Rabies

24:12Also called atopic dermatitis that is not well controlled with prescription therapies used on the skin or topicals or who cannot use topical therapies. EBCLIS can be used with or without topical corticosteroids. Don't use if you're allergic to EBCLIS. Allergic reactions can occur that can be severe. Eye problems can occur. Tell your doctor if you have new or worsening eye problems. You should not receive a live vaccine when treated with EBCLIS. Before starting EBCLIS, tell your doctor if you have a parasitic infection. Ask your doctor about EBCLIS and visit EBCLIS.lily.com or call 1-800-LILY-RX or 1-800-545-5979.

24:41Every business has an ambition. PayPal Open is the platform designed to help you grow into yours. with access to business loans so you can expand and hundreds of millions of PayPal customers worldwide. Your customers can pay all the ways they want today with PayPal, Venmo, Pay Later, and all major cards so you can focus on the future. When you need a partner trusted by millions, there's one platform for all business. PayPal Open. Grow today at paypalopen.com. Loan subject to approval in available locations. This is Jana Kramer from Wind Down with Jana Kramer. Hey, quick question for the parents listening right now.

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26:42Okay, we're back and we are taking a bite out of rabies today, furiously understanding the nature of this disease. So tell us, Kelly, how does one get exposed to rabies? What do we have to watch out for? Spelunkers and potholers alike. Well, the most common way, let's start with the most common way that you get exposed to rabies, and that's through bites and scratches from rabbit animals. And in the United States, the most common way you're going to get exposed to a bite or a scratch from a rabid animal is by interacting with a bat. And so if you are in the sort of unlucky situation where a bat accidentally ends up in your house and that bat bites you when it's trying to get out or you wake up in the middle of the night and there's a bat in your room.

27:26What? Kelly, you can't just drop that. That has happened to me. What? I know. I know. I didn't know at the time, but you might in those situations might want to call a medical professional to be like, I found a bat in my room. I was listening to a podcast of people who are studying for their medical boards. And they noted that in that instance, you're supposed to give people vaccines for rabies because you can't be sure they didn't get bitten while they were sleeping. And I was like, oh, man, I didn't call anyone when that happened. I just like opened the window and shooed the bat out. But anyway, I'm still here.

28:00So that's good news. Does the fact that that happened, is that the origin of like vampire myths? Like vampires fly in on the wings of a bat, bite you and then fly out again? Could be. But there are also like vampire bats that actually suck human blood when they have trouble getting access to other mammals. Oh, boy. I'm guessing that. So you could wake up in the middle of the night with a bat on your face or what else? But we hope not. But you could also – so if that animal bites you, its saliva gets into your body, and that's one way that the rabies virus can get into you. Also, if an animal scratches you, maybe they licked their hand and then they scratch you and that gets the virus in your body.

28:39Bats, skunks, raccoons, and foxes, which we talked about already in the United States, those are animals that are most frequently found to have rabies. That doesn't mean that most of those animals in the wild have rabies. But in the United States, the animals that are most likely to have rabies are those four kinds of animals. And is rabies a kind of virus that doesn't last very long in saliva outside the body? Like if a bat spits on a rock and then you lick that rock like a week later, are you OK? Or is that rock like dangerous forever? Yeah, right. That is a question only Daniel would ask. And that is and you would probably be fine.

29:14And I'm under the impression that that is why I was told I didn't need to get a rabies vaccine when I picked up that dead bat. I think they were like, that's probably been long dead. You're probably fine. Fascinating. It's amazing to me when viruses are so fragile and yet so able to spread anyway. It's incredible. It is. It is. And I just want to really highlight here. I am not a medical doctor. So if you're like, oh, Kelly said that that bat had been dead for a while that she touched. So I don't need to call the doctor. Always call the doctor if you have any question about rabies. If you've been exposed to anything that puts you at risk of rabies, call your doctor.

29:48And I don't suggest licking any rocks. I'm also not a medical professional. Yeah, yeah. No, actually, you should probably never do anything Daniel suggests. It's just a bad idea. I keep telling my kids that also. Yeah, yeah. Well, so if you live in Africa and Asia, you're most likely to get rabies from dog bites. People encounter dogs a lot. There's in a lot of countries, there's not good programs to regularly vaccinate dogs. And unfortunately, the majority of the bites happen to children who just want to pet a dog and then they get bit. I know. And so, yeah, so saliva from rabbit animals is the most common way.

30:19Now, it's worth noting that livestock animals like horses can also get rabies. And so you want to be careful and vaccinate as many animals as you're able to. Very rarely, the virus can be aerosolized for short periods of time. And so that's why, you know, if you're spelunking or potholing in a cave and there's a bunch of bats and there's not a lot of sunlight in there. So sunlight is something that kills the rabies virus pretty quickly. You might be able to breathe in some of the rabies virus. And that is why sometimes spelunkers will get vaccinated. Or if they're going into an area with a lot of bats and they're worried they're going to get bit, then they'll get vaccinated as well.

30:57And a very rare way that does sometimes result in rabies is organ transplants if it was missed that a donor had rabies and then you can transmit it that way. Again, very rare. We talked about that in the opening. So there's no way to get rabies by like listening to a podcast about rabies. Our listeners are safe. That's right. That's right. And, you know, I actually I feel like the more you learn about this kind of stuff, like, yes, it's scary initially. But once you understand how it's transmitted, you can say, OK, I know what I need to worry about. and then I know when I need to call a medical professional.

31:29Yes, I still worry because I am me, but I feel like the scope of my worrying has narrowed a little bit because now I understand when I need to worry and why I need to worry. And I feel like that gives me a little bit of control over the situation. Yeah, although statistics doesn't help anxiety. I mean, you can look at the numbers and be like, well, on average, that's pretty rare. It doesn't happen to very many people, these terrible scenarios, et cetera, et cetera. On the other hand, you're like, yeah, but there are 10 people out there who do die of rabies every year. And those are real people who also look to the numbers and they're like, yeah, I'll probably be fine.

32:01So there's sort of two ways to look at it, you know, from a public health perspective on average. And then also from the like, am I that one outlier case perspective, which is the one I always use as a warrior. Yeah. Okay. I do see your point. But like, so in the intro, we talked about a guy who got scratched by a skunk and bled. Presumably what he thought was, it's just a scratch. I probably didn't get bit. And I think this skunk was just trying to eat the kitten and wasn't actually rabid. And so they made some choices that if you knew enough about rabies or if you were enough of a worrier could have caused that person to have made a different decision to at least call the doctor and been like, I don't know, what do you think?

32:40I got scratched by a skunk that was angry and was willing to approach me to try to eat a kitten. What would you do? I suspect that doctor would have said, we're going to go ahead and give you some shots because rabies is 100 % fatal. So let's not take any risks. Yeah. Although if you are a worrier and you want to be informed by statistics, as you just suggested, then you would be shocked at like how dangerous it is to drive anywhere. And you should probably just never get in a car and how dangerous household accidents are. So you shouldn't, for example, try to do your kitchen by yourself. But we don't want Kelly to become a shut-in.

33:12So we're going to talk about what happens once the virus gets in your body. Daniel, what are you trying to do here? I'm just saying statistics-informed decisions are not the way we live our lives. Yeah, you're right. You're right. But anyway, tell us about the microbiology here. What happens when the virus gets in your body, Kelly? All right. So the virus gets in your body and it gets into your muscle tissue. And what we've talked about how viruses replicate, they essentially hijack the machinery inside your cell. And they tell the cell that it needs to start replicating the virus's genetic material and start making proteins for the virus.

33:45So it essentially, the cell becomes like a little factory that starts making more viruses. And then it spits the viruses out and the viruses go out to infect more cells. So that's generally how viruses work. If this sounds familiar to you, reminiscent of how like computer viruses work, that's not an accident. That's why they call computer viruses viruses, not the other way around. Biological viruses didn't steal this idea from hackers. Yes, and keep that in your head because we're going to come back to that comparison a little bit later. All right. So it starts by getting into like muscle tissue near the site of the bite.

34:16And for reasons we don't totally understand, it has the period where it replicates sort of slowly in those muscle tissues. And thank goodness for that, because that means there's a period where we can sort of get a leg up on the virus. And this is why we're able to give people a vaccine after they get bitten that can still save their life. And this is another part of why we don't need to mass vaccinate everybody because it still works if you just give it to someone afterwards, which doesn't work quite as well with some other things that we vaccinate against. That seems pretty unusual, right? Yeah.

34:48In almost all cases, you have to vaccinate first for it to take effect, right? Yeah, no, we are amazingly lucky that this virus has this period where it like sort of sluggishly replicates in muscles for a while before it starts heading for the nervous system. But eventually it will start finding nervous system cells and it will start following nerves to your spinal cord and then start moving up to your brain. And when it starts getting towards its final location, you are going to start getting symptoms like fever, flu-like stuff, gastrointestinal symptoms. symptoms and sort of eerily, the location that you got bit will start like tingling or having a prickly sensation.

35:29And the reason that's eerie is that this is usually happening about two months after your exposure to the virus. So that site has like long since healed. And now all of a sudden you're starting to feel tingling there again. By the time you start having these symptoms, which again, like take two months for the virus to go from that bite site up to the point where, you know essentially it's too late when you start getting those symptoms there's more or less no way to stop the virus at that point it's in your central nervous system and we don't have good treatments for it at that point rabies enters one of two forms the furious form which is about 80 percent of the cases average survival time for this is about six days symptoms include like you kind of come in and out of consciousness sort of strangely you become very afraid of water so this is called hydrophobia.

36:19There are some videos online that I've got to admit, I don't recommend looking up. I watched them once a couple of years ago and they're just incredibly upsetting to watch. But, you know, someone will try to take a drink of water because they're very thirsty, but they'll start having these like gagging reflexes. And it's like they're really afraid of the water and they kind of can't figure out why. You know, it's like they're, you know, like they've been hijacked, which essentially, you know, their brains have been. They start to hallucinate. And so help me understand what's happening here. This is all due to brain inflammation as the immune system responds to the rabies, or is this something rabies is doing to your brain directly?

36:56Yeah. So one of the interesting things about doing the research for this is that places like the World Health Organization say that there's a bunch of inflammation in the brain and that death occurs due to cardiorespiratory arrest. And, you know, you go into coma and essentially things shut down. But other sources that I read were like, there's surprisingly little inflammation happening in some of these cases. And so we seem a little bit confused. It looks like there's, or maybe not confused, but maybe there's a couple different ways that rabies can lead to death. It seems like there's a couple different competing hypotheses.

37:30It might depend on exactly what rabies is doing. It seems to take a couple different forms, and maybe it depends on what part of the brain the rabies ends up in. And in just a second, we're going to talk about a hypothesis that relies on there not being inflammation in the brain. So hold that thought for just a second. We will circle back to that. There's another form of rabies that happens about 20 % of the time called paralytic, where essentially starting at the scratch or bite site, the muscles start to become essentially paralyzed, and that gradually spreads over the course of the body. And over about 11 days, the person tends to go into a coma, and they die.

38:08This form tends to be misdiagnosed as a bunch of other things, so it might be underreported. But one way or another, a rabies death is really an unpleasant death, and we don't have a really good way of treating people once symptoms start showing. But you may remember around 2004, a long time ago, there was in the news this Milwaukee protocol where a young girl who started showing symptoms of rabies was brought back from rabies. Do you remember hearing about this? No, tell me. Okay. So there was this girl who was at church and there was a bat flying around the church and it like was trying to get out the window, but it couldn't get out the window.

38:47I think somebody hit it with a broom and it kind of fell down and the girl was trying to help. And so she like picked it up and kind of tried to fling it out the window and it bit her on the way out, but she didn't think anything of it. she didn't end up going to see a medical professional to get the rabies vaccine or anything. And like weeks later, she started like going down the tube. You know, all of your stories here, which aren't very dramatic, are also substantiating a lot of mythology. You got like bats in bedrooms. Now you've got bats in Belfries. Maybe these cartoons were accurate. I don't know.

39:18Maybe. So what happened to this girl? Yeah. So, so she started showing a bunch of symptoms and the doctors just like, could not figure out what was happening. And her mom at one point, like, Like, you know, she was having a chat with the pediatrician and her mom thought to mention, like, maybe it was that bat. There was a bat that bit her. And I guess the pediatrician, like, just went pale when the mom said something about, like, oh, there was the bat that bit her. And the pediatrician was like, I'll be right back and made a phone call. And it was confirmed pretty soon after that it was rabies.

39:48Oh, no. And I know. And so they talked to this other doctor and I listened to an interview with the doctor. And the doctor was like, OK, so while we were waiting for the results, I started going through a bunch of case reports for rabies. And there were a bunch of folks who were saying that actually, surprisingly, a bunch of brains didn't show evidence of massive inflammation. The brains looked pretty good, even in people who were dead. So if you do an autopsy, it was kind of amazing how good the brain looked. And so there were some folks who were guessing that actually what was happening wasn't that the virus was like smashing the brain to pieces.

40:22Like, you know, I know the brain gets compared to a computer a lot and that metaphor falls down in a lot of ways, but we're going to go with it here. We're going to go with the computer and the virus metaphor. You know, it's not like the virus is smashing the computer with a bat and totally destroying it. It's more like the virus is messing up the way the computer communicates with the different parts of the computer. and it's sort of messing up the way that it runs. And so what if you could essentially put somebody on life support to get them through a period where the immune system has a chance to catch up?

40:58Because some other autopsies found that there wasn't a lot of virus left in the brain, which suggested that the immune system was starting to catch up, but it just didn't have enough time. Oh, interesting. If you could get someone through, then, you know, maybe their immune system would catch up and they'd be OK. So they ended up putting this girl in a chemical-induced coma and they put her on life support so her brain didn't have to worry about, you know, breathing or, you know, making her a heartbeat or anything like that. That was all done with machines. And amazingly, she lived. How does going into a coma help the immune system catch up?

41:33Why does the coma slow down the virus but not the immune system? As far as I understand it, it's not that it's slowing anything down. It's just that the brain no longer has to worry about keeping the girl alive. That's all being done by a machine. And so even if the brain is no longer like communicating like it's supposed to, that's okay. Machines are taking care of all of that. So the immune system can just have the time that it needs to catch up. The machines are playing the role of the brain until the brain is cleared of the virus. and without the virus, the brain will start acting normal again.

42:07And I guess his biggest fear was that she might end up with like locked-in syndrome where she would sort of never quite be the same again or might never be able to like communicate again, but she'd still be kind of locked in inside of there. But she ended up making an almost complete recovery. Wow. And so this was heralded as maybe we finally figured out a way to save people from rabies. And this made the news and was absolutely huge. But in the approximately 20 years since. Here comes Kelly's wet blanket. Yeah, I know. Of course, right? How could it be any other way? Loads of attempts have been made using this protocol.

42:44And now you see papers called things like the demise of the Milwaukee protocol because it doesn't seem to work in most cases. And it looks like the girl for which this worked, her immune system had started making some antibodies to rabies pretty early on. And we're not quite sure why. It looks like maybe there's some variability. Some people, I don't know, maybe she got exposed to something rabies-ish early in her life. Like there's some subset of people who just seem to be able to mount a quick response. And maybe she just was one of those people and putting her on life support might have given her a little bit of an edge.

43:20but it looks like it just doesn't help the majority of people. And so it's possible that this protocol takes the probability of death once symptoms for rabies start and brings it from 100 % to like 99.5%. And I guess I'll be honest, if my kids got rabies and they were like, what do you think about going to extraordinary measures to increase their probability by 0.5%, I'd be like, yes. Smash that button. Yeah, I don't have to think about that. Let's do it. But, you know, the problem is, you know, this is going to come up like maybe 10 times a year in the United States. And for those families, no doubt, you know, that would be important to have some options.

43:55But in areas, you know, the areas where you're getting those 60 ,000 cases of rabies death, it's not really feasible to do these kinds of procedures. It's not even feasible in a lot of cases to have vaccine available for these people. And so, you know, I think if in general, we're worried about trying to reduce the number of people who die globally from this disease, what we want to be focusing on is getting vaccines, you know, affordable and distributed throughout the world. So there's some people still working on tinkering with this protocol. Hopefully this can be used to bring the numbers of rabies deaths to zero.

44:28But there's a lot of people who don't believe in this technique anymore. And Kelly has wet blanketed her way through segment two. And it is time for a break. And when we come back, we'll talk about the history of the rabies vaccine.

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47:19This product is not intended to diagnose, treat, cure, or prevent any disease.

47:32All right, we're back. And we're talking about rabies today. Kelly, we ended the last segment with a little bit of a wet blanket about the prospects for surviving rabies. So let's make everybody feel good by talking about another glorious story of vaccine development, science in action saving lives. How did this all happen? When did we get started trying to make a vaccine against rabies? Okay, yay science. All right. So around the early 1800s, we started to figure out that saliva was important for transmitting the virus from organism to organism. And that was important because that meant we could start keeping the virus in labs and in lab animals.

48:08And if you are not comfortable with animal research, you might want to skip the last part of this episode. So Louis Pasteur starts working in his lab in the 1880s, and they decide that they're going to tackle a rabies vaccine. They had already developed two different vaccines. One was for fowl cholera. I didn't realize that chickens got cholera, but maybe that's because we've got a vaccine for it now. And another for anthrax. So there were some other vaccines, they had experience with that. And at the same time, Emile Roux, do you know how to say that, Daniel? I think you said that correctly, yeah.

48:43Yes. Nice. All right. Emile Roux had developed a technique for inoculating dogs with rabies. Did it start with butter and flour all mixed together into a thick sauce? That was a food joke, of course. A delicious food joke. Everything delicious starts with the roux. That's what I learned. Yeah. No, I'm not going to go into too many details because what it involved was much less appetizing than that. But he found a way to keep a series of animals with rabies in the lab and a technique for starting to dry out the virus. As you noted earlier, if the virus dries out, it sort of stops being able to infect people.

49:24And actually, we had a series of really great questions from the Extraordinaries where they sent us emails. And they're like, well, in the polio episode, you were saying that there was a live virus version and a dead virus version. But then in another episode, you told us that viruses aren't even alive. So what do you mean by that? Good question. Yeah, such a fantastic question. Got me to rethink, you know, the way I was explaining it and the way it gets explained in like the, you know, literature in general. And so I think essentially what it means is like viruses are able to infect you, but if you mess them up a little bit, they lose some function that allows them to infect you.

50:01And one way that you can mess up the rabies virus is by drying it out. And whether we understand what's happened to the virus or not, once you've dried it out a little bit, something that it was able to do before, it now can't do. So it can't complete the process of getting into one of your cells, forcing your cells to make copies of it, and then getting out of the cell so that it can go and infect additional cells. Something about that no longer works when it gets dried out. But the virus still looks virus enough. Like enough of it is still sort of like present to be recognizable by your immune system.

50:37So your immune system can produce antibodies so that the next time it sees it, it can attack it. Does that make sense? Yeah, that makes sense. Okay, so Emile Roux had figured out how you can keep animals in the lab with rabies and how you can start drying out parts of these animals after you euthanize them. They call it attenuating the virus. So essentially start making it so that the virus can't infect people as well anymore. And I mention this just because Pasteur often seems to get credit for like coming up with the rabies vaccine as though nobody had done any prior work at all. But just like just about all scientific advances, he was building on the work that other people were doing at the time.

51:16Okay, so Pasteur gets to work, and he starts working in rabbits because working with rabid dogs is probably absolutely petrifying. And working with rabid rabbits is probably much less petrifying. And so he creates a series of rabbits that have rabies. He works on this system where essentially he takes out the rabbits' nervous systems. He dries them out for different lengths of time. And now he essentially has virus that has been inactivated because he has the nervous system cells that the rabbit had and he has dried them out to kill the virus. And how does a rabid rabbit react? I mean, anybody who has seen Monty Python, for example, knows to be terrified.

51:58Right, that they can jump at your neck and they know where the jugular is and you're like, ah! Is that also medically accurate? Yeah, probably. Yeah. And, you know, the way the knight was able to survive with like no limbs. Yeah. That's what Pasteur looked like when the experiments were done. I would love to have been a science consultant for Monty Python. Oh, my gosh. Me too. Me too. I read a variety of different sources and I did not find descriptions of how the rabbits were behaving. I think they were much less interested in rabbit behavior and much more interested in just accessing something they could use for a vaccine.

52:34And so they actually were able to show that if you gave a dog some of this material from the rabbits that had been dried out and then you exposed the dog to rabies, a dog would not get rabies. And so they were like, holy cow, this vaccine thing seems to be working. This works in dogs. But they were not ready to start testing it in people. In June of 1885, a child who was already starting to show signs of rabies, which we've already said it's too late at that point, was brought in. They tried to give her the vaccine. She passed away. That didn't work. That wasn't a great sign, but they kept doing the work.

53:09And then a little bit later in 1885, a boy named Joseph Meister came in. He was a nine-year-old boy. He was bit by a rabid dog a bunch of times, like more than 10 times. This kid had initially been brought to Emile Roux, who we talked about a little bit earlier. And Emile was like, I do not feel comfortable giving this kiddo the vaccine. He wasn't 100 percent clear about his reasons, but based on what he wrote in other places, we think that it's because he was like, look, I've tested it in dogs. My vaccine seems pretty good in dogs, but I just don't feel comfortable giving it to people yet. It could be way too dangerous.

53:42Yeah. That's a terrifying decision to have to make. Yes, absolutely. Right. Because, you know, if this kid was actually bitten by a rabid dog, you might be the only one who can save his life. But if he was just bitten by some dog that's a jerk, you might kill him with your vaccine. Oh, boy. And so he passed. But Pasteur's lab decided to go for it. Pasteur was a chemist, so he couldn't do the injection. But his colleague, Jacques-Joseph Grancher, why couldn't it just be people with boring English names that make scientific advances? I don't know. But my apologies to the French-speaking world. Anyway, he administered the rabies vaccine they had been working on.

54:22And then he gave this kid 12 additional doses that had a vaccine that had been dried for less and less time. So essentially he gave him stronger and stronger versions of the virus each time. And this kid survived. He's the first person we know of to survive being exposed to rabies, get a vaccine, and now he lives. which is amazing. And then they pulled this trick off again a little bit later with a kid who was a shepherd. Around this point, they also had the first, what we call prophylactic vaccine, which is where you get a vaccine before you get exposed. And this was essentially because while they were administering the vaccine, somebody accidentally injected themselves with the vaccine and they were like, well, now we're going to see how that goes.

55:08I guess so. I guess now we know about that. Accidental experiment. That's right. But that turned out okay. And so that was that was the start of our vaccine procedure with rabies. And then a bunch of labs around the world, you know, came to see how this worked. And they started growing, you know, rabbits in their labs and trying this procedure. And then the rabies vaccine, you know, a bunch of different labs popped up around the world that produce these rabies vaccines. And that's how it started. My favorite thing is when science can develop a treatment that helps save children's lives. You know, like how many children were bitten by dogs or scratched by dogs and then died a horrible, painful, excruciating death of rabies.

55:47Like any time when we can reduce childhood suffering, yay science. Yes. And that's part of like why this story also makes me so upset, because there are children dying around the world in the tens of thousands. Yeah. That shouldn't be because science has the solution. Yeah. But we haven't found a way to get them access to it. It's a political or financial or an engineering issue. Yeah, right. And that stinks when science has the answer and it's it's not getting to them. So let's let's go ahead and talk real quick about what happens today. We talked about how if you have a job where you know you're going to get exposed regularly to animals that might have rabies, you can get the vaccine ahead of time.

56:28So the vaccine is grown up in cell cultures. So you don't need like whole humans. We just have figured out how to keep some subset of human cells alive in like a Petri dish or some chicken embryos alive. We grow up the virus in there. We extract the virus. We kill it. And then you get that vaccine. That starts giving you some immunity. Then if you subsequently get exposed to rabies, you'll get some boosters. Wait, I just realized I didn't understand something basic. When my dog gets a rabies vaccine, it's not the same vaccine as I get, is it? Is there a human and a dog version or is it the same thing?

57:03I did not do extra research on the dog version. I do know that there's a couple different versions of vaccines. So, for example, sometimes if there's a lot of rabies in a wild population, they will put some vaccines in food and essentially drop the food from planes and, like, feed coyotes. And that is a totally different version than what humans get because it's way less regulated. And so I know that depending on what animal the vaccine is getting, there's different regulations. And so they can give different kinds of vaccines. But the same principle should apply, right? That if you have this weakened vaccine, it should help a dog's immune system or a human's immune system, even if those immune systems and the biology are different.

57:41Yeah. I mean, they might grow it up in dog cell cultures rather than human cell cultures so that you don't get like allergic reactions or something. But probably the idea is pretty similar. But again, I want to reiterate, I didn't actually research how those vaccines are made. I was focusing on human stuff for this episode. Okay. So if you're a veterinarian, you got your vaccines ahead of time, then you get bit by a rabid cat. You'll get a couple extra vaccines after you know you've gotten bitten just to boost your immune system. And that is almost 100 % effective. And you are very unlikely to die from rabies in that situation, which is absolutely amazing.

58:16Yay, science. Okay. If you have never gotten a rabies vaccine before, we do something a little bit different. And this is pretty awesome, I think. So we have something called rabies immune globulin. So essentially what they do is they immunize either people or horses with the rabies vaccine. And then they draw blood and they extract the plasma. We've talked about plasma before when we were talking about making synthetic blood and stuff. In the plasma, you have antibodies. We've talked about antibodies. They bind to something on, in this case, the rabies virus, and they inactivate it. For example, maybe they make it so that the virus can no longer bind to a muscle cell and get into it.

58:58And so they essentially make it so that the virus can't do what it needs to do to replicate. They neutralize it in some way. And so they take out the antibodies that the human or horse immune system made, and then they inject that into you near the bite site. So essentially, you outsourced the initial immune response from some other organism. Right. And that gives you a head start. So while your immune system is responding to the vaccine and is trying to make its own response to rabies, you're borrowing someone else's immune response to give you a head start. You know, maybe that will do the trick.

59:35Maybe that will bind to all of the viruses that are trying to get into muscles initially. And then just in case your, you know, your body will start making your own antibodies. And you'll get a series of, I think it's something like three vaccines. It used to be you'd get a bunch of vaccines in like your abdominal region. And I think there's a little bit of folklore where people used to think it was like 20 vaccines that all had to go through your abdominal wall into your stomach. And it was super painful. And it wasn't like that. Like it was painful. It was like in your sort of tummy region, but it didn't need to go like into your stomach through your abdominal wall.

1:00:09but now it is way less uncomfortable. It's like two or three shots, usually in like the muscle in your arm. We also have like a version that goes just like right under your skin now, way less painful. Yes, the next day you probably feel pretty sore, especially after the third shot, but you're probably not gonna die of rabies. So yay. Definitely worth it. Definitely worth it. Yeah, so those are our treatments. But so in the United States, about 100 ,000 people need to get those series of shots after they get exposed to an animal that might be rabid. But the main thing that we do that protects us is we have this system where each state has a series of laws where you have to vaccinate your dogs and your cats.

1:00:52And that's the main thing that protects us because globally, most of the people who get bit are getting bit by dogs. Not by bats in their bedroom. Not by bats in their bedroom. Yeah. Dogs are a much bigger risk. And so if we could just have similar programs where everybody like had to vaccinate their dogs and maybe there's some cultural problems, you know, cultural difficulties, hurdles to get across. But I think a lot of it is like having the infrastructure, the ability to get the vaccines there, the ability to like make sure that you've got records so that you're giving the vaccines every single year.

1:01:22But if you could get that stuff in place, we could have a lot fewer deaths. And the few times that people do get bit by rabbit animals, if you could have the human vaccines available, we wouldn't have to have about 60 ,000 people every year dying from this horrible disease. Yeah. Let's hope that the folks in charge of that figure it out. Yeah, I hope so. So should we end for anybody who I know we've discussed statistics isn't how we live our lives, but do we want to end on a couple notes about how to try to prevent rabies in your life? Yeah. Okay. Exactly. Other than vaccinating your pets and closing the windows in your bedroom, what should you do to avoid rabies?

1:02:00All right. Well, so I'll note this was a little bit surprising. You're supposed to vaccinate your cats and dogs, also your ferrets. There are some places that have rules about vaccinating ferrets. You can also vaccinate things like horses. My recommendation, anything you can vaccinate, vaccinate. Keep your pets from interacting with wild animals. So, you know, maybe don't just let your animals run wild. I am mostly talking to me. I live on a farm. Sometimes I just let my dog out and I'm like, go have fun. See you in a few hours. Maybe I should be more careful about that. Report stray animals to local authorities.

1:02:32You shouldn't touch wild animals. Like if you see a skunk that looks sick, call animal control or something. Don't touch them on your own. That poor animal could be rabid. They could give it to you. Keep bats out of your house. Make sure you have like screens on your windows if possible. If you are going to do a high-risk activity like spelunking in a cave that has a lot of bats, consider trying to get the vaccine preventatively. You can talk to your doctor. And if you think you've been exposed to the rabies virus, wash the area thoroughly and then immediately go seek medical attention. And if you are ever unsure, call a doctor or go see a doctor.

1:03:07For me, I think I'm supposed to call my local poison control center for advice. But, like, call 911. Figure out who you have to talk to. Don't worry about, you know, looking silly or something. This is a serious disease. Don't mess around. That's right. Don't worry about finishing this podcast before you call your doctor. Pause it right now and call your doctor. Yes, right. And Kelly is not a medical doctor. Kelly is not the kind of doctor that most people recognize as being a doctor. When they ask, is there a doctor on the plane? They don't mean me. So don't take medical advice from me. Talk to a medical doctor.

1:03:40But thank you, Kelly, for that tour of the history of rabies. And thank you, Gurjeet, for sending us your curious question. If there are things you want to hear a deep dive about, please don't hesitate to write to us. We want to hear from you. Questions at danielandkelly.org. Thanks, everyone. Have a good day. Avoid skunks.

1:04:07Daniel and Kelly's Extraordinary Universe is produced by iHeartRadio. We would love to hear from you. We really would. We want to know what questions you have about this extraordinary universe. We want to know your thoughts on recent shows, suggestions for future shows. If you contact us, we will get back to you. We really mean it. We answer every message. Email us at questions at danielandkelly.org. Or you can find us on social media. We have accounts on X, Instagram, Blue Sky, and on all of those platforms, you can find us at D &K Universe. Don't be shy. Write to us. This is Jana Kramer from Wind Down with Jana Kramer.

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