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Stardate
20020330.2141 (On Screen): What is the most lethal disease there is? The one with the highest deathrate among those infected? Most of the really lethal diseases out there now which are difficult to treat are members of a group known as "hemorrhagic fevers". There was one in Korea which gave the doctors during the Korean war fits, and cost the lives of a lot of men, but as such things go that particular one was not very deadly and the majority of those who got it survived. They're found all over the world, and they are mean and nasty; all the more so because they are readily communicable. For a long time, Marburg with its 70% fatality rate was the scary one, and then Ebola appeared. It has a 95% fatality rate.
But that's not the worst. There is one disease with a 100% fatality rate. Every single person who develops symptoms will be killed by it. To those who are not aware of it, this comes as a surprise: it's rabies.
There are several pieces of good news. First, rabies is not very easy to get. It is not contagious by casual contact; you have to be bitten. Bats, skunks and canines are the most common carriers, but felines can also be infected. I have a friend who had to go through a rabies sequence because she was bitten by a strange cat and they couldn't find it.
Because that's the second piece of good news: it doesn't develop into disease very rapidly. So there's a window in which a person can be given a very strong sequence of vaccination injections which will sensitize their immune system to the virus before it gets dangerous. Then the immune system can kill the virus off before it can kill you. It used to be that the injections had to be directly into the abdomen, which hurt like mad, but they've now developed a new form which is administered in the arm (much to the relief of my friend).
But without the shots, if you're infected you die. Invariably. By the time symptoms have developed, it's too late. Which is why they don't take chances; if you've been bitten by a strange animal and they cannot prove that it is not infected, they assume it was and begin the series of shots. The consequences of being wrong the other direction are too great to take the chance.
By the way, an piece of trivia: one conjecture is that the vampire legends are actually based on the symptoms of human rabies sufferers. The relationship to bats and wolves was due to the fact that those were the most common sources of infection. At one stage in development of the disease, a human rabies sufferer becomes extremely sensitive to light and finds bright light painful, and will tend to avoid it; this may be the source of the mythical abhorrence of daylight by vampires. And creatures who are afflicted by rabies do tend to bite, which may be where the "bite and drink blood" part of the story came from.
Update 20020331: Eric writes:
The pathology of rabies is a bit more complicated than
you suggest:
(1) Even if you're bitten by an infected animal, you have
a reasonable chance of not developing the disease at all.
The human body has a fair amount of resistance to the virus.
Depending on where you're bitten and how bad the bite is,
survival rates can be as good as 9 out of 10. It helps
a lot if proper wound care is followed, including at least
washing with soap and hopefully povidone iodine.
(2) Even if you get clinical rabies, you sometimes (very rarely)
survive.
From the CDC web site:
"Once clinical signs of rabies appear, the disease is nearly always
fatal, and treatment is typically supportive. Disease prevention is
entirely prophylactic and includes both passive antibody (immune
globulin) and vaccine. Non-lethal exceptions are extremely rare. To
date only six documented cases of human survival from clinical rabies
have been reported and each included a history of either pre- or
postexposure prophylaxis."
Some sources claim that people occasionally survive rabies even
if they don't get the vaccine series, but I haven't been able
to track down the specific case studies.
Update: Harold writes:
Rabies is no longer 100% fatal. there is at least one, and now possibly two or more survivors. AFirst survivor was in NY. The doctors practiced very agressive treatment. Normal treatment was to wait until symptoms appeared, then treat the symptoms, and wait until the patient inevitably died. The doctors for this patient tried something different. The course of rabies is well document, what symptoms in what order. The doctors very aggressively treated the symptoms before they appeared, with large measures of appropriate treatment for the symproms. Lo and behold, the first survivor. This occurred in the 1990's, after 1994 I'm pretty sure.
Update 20020401: A reader writes to tell me that he's died.
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