Talk:Rabies

This article was the subject of a Wiki Education Foundation-supported course assignment, between 1 October 2018 and 12 December 2018. Further details are available on the course page. Student editor(s): Gikdavis (article contribs).

Tragedy in Germany: six transplants have rabies

Terrible tragedy looms in Germany: more recent news say all six transplants have rabies now. Added to the article. See: http://news.bbc.co.uk/1/hi/world/europe/4271453.stm

Mentioned in FoxTrot

This article was mentioned in a FoxTrot comic strip (the image) about Wikipedia today (May 7 2005), though it obviously didn't get the same attention that Warthog did as a result [1]. Just thought I'd mention it. --Phoenix-forgotten 17:52, 2005 May 7 (UTC)

Regarding the Milwaukee Protocol and Objectivity

I think it bears mentioning how frequently the information on this article regarding the Milwaukee Protocol (and the lesser-known Recife Protocol) has been updated, amended, added, and removed -- often without a full representation of the still-ongoing scientific debate as to its effectiveness. As the already-cited sources point out, many purported instances of survival cannot be 100% verified as having been cases of rabies in the first place — often due to a purported lack of neutralizing anti-rabies virus antibodies on later testing (as an aside,citations 39 and 41 of this currently cited source arguing against the protocol, which are cited in the source after these claims that survivors lacked neutralizing antibodies, are both impossible to locate in publicly available forms — it's impossible, therefore, to verify whether these sources do, in fact, state that this conspicuous lack of antibodies was noted). Additionally, those instances of survival that have been confirmed cases of rabies are often confounded by factors, such as administration of vaccines immunoglobin/presence of antibodies prior to exposure or in the course of post-exposure treatment, either as a prophylactic measure or alongside Milwaukee Protocol-esque post-onset treatment.

However, those sources also solely focus on cases reported in the USA, the UK, and in Canada between 2004 (when the Milwaukee Protocol was first introduced) and 2014. Considering one of these countries claims to have eliminated wild rabies, its inclusion in this data seems odd. Moreover, other, more recent sources note the difficulty in verifying case details, while also clearly stating that 11 cases of survival of suspected rabies following Milwaukee-style treatment protocols have been documented. I think it's hardly fair to say — as the current blurb about this subject does — that there have been no more cases of survival since the initial case from which the protocol takes its name. Putting aside the 2011 California case which some allege was never rabies to begin with, you have this case in which a 13-year-old boy from India survived without prophylactic post-exposure vaccination or immunoglobin, and also seemingly without any Milwaukee protocol-style intervention, despite the confirmed presence of rabies antigens. This would mean that there has been at least one more survivor since 2004 who did not receive any prophylactic pre-onset treatment. This would patently rule out the statement in the current section that there have been no further survivors.

Ultimately, I think more in-depth research into the body of available literature on these protocols is required, and the section on post-onset treatment should be updated to more accurately reflect that this is an ongoing area of scientific study that has hitherto produced mixed-quality evidence of efficacy. It is inherently un-Wikipedian, in my opinion, to have a section such as the current one that presents the Milwaukee protocol and regimens like it as forgone or abandoned avenues of post-exposure treatment. It would be wise, I think, to include some of the sources I linked above, and to rewrite the section in a way that reflects the current lack of a medical consensus regarding this protocol's effectiveness.Crossark (talk) 06:56, 20 March 2021 (UTC)

Semi-protected edit request on 21 March 2021

Hi Crossark, i think you are absolutely right about what you say! The article makes it seem, like it has been proven without doubt, that the treatment is ineffective. Also to me it is too unstructured.

Proposal: Change "After onset" to: At least two treatment schemes have been proposed to treat Rabies after the onset of disease, namely the Milwaukee Protocol and the Recife Protocol. The Milwaukee Protocol initially came into use in 2003, when it has been tested on Jeanna Giese. Subsequently, the teenager from Wisconsin became the first person known to have survived rabies without preventive treatments before symptom onset.[78][79] The basic idea is putting a person into a chemically induced coma and using antiviral medications to prevent fatal dysautonomia. However, the overall protocol is complex. The sixth version of the protocol last updated in 2018 consists of 17 pages with 22 steps of treatment, detailed monitoring and a timeline of expected complications. The Recife Protocol follows the same principle but differs in details like termination of sedation and supplementary medication. Some experts assed the Milwaukee Protocol as an ineffective treatment with concerns related to the costs and ethics.[77][81] Yet a study published in 2020 found 38 case reports for the Milwaukee Protocol and only one for the Recife Protocol with a total of 11 known survivors with varying sequelae.

References

I could not edit the original source, so it has to be reformatted before updating. Franzpuntila (talk) 16:37, 21 March 2021 (UTC)

Please do not request an edit until you have consensus for the change. Thanks. ScottishFinnishRadish (talk) 12:56, 23 March 2021 (UTC)

"and consensus should be obtained before requesting changes that are likely to be controversial" Why is this change likely to be controversial? It is more up to date, cites publicly available scientific sources and keeps most of the existing information. I removed the answered tag. Franzpuntila (talk) 19:02, 23 March 2021 (UTC)

References

To editors Franzpuntila, Crossark and ScottishFinnishRadish:  Not done for now: please establish a consensus for this alteration before using the {{edit semi-protected}} template. The answer to your question, Franzpuntila, lies in what Crossark noted above: [...] it bears mentioning how frequently the information on this article regarding the Milwaukee Protocol (and the lesser-known Recife Protocol) has been updated, amended, added, and removed [...]. This means that changes in the past to this issue have been ongoing and controversial. That is why a consensus must be garnered before the {{Edit semi-protected}} template is reactivated. It is not by any means a reflection of the nature of your arguments or sources. Thank you for your input! P.I. Ellsworth  ed. ^put'r there 19:47, 31 March 2021 (UTC)

Really, y'all...harping on an editor for "not obtaining consensus before requesting an edit" is kind of ridiculous. Just let the edit request become the proposal (which it appears it hath anyway). likewise, if consensus for a change through discussion has been reached, one of the editors involved should just make the edit - making the original proposer request an edit after consensus is ridiculous. we aren't a bureaucracy. Firejuggler86 (talk) 20:07, 3 April 2021 (UTC)

Sorry if you consider this "harping on an editor". Let me assure you that is not my intent. After reading the entire content in this section above, it seemed necessary to ask to see if consensus has changed. Guess it appeared to me to be ill-advised to add content to this article that had been added/removed/added/removed/added/removed in the past without getting a solid consensus first. We're all volunteers here and we're all hopefully here to improve this encyclopedia. If we harp or seem to harp, then that's why. After we get a good, solid consensus for this edit, then it will be easier to point future dissenters and reverters to the discussion below. Thank you for your opinion! P.I. Ellsworth  ed. ^put'r there 22:56, 5 April 2021 (UTC)

Hi, thank you for your input. I do not agree that the edit history of any page, makes changes to a more detailed, precise and up-to-date article with scientific sources controversial - especially when the status quo is outdated and biased. But if it is seen like this around here, let's make the best of it. I invite everyone interested in the article to suggest changes to my proposal, that I will happily incorporate if they provide better information. Also outside opinions are highly welcome.

Reopend. Franzpuntila (talk) 20:23, 19 May 2021 (UTC)

I would like to change the after-onset treatment to the proposal above. Happy to hear any input!

I will then reopen the edit request within three weeks from now. Franzpuntila (talk) 22:08, 1 April 2021 (UTC)

• Support the change – Franzpuntila's proposal appears to be a well-sourced and neutral-sounding update, so unless someone points out problems with it, I'd say go ahead. Dicklyon (talk) 05:16, 2 April 2021 (UTC)
• Support - Satisfied with its sourcing. Idealigic (talk) 21:18, 27 April 2021 (UTC)

To editor Franzpuntila: (et al.)  done, and thank you very much for your patience! P.I. Ellsworth  ed. ^put'r there 17:33, 20 May 2021 (UTC)

Semi-protected edit request on 21 May 2021

Cricopharyngeal spasm should be the hyperlink for violent movements I believe according to https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4372763/ Banana Of Hell (talk) 14:57, 21 May 2021 (UTC)

 Not done: It's not just throat spasms, there are other spasms and violent movements. ScottishFinnishRadish (talk) 15:09, 21 May 2021 (UTC)

Semi-protected edit request on 14 June 2021

"It then travels along the afferent nerves toward the central nervous system."

Should be

"It then travels along the efferent (motor) nerves toward the central nervous system."

Source: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6842493/#S2title , which says

"It is thought that RABV entry into primary motor neurons is followed by retrograde axonal transport, replication and assembly in the neuronal cell body, and then transport to and budding from another synapse to start a new round of infection and resultant neuron-to-neuron spread." (emphasis mine)

For more confirmation see the other facts in the article: 1. Rabies uses anterograde transport, which means that to get to the CNS it must be traveling up neurons carrying signals away from the brain (i.e. efferent neurons) and 2. Rabies uses motor (i.e. efferent) neurons to replicate and reach the CNS.

The linked source for the original fact does mention "afferent" at page 258 https://books.google.com/books?id=p8rMezRaD4oC&newbks=0&printsec=frontcover&pg=PA290&hl=en&source=newbks_fb#v=onepage&q=afferent&f=false But not in the way it is used in this article: the source mentions that one variation of the virus did infect afferent sensory neurons (among other areas) when the virus was injected into the eye but it does not say that this is the usual mechanism of transport from infection site to CNS (e.g. looking at Figure 3 we can see that the other variant travels along efferent nerves). In Figure 1 on page 247 the book clearly shows the virus reaching the CNS via motor neurons (#3, #4, #5). However I think that the fact about the variant is still interesting as it shows that the pathway to the brain is not strictly via efferent neurons. Cameronfr (talk) 00:21, 15 June 2021 (UTC)

I agree. Will make the change. MartinezMD (talk) 00:47, 15 June 2021 (UTC)

Semi-protected edit request on 12 July 2021

Please change these sentences in the introduction:

Rabies causes about 56,000 deaths worldwide per year.[4] More than 95% of human deaths from rabies occur in Africa and Asia.[1] About 40% of deaths occur in children under the age of 15.[14] 

to

Rabies causes about 56,000 deaths worldwide per year,[4] about 40% of which are in children under the age of 15.[14]  More than 95% of human deaths from rabies occur in Africa and Asia.[1] 74.98.192.38 (talk) 20:09, 12 July 2021 (UTC)