Talk:Rabies/Archive 3

Expansion needed on symptoms

The article makes it clear that rabies is associated with 'rage' and 'violence', and even mentions 'furious rabies', but the Signs and Symptoms section only briefly mentions agitation (psychomotor agitation at that) and abnormal behavior among other symptoms. It's possible there was an overcorrection, but at the moment it seems like any mention of aggression or violent behavior is missing entirely from the symptoms. 2600:8800:2382:E200:4DCA:74C9:7EB:D101 (talk) 15:08, 24 February 2022 (UTC)

Violence is only mentioned in the name root and rage is mentioned in fictional portrayals. What specific clear association are you referring to? Quote a section for us so we know which to address. MartinezMD (talk) 15:31, 24 February 2022 (UTC)

Yes, the name root and association with the Greek spirit of mad rage, the aformentioned "furious" rabies (as opposed to "dumb" rabies), and descriptions such as "In many cases, the infected animal is exceptionally aggressive, may attack without provocation, and exhibits otherwise uncharacteristic behavior." I'm sure fictional portrayals exaggerate the aggression, especially in humans/zombies, but it seems unlikely they made it up too. Feels like there should be some mention of aggression in the signs/symptoms of a disease literally named after it. If not, it may need elaboration on why it's a misconception. My thoughts anyway. 2600:8800:2382:E200:4DCA:74C9:7EB:D101 (talk) 17:41, 24 February 2022 (UTC)

Gotcha. For sure it happens in animals. In my rural area whenever a usually timid/skittish wild animal attacks someone it's usually due to a case of rabies. Let's see what we can find. MartinezMD (talk) 00:06, 25 February 2022 (UTC)

Found a really interesting review article on the subject Diabolical effects of rabies encephalitis "Rabies vectors frequently show behavioral changes. Aggressive behavior with biting is important for transmission of the virus to new hosts at a time when virus is secreted in the saliva. Aggression is associated with low serotonergic activity in the brain. Charlton and coworkers performed studies in experimentally infected striped skunks with skunk rabies virus and observed aggressive behavioral responses."

Make a change to the article or propose some wording here and I'll include it if you'd like me to do it. MartinezMD (talk) 04:35, 25 February 2022 (UTC)

References

Conflicting info in the first paragraph

Rabies is a viral disease ... Once symptoms appear, the result is virtually always death.[1] ... The disease can be diagnosed only after the start of symptoms.[1]

So these two statements mean that if you are diagnosed with rabies you will virtually always die. That doesn't sound right, but if true the paragraph needs some rewriting.

--Asherkobin (talk) 22:05, 7 April 2022 (UTC)

That is exactly what happens. Most diagnosed cases die. MartinezMD (talk) 22:12, 7 April 2022 (UTC)

The first person known to have survived the onset of symptoms was in 2003. Hence, post-exposure prophylaxis. --jpgordon^{𝄢𝄆𝄐𝄇} 22:17, 7 April 2022 (UTC)

A Commons file used on this page or its Wikidata item has been nominated for deletion

The following Wikimedia Commons file used on this page or its Wikidata item has been nominated for deletion:

• Medieval rabies folio.jpg

Participate in the deletion discussion at the nomination page. —Community Tech bot (talk) 02:06, 15 May 2022 (UTC)

New world old world distinction problematic; Africa

The distinction between New and Old Worlds is outmoded and Eurocentric. Please consider changing this. Although it is clear that there is a great deal of rabies in Africa, there is little suggestion as to why. I would imagine it has to do with he massive changes wrought by colonialism (including, presumably, the arrival of rabies itsel?), and a poor medical and veterinary infrastructure. Please help us understand. Thank you! 197.229.6.167 (talk) 06:18, 3 July 2022 (UTC)

Rabies vs Australian Bat Lyssavirus

The article currently asserts that rabies can be caused by rabies virus or by Australian bat lyssavirus. That's sourced to a webpage from the Australian Department of Health, which actually doesn't say that. What it says is:

There is no rabies in Australia. However, Australian bats carry other viruses in the lyssavirus family including Australian bat lyssavirus, which is closely related to rabies.

While the disease caused by ABLV is obviously a lot like rabies, the source does not say that it is rabies.

I saw a similar claim at megabat:

Notably, flying foxes can transmit Australian bat lyssavirus, which, along with the rabies virus, causes rabies.

That one is sourced here, which seems a bit self-contradictory. In one spot it says:

Rabies virus and Australian bat lyssavirus (ABLV) belong to a group of viruses called lyssaviruses. These viruses are usually transmitted via a bite from an infected (“rabid”) animal. They all cause a similar illness known as rabies....

but in another it says

Rabies and ABLV infection are thought to cause similar symptoms.

I think we should correct these articles to report the disease caused by ABLV as separate from rabies, which strictly speaking is (I think) caused only by the rabies virus, not by ABLV. --Trovatore (talk) 01:35, 9 August 2022 (UTC)

I'm not sure that they're really different. Pneumonia caused by any of several bacteria is still pneumonia as a comparison. It would depend on the definition of Rabies as an illness. Making the association even stronger is that treatment with rabies vaccines and immune globulin is both preventive and therapeutic if contracted. The WHO factsheet even refers to "rabies-related viruses" and says "Rabies is a vaccine-preventable, zoonotic, viral disease", not specifying rabies-virus. We should look further. MartinezMD (talk) 01:57, 9 August 2022 (UTC)

They might not be "really" different, but that's not our call as Wikipedia editors. The question is whether the sources include ABLV as a subset of rabies, and I think by and large, they don't. --Trovatore (talk) 02:07, 9 August 2022 (UTC)

That's my point. WHO doesn't appear to make a distinction and melds them. Whose definition are we using? MartinezMD (talk) 04:19, 9 August 2022 (UTC)

If you're talking about this WHO factsheet, it doesn't seem to mention ABLV by name. It does claim rabies is "an emerging public health threat in Australia", but it's pretty inferential to go from there to concluding that they count ABLV as rabies.

Anyway, these sources we've seen so far are all low-quality sources, government public-health info and so on, not much like secondary scientific sources. We should try to find better ones. --Trovatore (talk) 05:38, 9 August 2022 (UTC)

I was primarily going by their inclusion of "rabies-related viruses" implying the Lyssa category. I do agree better sources are needed. MartinezMD (talk) 03:18, 10 August 2022 (UTC)

Here, first hit on a search for "rabies review article" results with a Nature review. They define rabies as "a zoonotic disease that is caused by infection with viruses of the Lyssavirus genus" Here and here are articles from other good reviews with similar defintions, in essence making Rabies a categorical illness not specific to one specific species of virus rather the genus. MartinezMD (talk) 03:26, 10 August 2022 (UTC)

Milwaukee protocol

"Milwaukee Protocol was first used in 2003 on Jeanna Giese". Wasn't that in 2004? https://childrenswi.org/newshub/stories/jeanna-giese-rabies states this date. 62.122.5.242 (talk) 00:30, 7 September 2022 (UTC)

You are correct. There've been so many changes to the articles that it's hard to keep track of them. MartinezMD (talk) 01:06, 7 September 2022 (UTC)

figures wrong

Change In 2010, an estimated 26,000 people died from rabies, down from 54,000 in 1990. The majority of the deaths occurred in Asia and Africa. As of 2015, India, followed by China (approximately 6,000) and the Democratic Republic of the Congo (5,600), had the most cases. To:

by deleting it, it is based on reported figures NOT prevalence - hence earlier in the article says 59 000 - the figure WHO and CDC use.

Article is protected and this should be deleted 88.112.31.26 (talk) 17:46, 13 November 2022 (UTC)

Semi-protected edit request on 17 November 2022

The rabies virus can gain entry into the nervous system through nicotinic acetylcholine receptors (nAChR) on muscle cells and p75NTR receptors on neurons in the intermuscular junction to gain access into nervous system and to travel to the brain. 2601:14F:4401:63C0:56A:256C:F161:2F3C (talk) 00:14, 17 November 2022 (UTC)

• No sources, not even unacceptable ones, are provided. Drmies (talk) 00:15, 17 November 2022 (UTC)

Semi-protected edit request on 17 November 2022 (2)

99% of rabies cases in humans were because of a dog bite. Dkecli123 (talk) 00:21, 17 November 2022 (UTC)

 Not done: it's not clear what changes you want to be made. Please mention the specific changes in a "change X to Y" format and provide a reliable source if appropriate. ScottishFinnishRadish (talk) 00:26, 17 November 2022 (UTC)

Transmission from bitten to biter?

What if a carnivore, say a dog, were to bite or eat an infected animal? Could the biter get infected that way?CountMacula (talk) 22:51, 5 December 2022 (UTC)

Theoretically possible I imagine, but you'd need a reliable source to say. WP:RS. MartinezMD (talk) 23:09, 5 December 2022 (UTC)

Should this article and Rabies in animals be merged?

It's the same disease, caused by the same virus, and rabies is humans is normally caught from animals. Other diseases that similarly spread from animal populations to humans (e.g. Ebola) aren't split like this. 2A00:23C5:C384:9101:99A1:2C0A:5CC:2BB6 (talk) 08:21, 13 February 2023 (UTC)

"Rabies virus micrograph"

It's hard to tell exactly what it is without a scale bar, but that micrograph at the bottom of the page is definitely not rabies virus. It was probably misannotated in the original source. It looks like a bacterium. 138.26.202.152 (talk) 17:08, 6 October 2023 (UTC)

I don't think it's an error. It looks very much like the diagram depicted by the CDC. MartinezMD (talk) 18:12, 6 October 2023 (UTC)

https://www.cdc.gov/rabies/about.html#:~:text=Print-,What%20is%20rabies%3F,in%20the%20brain%20and%20death. MartinezMD (talk) 18:12, 6 October 2023 (UTC)

"She, however, already had antibodies against rabies when she initially arrived at hospital."

In my opinion, this sentence implies that a possible reason that Jeanna Giese survived is that she had pre-existing antibodies to rabies before her infection. However, I believe that this is a misreading of the source. The review linked states that Jeanna had neutralizing antibodies against rabies upon presentation at the hospital, but the review also states that the presence of neutralizing antibodies against rabies in a patient with no previous rabies vaccinations is diagnostic for rabies infection. The source also lists known survivors of rabies and whether they received any pre-exposure or post-exposure vaccinations, and Jeanna is listed as receiving no vaccination either before or after her infection. I believe that this sentence is misleading and should be removed. Sappholococcus (talk) 05:23, 12 October 2023 (UTC)

Well it's what the source says about Giese, so Wikipedia is right to mirror it. We could add (per the same source) that's it's unknown why she had a fairly good outcome. Bon courage (talk) 05:36, 12 October 2023 (UTC)

The source says she had antibodies against rabies when she arrived at the hospital, but (from my reading of the source) she had antibodies because she had an active rabies infection. The antibodies were proof that she was infected with rabies and would be present in almost anyone with an active rabies infection, not only Giese or people with an unusually good outcome. I think the way the sentence is phrased implies that the antibodies she had when presenting at the hospital were or could be protective, which I think is a misreading of the source (obviously antibodies have the potential to be protective, but they weren't unique to Giese or even unusual; people who die of rabies also have rabies antibodies by the time they have rabies symptoms). Sappholococcus (talk) 18:37, 12 October 2023 (UTC)

Yes, the source cited says "One possibility, mentioned by the authors, is that she may have been infected by an attenuated variant of bat rabies virus, perhaps one never yet isolated, and that the specific therapeutic agents she received may have played an insignificant or only a minor role in the outcome." So maybe the best solution is simply to remove the sentence. Bon courage (talk) 19:22, 12 October 2023 (UTC)

Protection

Why is this article semi-protected, exactly? 78.240.252.185 (talk) 23:02, 7 January 2024 (UTC)

There was some ongoing really stoooopid vandalism. Maybe the idiots have moved on. I've unprotected. --jpgordon^{𝄢𝄆𝄐𝄇} 03:59, 8 January 2024 (UTC)

The torrent of vandalism and unhelpful editing resumed after the protection was removed. The page has been re-protected. MaterialsPsych (talk) 22:52, 20 February 2024 (UTC)

Thanks. --jpgordon^{𝄢𝄆𝄐𝄇} 23:02, 20 February 2024 (UTC)

Milwaukee Protocol needs nuance

The wiki article implies the Milwaukee Protocol is a viable treatment for rabies, but this is increasingly controversial. There is some evidence it may not actually be helpful.

https://www.medrxiv.org/content/10.1101/2022.12.14.22283490v1.full

https://www.mjdrdypu.org/article.asp?issn=0975-2870%3Byear%3D2017%3Bvolume%3D10%3Bissue%3D2%3Bspage%3D184%3Bepage%3D186%3Baulast%3DAgarwal&ref=connortumbleson.com

https://www.wired.com/2012/07/ff-rabies/

https://pandorareport.org/2014/05/01/no-rabies-treatment-after-all-failure-of-the-milwaukee-protocol/ Jamescobalt (talk) 00:33, 19 September 2023 (UTC)

It's discredited, and somehow misinformation from poor sources had crept back into the article. Have fixed. This has been discussed at some length here before.[1] Bon courage (talk) 19:18, 1 October 2023 (UTC)

The current section on the Milwaukee Protocol is blatantly incorrect. While I do agree it's a controversial medical protocol, it's flat out not true that there was only a single survivor. [2] This review from 2020 reports 11 survivors and notes that all of them were under 18. Within the US, there are three known survivors. The original in 2004, a 17 year old girl in 2010, and the third was in 2011 [3]. The current section is just false. Not only that, the CDC still lists Milwaukee Protocol as one of two options for management of rabies [4]. I feel like we can't be out here saying it's discredited and not mentioning that the CDC still suggests it. 162.248.150.100 (talk) 09:13, 30 November 2023 (UTC)

The CDC does not "list it as an option" on that page. As I recall our cited review goes into some detail on why any cases of survival cannot confidently be ascribed to the Protocol, and indeed the Brazilian review you link says "The effectiveness of the Milwaukee Protocol and the lethality of rabies cannot be quantitatively estimated due to difficulties in obtaining information about the cases in which it was used". It might be worth going into a little bit of detail about this in the article. Bon courage (talk) 09:29, 30 November 2023 (UTC)

This article : https://www.medscape.com/viewarticle/712839_7?form=fpf too mentions several cases of survival after implementation of the Milwaukee protocol. Even assuming that "cases of survival cannot confidently be ascribed to the protocol", as you state, it doesn't mean that the Milwaukee protocol can confidently be rejected as the cause, either. Especially given that in its absence, there's no survival at all. In any case, the categorical assertion that "there has been no further case of survival" is incorrect, as, at worst, cases of survival are dubious, so I'm deleting this sentence from the article. 78.240.252.185 (talk) 22:57, 7 January 2024 (UTC)

The sentence has returned, obsolete or not. --2A02:908:898:9780:B130:E3F0:69CB:834 (talk) 21:30, 28 January 2024 (UTC)

I think the sentence should be removed, or at the very least, rephrased. It says, "While this treatment has been tried multiple times since, there have been no further cases of survival." As currently worded, it implies that only one person who has undergone the Milwaukee protocol has ever survived, and all other instances ended in death. From what I've been able to find, this is objectively false. There is at least one other case where a person has been put through the protocol and survived. [1][2]

That's not to say that additional clarification isn't warranted or that the general gist that the article is attempting to convey is necessarily wrong. To quote this [3] article, in Advances in Virus Research:

"The main component of the protocol is therapeutic coma, which was correctly predicted to lack efficacy in the accompanying editorial with the case report (Jackson, 2005)... The protocol lacks a firm scientific rationale (Zeiler & Jackson, 2016) and at least 53 failures have now been documented... plus an additional six cases... (Willoughby & Epstein, 2019). Claimed successes of the Milwaukee protocol include patients who have died and who likely did not have rabies, and others who received rabies vaccine prior to the onset of illness similar to many patients who survived without the protocol... There have been 10 successes reported from India with critical care since 2015, but without other components of the protocol. Hence, critical care is probably the only effective component of the protocol and has been previously recommended for aggressive therapy of rabies patients (Jackson et al., 2003)." TalkingMarlin (talk) 15:55, 23 February 2024 (UTC)

As I said above, as I recall our cited review goes into some detail on why any cases of survival cannot confidently be ascribed to the Protocol, and indeed the Brazilian review linked above says "The effectiveness of the Milwaukee Protocol and the lethality of rabies cannot be quantitatively estimated due to difficulties in obtaining information about the cases in which it was used". The Jackson chapters says "critical care is probably the only effective component of the protocol" (i.e. not the protocol). The last thing we want is hopium from newspapers, too. Bon courage (talk) 16:10, 23 February 2024 (UTC)

I'm not disagreeing with anything you're saying here. However, as phrased, what you've detailed is not exactly what the article says. I'm proposing that this sentence is removed or reworded:

"While this treatment has been tried multiple times since, there have been no further cases of survival."

As currently worded, this sentence would be interpreted as, "No one who has undergone the Milwaukee protocol since then has survived", rather than, "No cases of rabies survival can be confidently attributed to the Milwaukee protocol". There's an important distinction here. The former is false, whereas the latter appears (to me) to be true. There appear to be survivors who have been treated with the protocol, even if the protocol is not what led to their survival. TalkingMarlin (talk) 18:22, 23 February 2024 (UTC)

Semi-protected edit request on 25 February 2024

Since it appears that even Talk in this article is protected, I have to ask that the following edit be made to the recently submitted new Talk section, regarding potential legal and ethical issues involving the 46 sec video currently appearing (just submitted, in this timestamped hour).

Correction: The link written into that newly submitted Talk section on the legal-ethical issues, the square bracketed link to a source of license and copyright information in that new Talk section, should be the following specific link, and not the one to PLOSOne originally posted. It makes no great difference, but it is best to be correct about such things.

https://journals.plos.org/plosmedicine/s/licenses-and-copyright 24.14.18.35 (talk) 23:12, 25 February 2024 (UTC)

Just a note here; not responding to the request: This talk page is not in fact protected. You can check this at https://en.wikipedia.org/w/index.php?title=Talk:Rabies&action=info. I don't know what obstacle you ran into trying to edit your earlier request, but it was not page protection. --Trovatore (talk) 22:25, 26 February 2024 (UTC)

 Done I have edited the link as you requested. I will have a more substantial response to your original request shortly. Anon126 (notify me of responses! / talk / contribs) 04:24, 27 February 2024 (UTC)