Viewpoint: management of human rabies

Rabies remains a serious public health problem in many developing countries. A case in the West received media attention with the recovery of an American teenager who had not received rabies post-exposure prophylaxis. This case confirmed that rabies is not an invariably fatal disease. Review of the literature revealed only two survivors with good neurological status in nearly 40 years. Both had neutralizing antibodies in cerebrospinal fluid at or shortly after presentation, but the usual diagnostic tests for rabies were negative, a rather unique finding. It is highly probable that these two children managed to mount an unusually effective early immune response to the infection that contributed to, or was responsible for, recovery. Curative efforts for human rabies using critical care resources should especially target patients who show early neutralizing antibody. More basic research is needed to develop effective therapies for human rabies.