Understanding the Incurable: Investigating Rabies and the Science Behind Its Evolving Therapies
- ACS BCP
- 6 days ago
- 5 min read
Introduction-
A recent case of 28th June 2025 in India of a 22-year-old State gold
medallist kabaddi player Brijesh Solanki who wasn’t vaccinated after a
Dog bite, passed away due to Acute Neurological Stage of Rabies. On
11th August 2025, the Delhi Supreme Court issued a mandate of
capturing and relocation of stray dogs from Delhi-NCR Streets to
shelters due to increasing number of dog bite cases with fatal
consequences due to rabies, later on similar actions were taken by the
Rajasthan and Madras High Court.
So, the question arises why to mandate these orders strictly and why is there a major concern
regarding rabies?
Well, Rabies in India is Significant public health concern and it remains a
serious issue with a fatality rate of 99.9%. India estimates suggesting
18,000-20,000 deaths annually, representing 36% 0f global fatalities
according to World Health Organization (WHO), we found that Dogs are
the main source of Rabies Transmission to Humans, accounting to 99%
of deaths. However, rabies is 100% preventable if individuals receive
appropriate Post-exposure prophylaxis (PEP) can prevent onset of
symptoms (e.g. Fever, Hydrophobia, Aerophobia) and subsequent
death. But then what if the symptoms start to appear? This is one of the
questions we’ve always meant to look up again, having previously not
found a good answer, but after thorough research on Articles, Research
papers published, investigating some rare cases and therapies we found
some of them demonstrating positive Results.
Possible Treatments and Therapies-
As we discussed Earlier to prevent development of Rabies virus a series
of treatments (PEP- Post Exposure Prophylaxis) given to a person after
potential exposure to the virus. PEP is a three-pronged approach which
include Management of animal bite wound, Passive immunization with
Rabies Immunoglobulin (RIG) and Active immunization with anti-rabies
vaccines (Rabies vaccine). The World Health Organization outlines three
categories of animal exposure and the corresponding post-exposure
prophylaxis (PEP) recommendations. “Category I” involves minimal
contact such as touching or feeding animals, licks on intact skin, or
contact of intact skin with secretions from a rabid animal; no PEP is
needed if the history is reliable, but the area should be washed with
soap and water for 15 minutes and antiseptic applied. “Category II”
includes nibbling of uncovered skin or minor scratches/abrasions without
bleeding; management involves thorough wound washing and
administration of rabies vaccine. “Category III” covers severe
exposures such as single or multiple transdermal bites or scratches,
licks on broken skin, or saliva contact with mucous membranes;
treatment requires wound washing, rabies vaccine, and rabies
immunoglobulin. also the bites from wild animals or any bites in forest
areas should always be treated as Category III exposures. Efforts are
ongoing globally to improve access to timely and appropriate PEP,
particularly in rabies-endemic regions.
Figure 1:- Animal scratch
Figure 2:-Animal Bite
Figure 3- Three categories of animal exposure
We also found an article by Alan C Jackson on Milwaukee Protocol for
Rabies which discusses various cases of Rabies survivors who followed
this protocol, it is a therapy that included therapeutic induced coma with
benzodiazepines (midazolam) and barbiturates to achieve a burst
suppression pattern on the electroencephalogram, ketamine, and
antiviral therapy with ribavirin and amantadine. This therapeutic
approach has been dubbed the “Milwaukee protocol” and has been
relentlessly promoted by its main proponent for about 20 years despite
accumulating evidence of its lack of efficacy. This protocol included,
therapeutic induced coma with administration of continuous intravenous
anesthetic drugs, which is a generally accepted therapy for the treatment
of refractory status epilepticus. This therapy works by terminating the
firing of synchronous bursts of neurons that occur in epileptic seizure
activity. The initial goal of therapy is to maintain electrographic seizure
cessation for a minimum of 24 to 48 hours. In 2018 it is claimed to have
Figure 3:- Three categories of animal exposure
18 survivors of human rabies with the Milwaukee protocol, but there are
no high-quality reports of survivors beyond the index case in Milwaukee.
Another approach is using a novel monoclonal antibody cocktail for
rabies post-exposure prophylaxis, TwinRabTM which is a cocktail of two
human monoclonal antibodies. Miromavimab which is a IgG1 antibody
targeting antigenic site II of rabies virus glycoprotein (RABV G). and
Docaravimab a IgG2b antibody targeting antigenic site III of RABV G.
which is reported to be Created in collaboration with WHO and
authorized in India in 2019 then added to WHO Essential Medicines List
in 2021. which neutralizes rabies virus by binding to two distinct
antigenic sites, offering broad-spectrum coverage against multiple
rabies-related viruses.
We found a case of a 13-year-old boy from India who sustained an
unprovoked street dog bite on his right hand on August 26, 2014. Ten
days later, he developed headache and fever, followed by vomiting and
drowsiness. On day 35 post-bite, he was admitted with altered
consciousness, He was managed in the ICU with ventilator support,
antibiotics, seizure control, autonomic storm management,
tracheostomy, and physiotherapy. His course was complicated by
pneumonia, recurrent seizures, and prolonged coma. After eight weeks,
he was weaned off the ventilator, and over the next two months, he
regained partial motor function and responsiveness. Following five
months of hospitalization, he was discharged with neurological
sequelae, and follow-up MRIs showed reduced hyperintensities but
marked cortical atrophy. Two months post-discharge, he could make
meaningful eye contact and follow single-step commands. As of 2025,
fewer than 35 human rabies survivors have been reported worldwide,
the reporting of more survivors in recent years may be partly due to
better critical care facilities and increased awareness in rabies. Out of 35
human survivors only 2 recovered without neurological damage. The
majority survived with mild to severe neurological issues. While not a
cure, high level supportive care in an intensive care setting is considered
the main reason patients survive the acute phase of the illness.
Conclusion-
Our key takeaway from all this is that, Rabies has long stood as a
symbol of medical helplessness a disease with near-certain fatality once
symptoms emerge. Yet, as we dive deep into the layers of its research,
rare survivor cases, and evolving therapeutic strategies, a glimmer of
hope begins to shine. The tragedy of Brijesh Solanki is not just a
heartbreaking loss, it is a call for systemic change, scientific urgency,
and public awareness.
While the Milwaukee Protocol remains controversial and monoclonal
antibody therapies like TwinRabTM are still in their infancy, but they have
the potential to represent the growing edge of innovation in rabies care.
These developments when coupled with improved critical care
infrastructure and global collaboration it suggests that the narrative of
rabies is no longer one of incurable, but of a possibility. India, bearing
the weight of the world’s highest rabies burden, stands at a crossroads.
Prevention still remains our strongest weapon, but research and
resilience will one day surely offer a cure.
References-
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