbit comes from.
Speaker 2: Yeah, that's a great question. So I was listening to,
Speaker 2: you know, to research this. I was listening to a
Speaker 2: bunch of different like history podcast, veterinarian podcast, blah blah blah,
Speaker 2: and almost everybody referenced this story. But I was able
Speaker 2: to find a like, you know, history reference that was
Speaker 2: dealing with this exact quote, and it said that another translation,
Speaker 2: instead of translating it as rabbit, translated it as like
Speaker 2: furious or angry. So like, is it really saying if
Speaker 2: your dog is a jerk and we tell you your dog's
Speaker 2: a jerk and you need to like chain that dog up,
Speaker 2: you know we're gonna we're gonna find you if that
Speaker 2: dog bites somebody. But references from the same time period
Speaker 2: note that it's it seems to be that people recognize
Speaker 2: that it is saliva that is transmitting something that will
Speaker 2: kill people. So it suggests to me that they do
Speaker 2: recognize that there is some disease that is being passed
Speaker 2: by the dog through a bite and saliva has something
Speaker 2: to do with it, which sounds like it's not just
Speaker 2: there's a dog that's angry, and they realize some dogs
Speaker 2: are jerks and jerks should be tied up. They actually
Speaker 2: recognize that some dogs carry diseases and those diseases get transmitted.
Speaker 3: Before we understood the microbiology of it all. Of course, yes,
Speaker 3: I'm noting that the Oxford English Dictionary says that the
Speaker 3: earliest use of the word rabbit is from the late
Speaker 3: fifteen hundreds by George Chapman, and so obviously the Iraqis
Speaker 3: didn't use the word rabbit itself, but the idea is
Speaker 3: translated to the modern word rabbit. Fascinating.
Speaker 2: Yeah, yeah, And if you look throughout time, you know,
Speaker 2: from four thousand years ago onwards, there are lots of
Speaker 2: different cultures who have things where you're like, oh, it
Speaker 2: really sounds like they're talking about rabbit animals from the
Speaker 2: point that dogs were domesticated onwards.
Speaker 3: That was my other question is this a disease that
Speaker 3: arises because of the mystification urbanization of civilization, the way
Speaker 3: many diseases come from, like you know, animals in close
Speaker 3: quarters or is this something that existed and exists among
Speaker 3: like wild wolves.
Speaker 1: Yeah, great question.
Speaker 2: This is a disease that exists in the wild and
Speaker 2: has probably existed in the wild long before animal domestications. So,
Speaker 2: for example, in the United States, it's very common in bats, skunks, raccoons,
Speaker 2: and foxes. You can find it in coyotes sometimes also,
Speaker 2: so it's in a lot of wildlife. It happens to
Speaker 2: also do really well in dogs when they aren't vaccinated,
Speaker 2: and so when we started living with dogs, we were
Speaker 2: bringing it closer to us and in contact with us
Speaker 2: more often. But this is definitely something that you could
Speaker 2: have gotten from wild animals, for example, when you were
Speaker 2: hunting before that.
Speaker 3: I see. So if it's an ancient disease, there must
Speaker 3: be a lot of hilarious ancient treatments for it.
Speaker 2: Yeah, right, So hair the dog was one of them.
Speaker 2: Another one that I came across was you would take
Speaker 2: a rooster, you would pull the feathers off of the
Speaker 2: roosters anus and.
Speaker 3: It's still alive while you're doing that.
Speaker 2: Yeah, yeah, And I'll note it's actually you know, it's
Speaker 2: called an anus, but it's actually a cloaca, which is
Speaker 2: a word for sewer, because for chickens, everything comes out
Speaker 2: of the same hole. But anyway, and then you would
Speaker 2: put it on the bite, and if the anus swelled up,
Speaker 2: you could assume that like the poison had been sucked
Speaker 2: out by the anus.
Speaker 1: This did not.
Speaker 3: Workit what do you put on the bite, the feathers or.
Speaker 1: The anis the anus? Yeah?
Speaker 3: Oh wow, I totally misunderstood that.
Speaker 2: Yeah, right, And so now maybe you have like whatever
Speaker 2: bacteria was on the chicken's butt in your wound, which
Speaker 2: doesn't sound good.
Speaker 3: How long do you have to have the chicken butt
Speaker 3: on your wound?
Speaker 1: I don't know.
Speaker 2: As long as it takes for it to swell up,
Speaker 2: I guess, I don't know. And there was another one that,
Speaker 2: unfortunately was like, oh, if the dog bit you, you have
Speaker 2: to like take some of the dog's brain and put
Speaker 2: that in the wound. And so like, if you didn't
Speaker 2: have rabies before, you probably have rabies now. Yeah, So
Speaker 2: that's unfortunate, But some of these methods probably seemed to
Speaker 2: work because First of all, not every angry animal that
Speaker 2: bites you has rabies, and so maybe you get bit
Speaker 2: you tried the thing, you don't get rabies in your Like, oh,
Speaker 2: that's great that you know the chicken butt thing worked,
Speaker 2: but like you weren't gonna get rabies anyway, because that
Speaker 2: dog was just a jerk. It didn't have rabies. And
Speaker 2: not every bite or scratch actually probably has enough rabies
Speaker 2: virus in it to give you rabies.
Speaker 3: These are not randomized controlled trials. They're very hard to
Speaker 3: interpret it.
Speaker 2: Yeah, yes, right, right, yeah, so but I mean, you know,
Speaker 2: you can laugh and be like, oh ha haha, what idiots,
Speaker 2: How could they ever think the chicken butt thing would work?
Speaker 2: But you know, there were probably a couple instances where
Speaker 2: they were like, hey, you know, Fred got bit by
Speaker 2: a dog and then he didn't get rabies after he
Speaker 2: did the chicken butt thing, and you could be like, well,
Speaker 2: you know, it's worth a.
Speaker 3: Shot anytime something good happens after a human does something weird,
Speaker 3: and you like create some mythology and you're like, better
Speaker 3: put a chicken butt on your wrist before you go
Speaker 3: outside if you want gold to fall from the tree
Speaker 3: or whatever. It's amazing how these things just reinforce themselves.
Speaker 3: We are like bad at statistics natively.
Speaker 2: Well, I mean, what's the downside, right? I guess if
Speaker 2: you ask the chicken, there'd be a pretty clear down sta. Wow.
Speaker 3: You know, I haven't been to Virginia in a while,
Speaker 3: but the culture there has really gone up the deep end.
Speaker 2: We got rid of our chickens, so we're not so
Speaker 2: into that kind of stuff, but.
Speaker 3: Got rid of Wow.
Speaker 1: Well, we gave them to our brother and sister in law.
Speaker 3: I see.
Speaker 2: We had enough gold falling from the sky after doing
Speaker 2: the chicken butt thing, so we moved on.
Speaker 3: As one does. Yeah. Yeah, So rabies is a disease.
Speaker 3: What does it cost?
Speaker 2: By you said it's a virus, it's a virus, and
Speaker 2: in the United States we are pretty lucky. This virus
Speaker 2: is not something humans need to worry about so much.
Speaker 2: So about less than ten people in the United States
Speaker 2: die from rabies every year.
Speaker 1: Oh wow, that's pretty good odds.
Speaker 3: It's like fewer than shark attacks.
Speaker 2: Yeah yeah, I guess I don't actually know how many
Speaker 2: shark attacks there are, but that sounds about right.
Speaker 3: It's close to shark attacks or like struck by lightning
Speaker 3: or something. It's like, that's very rare.
Speaker 1: Yeah, super rare.
Speaker 2: But about one hundred thousand people every year are vaccinated
Speaker 2: after they have a potential rabies exposure, and so these
Speaker 2: are probably people like veterinarians who had a stray cat
Speaker 2: brought in that then went on to bite them, animal
Speaker 2: control people who had to go out and get an
Speaker 2: animal that was presumed to be rabid something like that.
Speaker 2: So there are a lot of people exposed to animals
Speaker 2: that might be rabid. But because we have great control
Speaker 2: measures in great vaccines, very few people die from.
Speaker 3: This, right, And those two numbers are closely linked, right,
Speaker 3: It's not like, why are we doing this? Hardly anybody dies,
Speaker 3: It's like, oh, we're not feeling the rain because we're
Speaker 3: holding an umbrella. The reason few people die is because
Speaker 3: we vaccinate people, right.
Speaker 2: Right, And that's not true around the world. So globally,
Speaker 2: sixty thousand people die of rabies every year, and this
Speaker 2: is considered a neglected tropical disease because there are parts
Speaker 2: of the world that can't afford vaccines or can't handle
Speaker 2: the kinds of mass vaccination efforts. You need to keep
Speaker 2: cats and dogs that are around people vaccinated year after year,
Speaker 2: and so we are very lucky science has a solution
Speaker 2: to this. And in the United States we have the
Speaker 2: infrastructure and the money to make sure it gets where
Speaker 2: it needs to go. But in other parts of the
Speaker 2: world that's not the case.
Speaker 3: So we vaccinate all the pets, and then humans, if
Speaker 3: they've been exposed, we vaccinate them. We don't use vaccinate
Speaker 3: humans across the board.
Speaker 1: Yeah, so it depends on who you are.
Speaker 2: So we have a vaccine that you can give to
Speaker 2: people who are likely to get exposed. So if you
Speaker 2: are a veterinarian, you probably get a prophylactic vaccine. Veterinarians
Speaker 2: get it. VET texts get it. People who work in
Speaker 2: animal control get it. If you like to go spelunking,
Speaker 2: I think in the United Kingdom this is called potholing.
Speaker 1: What yeah, yeah, let's go.
Speaker 3: For an afternoon in that pothole that nobody ever.
Speaker 2: Well, unless you're in the UK, said plenty of UK people,
Speaker 2: I think.
Speaker 1: And the idea there is that caves.
Speaker 2: Are places where you find a lot of bats, and
Speaker 2: bats could be spreading rabies either through bites or through
Speaker 2: you know, like saliva. You could breathe it in in
Speaker 2: an aerosolized sort of way. If you're a hunter, you
Speaker 2: might want to consider getting vaccinated, depending on what kind
Speaker 2: of animals you're going after, because when you are skinning
Speaker 2: those animals, if you have a cut, you can maybe
Speaker 2: get some stuff in that cut that could transmit rabies
Speaker 2: to you. So there are certain activities that can increase
Speaker 2: your risk, and you are able to get vaccinated for
Speaker 2: rabies ahead of time. And then if you engage in
Speaker 2: another behavior where you think, okay, this time, I was
Speaker 2: definitely exposed to rabies, you'll go in and get some
Speaker 2: more vaccines to boost your immunity.
Speaker 3: And what kind of infrastructure is required is raby is
Speaker 3: one of the vaccines that needs to be chilled, and
Speaker 3: it's really complicated and that's why it's not easily available everywhere.
Speaker 2: Yeah, So the way that we make this vaccine now,
Speaker 2: and we can talk about the history of the vaccine later,
Speaker 2: but the way that we make the vaccine now is
Speaker 2: we essentially grow it in human cells in the lab,
Speaker 2: or we can grow it in like chicken embryos in
Speaker 2: the lab. Either way, we're not like growing this in
Speaker 2: live animals or anything like that. You extract the virus
Speaker 2: you kill it and then you suspend it, and it
Speaker 2: is kind of expensive.
Speaker 1: That is part of it.
Speaker 2: But I think a bigger problem with the vaccine is
Speaker 2: that this vaccine does have some side effects. So for example,
Speaker 2: some people will have a reaction called anaphylaxis where you
Speaker 2: have trouble breathing. Some people will have like an allergic
Speaker 2: sort of response to it. The rate of these reactions
Speaker 2: is pretty low. And what you really need to know
Speaker 2: here is that once you start showing symptoms for rabies,
Speaker 2: you are nearly one hundred percent sure to die from rabies.
Speaker 3: Oh wow.
Speaker 2: And so if you are exposed to an animal that
Speaker 2: has rabies, the risk of any of these issues pales
Speaker 2: in comparison to your risk of dying of rabies, And
Speaker 2: so you are definitely going to go ahead and get
Speaker 2: the vaccine.
Speaker 3: I see. Okay, so this is not the kind of
Speaker 3: vaccine you just give everybody because there are side effects,
Speaker 3: But if you've been exposed, then it's definitely a gamble
Speaker 3: we're taking.
Speaker 2: Yes, right, So between the costs and the potential side effects,
Speaker 2: we don't want to go and vaccinate everyone, especially because
Speaker 2: in the United States, most of us probably are not
Speaker 2: going to encounter a rabit animal. So it seems not
Speaker 2: worth the risk, but for people in risky professions it
Speaker 2: might be.
Speaker 3: So I was surprised by what you said earlier about exposure,
Speaker 3: Like just going for a hike in a cave where
Speaker 3: there are bats that have rabies might be enough, like aerosolized.
Speaker 3: I thought you had to get bitten by some cartoon animal.
Speaker 1: Yeah.
Speaker 2: Well, so let's take a break, and when we come
Speaker 2: back from the break, we'll go through the various ways
Speaker 2: that you can get infected by rabies.
Speaker 3: Okay, we're back, and we are taking a bite out
Speaker 3: of rabies today, furiously understanding the nature of this disease.
Speaker 3: So tell us, Kelly, how does one get exposed to
Speaker 3: Arabi's What do we have to watch out for spelunkers
Speaker 3: and potholers alike.
Speaker 2: Well, the most common way, let's start with the most
Speaker 2: common way that you get exposed to rabies, and that's
Speaker 2: through bites and scratches from rabbit animals. And in the
Speaker 2: United States, the most common way you're going to get
Speaker 2: exposed to a bite or a scratch from a rabbit
Speaker 2: animal is by interacting with a bat. So, if you
Speaker 2: are in the sort of unlucky situation where a bat
Speaker 2: accidentally ends up in your house and you that bat
Speaker 2: bite you when it's trying to get out, or you
Speaker 2: wake up in the middle of the night and there's
Speaker 2: a bat in your room.
Speaker 3: What, Kelly, you can just drop.
Speaker 2: That that has happened to me. I know, I know,
Speaker 2: I didn't know at the time, but you might in
Speaker 2: those situations might want to call a medical professional to
Speaker 2: be like, I found a bat in my room. I
Speaker 2: was listening to a podcast of people who are studying
Speaker 2: for their medical boards, and they noted that in that instant,
Speaker 2: you're supposed to give people vaccines for rabies because you
Speaker 2: can't be sure they didn't get bitten while they were sleeping.
Speaker 2: And I was like, oh, man, I didn't call anyone
Speaker 2: when that happened. I just like opened the window and
Speaker 2: shoot the bat out. But anyway, I'm still here, so
Speaker 2: that's good news.
Speaker 3: Does the fact that that happen is that the origin
Speaker 3: of like vampire myths like vampires fly in on the
Speaker 3: wings of a bat, bite you and then fly out again.
Speaker 2: Could be But there are also like vampire bats that
Speaker 2: actually suck human blood when they have trouble getting access
Speaker 2: to other mammals.
Speaker 1: Oh boy, I'm guessing that.
Speaker 3: So you could wake up in the middle of the
Speaker 3: night with a bat on your face or what else.
Speaker 2: But we hope not, but you could also, So if
Speaker 2: that animal bites you, it's saliva gets into your body,
Speaker 2: and that's one way that the rabies virus can get
Speaker 2: into you. Also, if an animal scratches you, you know,
Speaker 2: maybe they like licked their hand and then they scratch you,
Speaker 2: and that gets the virus in your body. That's skunks, raccoons,
Speaker 2: and foxes, which we talked about already. In the United States,
Speaker 2: those are animals that are most frequently found to have rabies.
Speaker 2: That doesn't mean that most of those animals in the
Speaker 2: wild have rabies, but in the United States, the animals
Speaker 2: that are most likely to have rabies are those four
Speaker 2: kinds of animals.
Speaker 3: And these rabies a kind of virus that doesn't last
Speaker 3: very long in saliva outside the body. Like if a
Speaker 3: bat spits on a rock and then you lick that
Speaker 3: rock like a week later, are you okay or is
Speaker 3: that rock like dangerous forever?
Speaker 1: Yeah?
Speaker 2: Right, that is a question only Daniel would ask, and
Speaker 2: that is uh and you would probably be fine. And
Speaker 2: I'm under the impression that that is why I was
Speaker 2: told I didn't need to get a rabies vaccine when
Speaker 2: I picked up that dead bat. I think they were like,
Speaker 2: the bat's probably been long dead, you're probably fine.
Speaker 3: Fascinating. It's amazing to me when viruses are so fragile
Speaker 3: and yet so able to spread anyway, It's incredible.
Speaker 2: It is, it is, And I just want to really
Speaker 2: highlight here. I am not a medical doctor. So if
Speaker 2: you're like, oh, Kelly said that bat had been dead
Speaker 2: for a while that she touched, so I don't need
Speaker 2: to call the dot.
Speaker 1: Always call the doctor.
Speaker 2: If you have any question about rabies, if you've been
Speaker 2: exposed to anything that puts you at risk of rabies,
Speaker 2: call your doctor.
Speaker 3: And I don't suggest licking any rocks. I'm also not
Speaker 3: a medical professional.
Speaker 2: Yeah, yeah, no, Actually, you should probably never do anything
Speaker 2: Daniel suggests.
Speaker 1: It's just a bad idea.
Speaker 3: I keep telling my kids that also, yeah.
Speaker 2: Yeah, yeah, well so, And if you live in Africa
Speaker 2: and Asia, you're most likely to get rabies from dog bites.
Speaker 1: People encounter dogs a lot.
Speaker 2: There's in a lot of countries there's not good programs
Speaker 2: to regularly vaccinate dogs, and unfortunately, the majority of the
Speaker 2: bites happened to children who just want to pet a
Speaker 2: dog and then they get oh I know, and so yeah,
Speaker 2: so saliva from rabbit animals is the most common way. Now,
Speaker 2: it's worth noting that livestock animals like horses can also
Speaker 2: get rabies, and so you want to be careful and
Speaker 2: vaccinate as many animals as you're able to. Very rarely,
Speaker 2: the virus can be aerosolized for short periods of time,
Speaker 2: and so that's why you know, if you're spelunking or
Speaker 2: potholing in a cave and there's a bunch of bats
Speaker 2: and there's not a lot of sunlight in there, so
Speaker 2: sunlight is something that kills the rabies virus pretty quickly.
Speaker 2: You might be able to breathe in some of the
Speaker 2: rabies virus, and that is why sometimes spelunkers will get vaccinated,
Speaker 2: or if they're going into an area with a lot
Speaker 2: of bats and they're worried they're going to get bit
Speaker 2: then they'll get vaccinated as well. And a very rare
Speaker 2: way that does sometimes result in rabies is organ transplants.
Speaker 2: If it was missed that a donor had rabies, and
Speaker 2: then you can transmit it that way again, very rare.
Speaker 1: We talked about that in the opening.
Speaker 3: So there's no way to get rabies by like listening
Speaker 3: to a podcast about rabies.
Speaker 2: Our listeners are saying, that's right, that's right, and you know,
Speaker 2: I actually I feel like the more you learn about
Speaker 2: this kind of stuff, like, yes, it's scary initially, but
Speaker 2: once you understand how it's transmitted, you can say, Okay,
Speaker 2: I know what I need to worry about, and then
Speaker 2: I know when I need to call a medical professional. Yes,
Speaker 2: I still worry because I am me, but I feel like,
Speaker 2: you know, the scope of my worrying has narrowed a
Speaker 2: little bit because now I understand when I need to
Speaker 2: worry and why I need to worry, and I feel
Speaker 2: like that gives me a little bit of control over
Speaker 2: the situation.
Speaker 3: Yeah, although you know, statistics doesn't help anxiety. I mean,
Speaker 3: you can look at the numbers and be like, well,
Speaker 3: on average, that's pretty rare. It doesn't happen to very
Speaker 3: many people, these terrible scenarios, et cetera, et cetera. On
Speaker 3: the other hand, you're like, yeah, but there are ten
Speaker 3: people out there who do die raby's every year, and
Speaker 3: those are real people. Who also looked at the numbers
Speaker 3: and they were like, yeah, I'll probably be fine. So
Speaker 3: the sort of two ways to look at it, from
Speaker 3: a public health perspective on average, and then also from
Speaker 3: the like, am I that one outlier case perspective, which
Speaker 3: is the one I always use as a worrier?
Speaker 1: Yeah, okay, I do see your point.
Speaker 2: But like so in the intro, we talked about a
Speaker 2: guy who got scratched by a skunk and bled. Presumably
Speaker 2: what he thought was it's just a scratch. I probably
Speaker 2: didn't get it, and I think this skunk was just
Speaker 2: trying to eat the kitten and wasn't actually rabid, And
Speaker 2: so they made some choices that if you knew enough
Speaker 2: about rabies, or if you were enough of a warrior, yeah,
Speaker 2: could have caused that person to have made a different
Speaker 2: decision to at least call the doctor and been like,
Speaker 2: I don't know, what do you think I got scratched
Speaker 2: by a skunk that was angry and was willing to
Speaker 2: approach me to try to eat a kitten.
Speaker 1: What would you do?
Speaker 2: I suspect that doctor would have said, we're gonna go
Speaker 2: ahead and give you some shots, because rabies is one
Speaker 2: hundred percent fatal, So let's not take any risks.
Speaker 3: Yeah, although if you are a worrier and you want
Speaker 3: to be informed by statistics, as you just suggested, then
Speaker 3: you would be shocked at like how dangerous it is
Speaker 3: to drive anywhere and you should probably just never get
Speaker 3: in a car, and how dangerous household accidents are, so
Speaker 3: you shouldn't, for example, try to do your kitchen by yourself.
Speaker 2: But we don't want Kelly to become a shut in.
Speaker 2: So we're going to talk about what happens once the
Speaker 2: virus gets in your body. Daniel, what are you trying
Speaker 2: to do here?
Speaker 3: I'm just saying statistics and formed decisions are not the
Speaker 3: way we live our lives.
Speaker 1: Yeah, you're right, you're right.
Speaker 3: But anyway, tell us about the microbiology here. What happens
Speaker 3: when the virus gets in your body? Killing?
Speaker 2: All right, So the virus gets in your body and
Speaker 2: it gets into your muscle tissue. And what we've talked
Speaker 2: about how viruses replicate. They essentially hijack the machinery inside
Speaker 2: your cell, and they tell the cell that it needs
Speaker 2: to start replicating the virus' genetic material and start making
Speaker 2: proteins for the virus. So it essentially the cell becomes
Speaker 2: like a little factory that starts making more viruses, and
Speaker 2: then it spits the viruses out and the viruses go
Speaker 2: out to infect more cells.
Speaker 1: So that's generally how viruses work.
Speaker 3: If this sounds familiar to you, reminiscent of how like
Speaker 3: computer viruses work, that's not an accident. That's why they
Speaker 3: call computer viruses viruses, not the other way around. Biological
Speaker 3: viruses didn't steal this idea from hackers.
Speaker 2: Yes, and keep that in your head because we're gonna
Speaker 2: come back to that comparison a little bit later, all right.
Speaker 2: So it starts by getting into like muscle tissue near
Speaker 2: the site of the bite, and for reasons we don't
Speaker 2: totally understand, it has the period where it replicates sort
Speaker 2: of slowly in those muscle tissues. And thank goodness for that,
Speaker 2: because that means there's a period where we can sort
Speaker 2: of get a leg up on the virus. And this
Speaker 2: is why we're able to give people a vaccine after
Speaker 2: they get bitten that can still save their life. And
Speaker 2: this is another part of why we don't need to
Speaker 2: mass vaccinate everybody, because it still works if you just
Speaker 2: give it to someone afterwards, which doesn't work quite as
Speaker 2: well with some other things that we vaccinate against.
Speaker 3: That seems pretty unusual. Right, In almost all cases you
Speaker 3: have to vaccinate first for it to take.
Speaker 2: Effect, right, Yeah, No, we are amazingly lucky that this
Speaker 2: virus has this period where it like sort of sluggishly
Speaker 2: replicates and muscles for a while before it starts heading
Speaker 2: for the nervous system. But eventually it will start finding
Speaker 2: nervous system cells and it will start following nerves to
Speaker 2: your spinal cord and then start moving up to your brain.
Speaker 2: And when it starts getting towards its final location, you
Speaker 2: are going to start getting symptoms like fever, flu like stuff,
Speaker 2: gastrointestinal symptoms, and sort of eerily, the location that you
Speaker 2: got bit will start like tingling or having a prickly sensation.
Speaker 2: And the reason that's eerie is that this is usually
Speaker 2: happening about two months after your exposure to the virus,
Speaker 2: so that site has like long since healed, and now
Speaker 2: all of a sudden, you're starting to feel tingling there again.
Speaker 2: By the time you start having these symptoms, which again
Speaker 2: like take two months for the virus to go from
Speaker 2: that bite site up to the point where you know,
Speaker 2: essentially it's too late. When you start getting those symptoms.
Speaker 2: There's more or less no way to stop the virus
Speaker 2: at that point. It's in your central nervous system, and
Speaker 2: we don't have good treatments for it.
Speaker 1: At that point.
Speaker 2: Rabies enters one of two forms, the furious form, which
Speaker 2: is about eighty percent of the cases. Average survival time
Speaker 2: for this is about six days. Symptoms include like you
Speaker 2: kind of come in and out of consciousness of strangely,
Speaker 2: you become very afraid of water. So this is called hydrophobia.
Speaker 2: There are some videos online that I've got to admit
Speaker 2: I don't recommend looking up. I watched them once a
Speaker 2: couple of years ago, and they're just incredibly upsetting to watch.
Speaker 2: But you know, someone will try to take a drink
Speaker 2: of water because they're very thirsty, but they'll start having
Speaker 2: these like gagging reflexes, and it's like they're really afraid
Speaker 2: of the water and they, you know, kind of can't
Speaker 2: figure out why. You know, it's like they're be you know,
Speaker 2: they like they've been hijacked, which essentially, you know, their
Speaker 2: brains have been They start to hallucinate.
Speaker 3: And so help me understand what's happening here. This is
Speaker 3: all due to brain inflammation as the immune system responds
Speaker 3: to the rabies, or is this something rabies is doing
Speaker 3: to your brain directly.
Speaker 1: Yeah.
Speaker 2: So one of the interesting things about doing the research
Speaker 2: for this is that places like the World Health Organization
Speaker 2: say that there's a bunch of inflammation in the brain
Speaker 2: and that death occurs due to cardio respiratory arrest and
Speaker 2: you know, you go into coma and essentially things shut down.
Speaker 2: But other sources that I read were like, the surprisingly
Speaker 2: little inflammation happening in some of these cases, And so
Speaker 2: we seem a little bit confused. It looks like there's
Speaker 2: or maybe not confused, but maybe there's a couple different
Speaker 2: ways that rabies can lead to death. It seems like
Speaker 2: there's a couple different competing hypotheses. It might depend on
Speaker 2: exactly what rabies is doing. It seems to take a
Speaker 2: couple different forms, and maybe it depends on what part
Speaker 2: of the brain the rabies ends up in. And in
Speaker 2: just a second, we're going to talk about a hypothesis
Speaker 2: that relies on there not being inflammation in the brain.
Speaker 2: So hold that thought for just a second. We will
Speaker 2: circle back to that there's another form of rabies that
Speaker 2: happens about twenty percent of the time called paralytic. We're
Speaker 2: essentially starting at the scratch or bite site. The muscles
Speaker 2: start to become essentially paralyzed, and that gradually spreads over
Speaker 2: the course of the body, and over about eleven days,
Speaker 2: the person tends to go into a coma and they die.
Speaker 2: This form tends to be misdiagnosed as a bunch of
Speaker 2: other things, so it might be underreported. But one way
Speaker 2: or another, a rabi's death is really an unpleasant death,
Speaker 2: and we don't have a really good way of treating
Speaker 2: people once symptoms start showing.
Speaker 1: But you may remember around two.
Speaker 2: Thousand and four, long time ago, there was in the
Speaker 2: news this Milwaukee protocol where a young girl who started
Speaker 2: showing symptoms of rabies was brought back from rabies.
Speaker 1: Do you remember hearing about this?
Speaker 2: No, tell me, Okay, So there was this girl who
Speaker 2: was at church and there was a bat flying around
Speaker 2: the church and it like was trying to get out
Speaker 2: the window, but it couldn't get out the window. I
Speaker 2: think somebody hit it with a broom and it kind
Speaker 2: of fell down and the girl was trying to help,
Speaker 2: and so she like picked it up and kind of
Speaker 2: tried to fling it out the window and it bit
Speaker 2: her on the way out, but she didn't think anything
Speaker 2: of it. She didn't end up going to see a
Speaker 2: medical professional to get the rabies vaccine or anything. And
Speaker 2: like weeks later she started like going down the tube.
Speaker 3: You know, all of your stories here, which aren't very dramatic,
Speaker 3: are also substantiating a lot of mythology. You got like
Speaker 3: bats in bedrooms, now you've got bats in belfrieze. Maybe
Speaker 3: these cartoons were accurate. I don't know, maybe, So what
Speaker 3: happened to this girl?
Speaker 2: Yeah, so, so she started showing a bunch of symptoms
Speaker 2: and the doctors just like could not figure out what
Speaker 2: was happening. And her mom at one point, like, you know,
Speaker 2: she was having a chat with the pediatrician and her
Speaker 2: mom thought to mention, like, maybe it was that bat.
Speaker 2: There was there was a bat that bit her, And
Speaker 2: I guess the pediatrician like just went pale when the
Speaker 2: mom said something about like, oh, there was the bat
Speaker 2: that bit her, And the pediatrician was like, ah, I'll
Speaker 2: be right back and made a phone call and it
Speaker 2: was confirmed pretty soon after that it was rabies, and
Speaker 2: I know, and so they talked to this other doctor
Speaker 2: and I listened to an interview with the doctor and
Speaker 2: the doctor was like, okay. So while we were waiting
Speaker 2: for the results, I started going through a bunch of
Speaker 2: case reports for rabies, and there were a bunch of
Speaker 2: folks who were saying that actually, surprisingly, a bunch of
Speaker 2: brains didn't show evidence of massive inflammation. The brains looked
Speaker 2: pretty good, even in people who were dead. So if
Speaker 2: you do an autopsy, it was kind of amazing how
Speaker 2: good the brain looked. And so there were some folks
Speaker 2: who were guessing that actually, what was happening wasn't that
Speaker 2: the virus was like smashing the brain to pieces, like
Speaker 2: you know, I know, the brain gets compared to a
Speaker 2: computer a lot, and that metaphor falls down in a
Speaker 2: lot of ways. But we're going to go with it here.
Speaker 2: We're going to go with the computer and the virus metaphor.
Speaker 2: You know, it's not like the virus is smashing the
Speaker 2: computer with a bat and totally destroying it. It's more
Speaker 2: like the virus is messing up the way the computer
Speaker 2: communicates with the different parts of the computer, and it's
Speaker 2: sort of messing up the way that it, you know,
Speaker 2: runs and so what if you could essentially put somebody
Speaker 2: on life support to get them through a period where
Speaker 2: the immune system has a chance to catch up. Because
Speaker 2: some other autopsies found that there wasn't a lot of
Speaker 2: virus left in the brain, which suggested that the immune
Speaker 2: system was starting to catch up, but it just didn't
Speaker 2: have enough time.
Speaker 3: Oh interesting, if.
Speaker 2: You could get someone through then you know, maybe their
Speaker 2: immune system would catch up and they'd be okay. So
Speaker 2: they ended up putting this girl in a chemical induced
Speaker 2: coma and they put her on life support, so her
Speaker 2: brain didn't have to worry about, you know, breathing or
Speaker 2: you know, making her heartbeat or anything like that. That
Speaker 2: was all done with machines, and amazingly she lived.
Speaker 3: How does going into a coma help the immune system
Speaker 3: catch up? Why does the coma slow down the virus
Speaker 3: but not the immune system.
Speaker 2: As far as I understand it, it's not that it's
Speaker 2: slowing anything down. It's just that the brain no longer
Speaker 2: has to worry about keeping the girl alive. That's all
Speaker 2: being done by a machine. And so even if the
Speaker 2: brain is no longer like communicating like it's supposed to,
Speaker 2: that's okay. Machines are taking care of all of that,
Speaker 2: so the immune system can just have the time that
Speaker 2: it needs to catch up. Oh, I see, the machines
Speaker 2: are playing the role of the brain until the brain
Speaker 2: is cleared of the virus, and without the virus, the
Speaker 2: brain will start acting normal again. And I guess his
Speaker 2: biggest fear was that she might end up with like
Speaker 2: locked in syndrome, where she would sort of never quite
Speaker 2: be the same again, or never be able to communicate again,
Speaker 2: but she'd still be kind of locked inside of there.
Speaker 2: But she ended up making an almost complete recovery.
Speaker 3: Wow.
Speaker 2: And so this was heralded as maybe we finally figured
Speaker 2: out a way to save people from rabies. And this
Speaker 2: made the news and was absolutely huge. But in the
Speaker 2: approximately twenty years since.
Speaker 3: Here comes Kelly's wet blanket.
Speaker 2: Yeah, I know, of course, right, how could it be
Speaker 2: any other way? Loads of attempts have been made using
Speaker 2: this protocol, and now you see papers called things like
Speaker 2: the demise of the Milwaukee protocol because it doesn't seem
Speaker 2: to work in most cases. And it looks like the
Speaker 2: girl for which this worked, her immune system had started
Speaker 2: making some antibodies to rabies pretty early on. And we're
Speaker 2: not quite sure why. It looks like maybe there's some
Speaker 2: variability some people. I don't know, maybe she got exposed
Speaker 2: to something Raybi's ish early in her life, Like there's
Speaker 2: some subset of people who just seemed to be able
Speaker 2: to mount a quick response, and maybe she just was
Speaker 2: one of those people, and putting her on life support
Speaker 2: might have given her a little bit of an edge.
Speaker 2: But it looks like it just doesn't help the majority
Speaker 2: of people. And so it's possible that this protocol takes
Speaker 2: the probability of death one symptoms for Raby's start and
Speaker 2: brings it from one hundred percent to like ninety nine
Speaker 2: point five percent. And I guess I'll be honest, if
Speaker 2: if my kids got rabies and they were like, what
Speaker 2: do you think about going to extraordinary measures to increase
Speaker 2: their probability by point five percent, I'd be like, yess
Speaker 2: that button, Yeah, yeah, I don't have to think about that.
Speaker 1: Let's do it.
Speaker 2: But you know the problem is, you know this is
Speaker 2: going to come up like maybe ten times a year
Speaker 2: in the United States, and for those families, no doubt,
Speaker 2: you know that would be important to have some options.
Speaker 2: But in areas, you know, the areas where you're getting
Speaker 2: those sixty thousand cases of raby's death. It's not really
Speaker 2: feasible to do these kind of procedures. It's not even
Speaker 2: feasible in a lot of cases to have vaccine.
Speaker 1: Available for these people.
Speaker 2: And so, you know, I think if if in general
Speaker 2: we're worried about trying to reduce the number of people
Speaker 2: who die globally from this disease, what we want to
Speaker 2: be focusing on is getting vaccines, you know, affordable and
Speaker 2: distributed throughout the world. So there's some people still working
Speaker 2: on tinkering with this protocol. Hopefully this can be used
Speaker 2: to bring the numbers of rabies deaths to zero, but
Speaker 2: there's a lot of people who don't believe in this
Speaker 2: technique anymore. And Kelly has wet blanketed her way through
Speaker 2: segment two, and it is time for a break, and
Speaker 2: when we come back, we'll talk about the history of
Speaker 2: the rabies vaccine.
Speaker 3: All right, we're back and we're talking about Raebi's today, Kelly,
Speaker 3: we ended the last segment with a little bit of
Speaker 3: a wet blanket about the prospects for surviving rabies. So
Speaker 3: let's make everybody feel good by talking about another glorious
Speaker 3: story of vac development, science in action, saving lives. How
Speaker 3: did this all happen? When did we get started trying
Speaker 3: to make a vaccine against rape's?
Speaker 1: Okay, yay, science all right.
Speaker 2: So around the early eighteen hundreds, we started to figure
Speaker 2: out that saliva was important for transmitting the virus from
Speaker 2: organism to organism, and that was important because that meant
Speaker 2: we could start keeping this virus in labs and in
Speaker 2: lab animals. And if you are not comfortable with animal research,
Speaker 2: you might want to skip the last part of this episode.
Speaker 2: So Louis Pastor starts working in his lab in the
Speaker 2: eighteen eighties and they decide that they're going to tackle
Speaker 2: a rabies vaccine. They had already developed two different vaccines.
Speaker 2: One was for foul cholera. I didn't realize that chickens
Speaker 2: got cholera, but you know, maybe that's because we've got
Speaker 2: a vaccine for it now, and another for anthrax. So
Speaker 2: there were some other vaccines. They had experience with that.
Speaker 2: And at the same time, Emil Roux, do you know
Speaker 2: how to say that, Daniel?
Speaker 3: I think you said that correctly.
Speaker 2: Yes, nice, all right. Emil ru had developed a technique
Speaker 2: for inoculating dogs with rabies.
Speaker 3: You could start with butter and flour all mixed together
Speaker 3: into a thick sauce.
Speaker 1: That was a food joke, of course, a delicious food joke.
Speaker 3: Everything delicious starts with the rue. That's what I learned.
Speaker 2: Yeah, no, I'm not going to go into too many
Speaker 2: details because what it involved was much less appetizing than that.
Speaker 2: But but he found a way to keep a series
Speaker 2: of animals with rabies in the lab and a technique
Speaker 2: for starting to dry out the virus. As you noted earlier,
Speaker 2: if the virus dries out, it sort of stops being
Speaker 2: able to infect people. And actually, we had a series
Speaker 2: of really great questions from the Extraordinaries where they sent
Speaker 2: us emails and they're like, well, in the polio episode,
Speaker 2: you were saying that there was a live virus version
Speaker 2: and a dead virus version, but then in another episode
Speaker 2: you told us that viruses aren't even alive. So what
Speaker 2: do you mean by that?
Speaker 3: Good question?
Speaker 2: Yes, such a fantastic question got me to rethink, you know,
Speaker 2: the way I was explaining it, in the way it
Speaker 2: gets explained in like the you know, literature in general.
Speaker 2: So I think essentially what it means is like viruses
Speaker 2: are able to infect you, but if you mess them
Speaker 2: up a little bit, they lose some function that allows
Speaker 2: them to infect you. And one way that you can
Speaker 2: mess up the rabies virus is by drying it out.
Speaker 2: And whether we understand what's happened to the virus or not,
Speaker 2: once you've dried it out a little bit, something that
Speaker 2: it was able to do before it now can't do.
Speaker 2: So it can't complete the process of getting into one
Speaker 2: of your cells, forcing your cells to make copies of it,
Speaker 2: and then getting out of the cell so that it
Speaker 2: can go and infect additional cells. Something about that no
Speaker 2: longer works when it gets dried out. But the virus
Speaker 2: still looks virus enough, like enough of it is still
Speaker 2: sort of like present to be recognizable by your immune system,
Speaker 2: so your immune system can produce antibodies so that the
Speaker 2: next time it sees it it can attack it. Does
Speaker 2: that make sense, Yeah, that makes sense?
Speaker 1: Okay.
Speaker 2: So emil Rue had figured out how you can keep
Speaker 2: animals in the lab with rabies and how you can
Speaker 2: start drying out parts of these animals after you euthanize them.
Speaker 2: They call it attenuating the virus, so essentially start making
Speaker 2: it so that the virus can't infect people as well anymore.
Speaker 2: And I mentioned this just because Pasteur often seems to
Speaker 2: get credit for like coming up with the rabies vaccine,
Speaker 2: as though nobody had done any prior work at all.
Speaker 2: But just like just about all scientific advances, he was
Speaker 2: building on the work that other people were doing at
Speaker 2: the time. Okay, So Pastor gets to work and he
Speaker 2: starts working in rabbits, because working with rabbid dogs is
Speaker 2: probably absolutely petrifying, and working with rabid rabbits is probably
Speaker 2: much less petrifying. And so he creates a series of
Speaker 2: rabbits that have rabies. He works on the system where
Speaker 2: essentially he takes out the rabbit's nervous systems. He drives
Speaker 2: them out for different lengths of time, and now he
Speaker 2: essentially has virus that has been inactivated because he has
Speaker 2: the nervous system cells that the rabbit had and he
Speaker 2: has dried them out to kill the virus.
Speaker 3: And how does a rabbit rabbit react? I mean, anybody
Speaker 3: who has seen monty python, for example, knows.
Speaker 1: To be terrifed.
Speaker 2: Right then they can jump at your neck and they
Speaker 2: know where the jugular.
Speaker 3: Is, and you're like, oh, is that also medically accurate.
Speaker 2: Yeah, probably, Yeah. And you know the way the night
Speaker 2: was able to survive with like no limbs. Yeah, that's
Speaker 2: what pastor looks like.
Speaker 1: When the experiments were done, I.
Speaker 3: Would love to have been a science consultant for the
Speaker 3: Monty python.
Speaker 1: Oh my gosh, me too, Me too.
Speaker 2: I read a variety of different sources, and I did
Speaker 2: not find descriptions of how the rabbits were behaving. I
Speaker 2: think they were much less interested in rabbit behavior and
Speaker 2: much more interested in just accessing something they could use
Speaker 2: for a vaccine. Sure, and so they actually were able
Speaker 2: to show that if you gave a dog some of
Speaker 2: this material from the rabbits that had been dried out,
Speaker 2: and then you exposed the dog to rabies, a dog
Speaker 2: would not get rabies. And so they were like, holy cow,
Speaker 2: this vaccine thing seems to be working. This works in dogs,
Speaker 2: but they were not ready to start testing it in people.
Speaker 2: In June of eighteen eighty five, a child who was
Speaker 2: already starting to show signs of rabies, which we've already
Speaker 2: said it's too late at that point, was brought in.
Speaker 2: They tried to give her the vaccine she passed away.
Speaker 2: That didn't work. That wasn't a great sign, but they
Speaker 2: kept doing the work. And then a little bit later,
Speaker 2: in eighteen eighty five, a boy named Joseph Meister came in.
Speaker 2: He was a nine year old boy. He was bit
Speaker 2: by a rabid dog a bunch of times, like more
Speaker 2: than ten times. This kid had initially been brought to
Speaker 2: Emil ru who we talked about a little bit earlier,
Speaker 2: and Emil was like, I do not feel comfortable giving
Speaker 2: this kiddo the vaccine. He wasn't one hundred percent clear
Speaker 2: about his reasons, but based on what he wrote in
Speaker 2: other places, we think that it's because he was like, look,
Speaker 2: I've tested it in dogs. My vaccine seems pretty good
Speaker 2: in dogs, but I just don't feel comfortable giving it
Speaker 2: to people yet it could be way too dangerous.
Speaker 3: Yeah, that's a terrifying decision.
Speaker 2: They have to make, yes, absolutely right, because you know,
Speaker 2: if this kid was actually bitten by a rabbit dog,
Speaker 2: you might be the only one who can save his life.
Speaker 2: But if he was just bitten by some dog that's
Speaker 2: a jerk, you might kill him with your vaccine. And
Speaker 2: so he passed, but Pastor's lab decided to go for it.
Speaker 2: Pasteor was a chemist so he couldn't do the injection.
Speaker 2: But his colleague Jacques Joseph Grancher, why couldn't it just
Speaker 2: be people with boring English names that make scientific advances.
Speaker 2: I don't know, but my apologies to the French speaking world. Anyway,
Speaker 2: he administered the rabies vaccine they had been working on,
Speaker 2: and then he gave this kid twelve additional doses that
Speaker 2: had a vaccine that had been dried for less and
Speaker 2: less time, so essentially he gave him stronger and stronger
Speaker 2: versions of the virus each time, and this kid survived.
Speaker 2: He's the first person we know of to survive being
Speaker 2: exposed to rabies get a vaccine and now he lives,
Speaker 2: which is amazing. And then they pulled this trick off
Speaker 2: again a little bit later with a kid who was
Speaker 2: a shepherd. Around this point, they also had the first
Speaker 2: what we call prophylactic vaccine, which is where you get
Speaker 2: a vaccine before you get exposed. And this was essentially
Speaker 2: because while they were administering the vaccine, somebody accidentally injected
Speaker 2: themselves with the vaccine and they were like, well, now
Speaker 2: we're going to see how that goes.
Speaker 3: I guess now we know about that experiment.
Speaker 2: That's right, But that turned out okay, And so that
Speaker 2: was the start of our vaccine procedure with rabies. And
Speaker 2: then a bunch of labs around the world, you know,
Speaker 2: came to see how this worked, and they started growing
Speaker 2: you know, rabbits in their labs and trying this procedure,
Speaker 2: and then the rabies vaccine. You know, a bunch of
Speaker 2: different labs popped up around the world that produced these
Speaker 2: rabies vaccines and that's how it started.
Speaker 3: My favorite thing is when science can develop a treatment
Speaker 3: that helps save children's lives. You know, like how many
Speaker 3: children were bitten by dogs or scratched by dogs and
Speaker 3: then died a horrible, painful, excruciating death of rabies. Like
Speaker 3: anytime when we can reduce childhood suffering, ya, science, Yes, And.
Speaker 2: That's part of like why this story also makes me
Speaker 2: so upset because there are children dying around the world.
Speaker 1: In the tens of thousands.
Speaker 2: Yeah that shouldn't be because science has the solution, but
Speaker 2: we haven't found a way to get them access to it.
Speaker 3: It's a political or financial or an engineering issue.
Speaker 2: Yeah, right, and that stinks when science has the answer
Speaker 2: and it's it's not getting to them. So let's let's
Speaker 2: go ahead and talk real quick about what happens today.
Speaker 1: We talked about.
Speaker 2: How if you have a job where you know you're
Speaker 2: going to get exposed regularly to animals that might have rabies,
Speaker 2: you can get the vaccine ahead of time. So the
Speaker 2: vaccine is grown up in cell cultures, so you don't
Speaker 2: need like whole humans. We just have figured out how
Speaker 2: to keep some subset of human cells alive in like
Speaker 2: a petri dish or some you know, chicken embryos alive.
Speaker 2: We grow up the virus in there, we extract the virus,
Speaker 2: we kill it, and then you get that vaccine. That's
Speaker 2: star it's giving you some immunity. Then if you subsequently
Speaker 2: get exposed to rabies, you'll get some boosters.
Speaker 3: Wait, I just realized I didn't understand something basic. When
Speaker 3: my dog gets a rabies vaccine, it's not the same
Speaker 3: vaccine as I get. Is it. Is there a human
Speaker 3: in a dog version or is it the same thing.
Speaker 2: I did not do extra research on the dog version.
Speaker 2: I do know that there's a couple different versions of vaccines.
Speaker 2: So for example, sometimes if there's a lot of rabies
Speaker 2: in a wild population, they will put some vaccines in
Speaker 2: food and essentially drop the food from planes and like
Speaker 2: feed coyotes. And that is a totally different version than
Speaker 2: what humans get because it's way less regulated. And so
Speaker 2: I know that depending on what animal the vaccine is getting,
Speaker 2: there's different regulations, and so they can give different kinds
Speaker 2: of vaccines.
Speaker 3: But the same principle should apply, right, that if you
Speaker 3: have this weekend vaccine, it should help a dog's immune
Speaker 3: system or a human's immune system, even if those immune
Speaker 3: systems and the biology are different.
Speaker 2: Yeah, I mean they might grow it up in dog
Speaker 2: cell cultures rather than human cell culture so that you
Speaker 2: don't get like a orgic reactions or something, but probably
Speaker 2: the idea is pretty similar. But again I want to reiterate,
Speaker 2: I didn't actually research how those vaccines are made. I
Speaker 2: was focusing on human stuff for this episode. Okay, so
Speaker 2: if you're a veterinarian, you got your vaccines ahead of time,
Speaker 2: then you get bit by a rabid cat, you'll get
Speaker 2: a couple extra vaccines after you know you've gotten bitten,
Speaker 2: just to boost your immune system. And that is almost
Speaker 2: one hundred percent effective, and you are very unlikely to
Speaker 2: die from rabies in that situation, which is absolutely amazing
Speaker 2: ya science. Okay, if you have never gotten a rabies
Speaker 2: vaccine before, we do something a little bit different, and
Speaker 2: this is pretty awesome, I think. So we have something
Speaker 2: called rabies immune globulin. So essentially what they do is
Speaker 2: they immunize either people or horses with the rabies vaccine
Speaker 2: and then they draw blood and they extract the plasma.
Speaker 2: We've talked about plasma before when we were talking about
Speaker 2: making synthetic blood and stuff. In the plasma, you have antibodies.
Speaker 2: We've talked about antibodies they bind to something on in
Speaker 2: this case, the rabies virus and they inactivate it. For example,
Speaker 2: maybe they make it so that the virus can no
Speaker 2: longer bind to a muscle sell and get into it,
Speaker 2: and so they essentially make it so that the virus
Speaker 2: can't do what it needs to do to replicate. They
Speaker 2: neutralize it in some way, and so they take out
Speaker 2: the antibodies that the human or horse immune system made
Speaker 2: and then they inject that into you near the bite site.
Speaker 2: So essentially you outsourced the initial immune response from some
Speaker 2: other organism and that gives you a head start. So
Speaker 2: while your immune system is responding to the vaccine and
Speaker 2: is trying to make its own response to rabies. You're
Speaker 2: borrowing someone else's immune response to give you a head start.
Speaker 2: You know, maybe that will do the trick. Maybe that
Speaker 2: will bind to all of the viruses that are trying
Speaker 2: to get into muscles initially, and then just in case,
Speaker 2: you know, your body will start making your own antibodies
Speaker 2: and you'll get a series of I think it's something
Speaker 2: like three vaccines. It used to be you'd get a
Speaker 2: bunch of vaccines in like your abdominal region. And I
Speaker 2: think there's a little bit of folklore where people used
Speaker 2: to think it was like twenty vaccines that all had
Speaker 2: to go through your abdominal wall into your stomach, and
Speaker 2: it was super painful, And it wasn't like that.
Speaker 1: Like it was painful.
Speaker 2: It was like in your sort of tummy region, but
Speaker 2: it didn't need to go like into your stomach through
Speaker 2: your abdominal wall. But now it is way less uncomfortable.
Speaker 2: It's like two or three shots usually in like the
Speaker 2: muscle in your arm. We also have like a version
Speaker 2: that goes just like right under your skin. Now way
Speaker 2: less painful. Yes, the next day you probably feel pretty sore,
Speaker 2: especially after the third shot, but you're probably not gonna
Speaker 2: die of radiance.
Speaker 1: So yay, definitely worth.
Speaker 2: It, Definitely worth it. Yeah, So those are our treatments.
Speaker 2: But so in the United States, about one hundred thousand
Speaker 2: people need to get those series of shots after they
Speaker 2: get exposed to an animal that might be rabin. But
Speaker 2: the main thing that we do that protects us is
Speaker 2: we have this system where each state has a series
Speaker 2: of laws where you have to vaccinate your dogs and
Speaker 2: your cats. And that's the main thing that protects us
Speaker 2: because globally, most of the people who get bit are
Speaker 2: getting bit.
Speaker 3: By dogs, not by bats in their bedroom.
Speaker 2: Not by bats in their bedroom. Yeah, dogs are a
Speaker 2: much bigger risk. And so if we could just have
Speaker 2: similar programs where everybody had to vaccinate their dogs. And
Speaker 2: maybe there's some cultural problems, cultural difficulties, hurdles to get across,
Speaker 2: but I think a lot of it is like having
Speaker 2: the infrastructure, the ability to get the vaccines there, the
Speaker 2: ability to make sure that you've got records so that
Speaker 2: you're giving the vaccines every single year. But if you
Speaker 2: could get that stuff in place, we could have a
Speaker 2: lot fewer deaths and the few times that people do
Speaker 2: get bit by rabbit animals. If you could have the
Speaker 2: human vaccines available, we wouldn't have to have about sixty
Speaker 2: thousand people every year dying from this horrible disease.
Speaker 3: Yeah, let's hope that the folks in charge of that
Speaker 3: figure it out.
Speaker 2: Yeah, I hope. So so should we end? For anybody
Speaker 2: who I know we've discussed statistics isn't how we live
Speaker 2: our lives. But do we want to end on a
Speaker 2: couple notes about how to try to prevent rabies in
Speaker 2: your life?
Speaker 3: Yeah? Okay, exactly other than vaccinateing in your pets and
Speaker 3: closing the windows in your bedroom, what should you do
Speaker 3: to avoid rabies?
Speaker 7: All right?
Speaker 2: Well, so I'll note this was a little bit surprising.
Speaker 2: You're supposed to vaccinate your cats and dogs, also your ferrets.
Speaker 2: I get there are some places that have rules about
Speaker 2: vaccinating ferrets. You can also vaccinate things like horses. My
Speaker 2: recommendation anything you can vaccinate, vaccinate. Keep your pets from
Speaker 2: interacting with wild animals, so you know, maybe don't just
Speaker 2: let your animals run wild. I am mostly talking to me.
Speaker 2: I live on a farm. Sometimes I just let my
Speaker 2: dog out and I'm like, oh, I have fun, see
Speaker 2: you in a few hours. Maybe I should be more
Speaker 2: careful about that. Report stray animals to local authorities. You
Speaker 2: shouldn't touch wild animals, like if you see a skunk
Speaker 2: that looks sick, call animal control or something. Don't touch
Speaker 2: them on your own. That poor animal could be rabid.
Speaker 2: They could give it to you. Keep bats out of
Speaker 2: your house. Make sure you have like screens on your
Speaker 2: windows if possible. If you are going to do a
Speaker 2: high risk activity like splunking in a cave that has
Speaker 2: a lot of bats, consider trying to get the vaccine preventively.
Speaker 2: You can talk to your doctor and if you think
Speaker 2: you've been exposed to the rabies.
Speaker 1: Virus, wash the area thoroughly.
Speaker 2: And then immediately go seek medical attention. And if you
Speaker 2: are ever unsure, call a doctor or go see a doctor.
Speaker 2: For me, I think I'm supposed to call my local
Speaker 2: poison control center for advice, but like call nine one one,
Speaker 2: figure out who you have to talk to. Don't worry about,
Speaker 2: you know, looking silly or something. This is a serious disease.
Speaker 2: Don't mess around, that's right.
Speaker 3: Don't worry about finishing this podcast before you call your doctor.
Speaker 3: Pause it right now and call your doctor.
Speaker 1: Yes, right, And Kelly is not a medical doctor.
Speaker 2: Kelly is not the kind of doctor that most people
Speaker 2: recognize as being a doctor. When they ask is there're
Speaker 2: a doctor on the plane, they don't mean me, So
Speaker 2: don't take medical advice from me.
Speaker 1: Talk to a medical doctor.
Speaker 3: Thank you Kelly for that tour of the history of rabies,
Speaker 3: and thank you Gurjeet for sending us curious question. If
Speaker 3: there are things you want to hear a deep dive about,
Speaker 3: please don't hesitate to write to us. We want to
Speaker 3: hear from you. Questions at Danielankelly dot org.
Speaker 1: Thanks everyone, have a good day, avoid skunks.
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