Pulling out of jaws of a certain furious death

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As a toddler, I was often warned. “Do not go near stray dogs – If they bite you, you will get fourteen injections in your tummy.” There were, and still are a plenty of stray animals around. Many kids including myself were taught, how to identify a friendly one from the furious one. “A friendly dog wags its tail.” So, even today while passing a stray dog, my entire attention is on its tail, looking for that reassuring vigorous wag.

When I started my medical school, I struggled to find logic behind “fourteen injections”. Only a few months ago, I discovered where this concept came from. These fourteen injects led me to the genesis of protection against rabies. It was quite a different story about a century and a half ago, when individuals bitten by a furious animal (usually canines) were destined to die. This certain death was because of Rabies, which in itself is also furious and painful.

A certain death sentence

Hindu God of death, Yama rides a buffalo, and his abode is guarded by two ferocious dogs, Sharvara and Shyam. Greek mythology also has a ferocious three headed dog Cerberus, who guards the dead. Throughout antiquity, it was well known that bite of a ferocious animal was a certain death. We know that bite itself is contagious, that transforms a calm mind to a violent, self destructive one. Rabies it was, derived from the word rage. With no remedy, and a certain death, many of those bitten by ferocious animals, would either wait for symptoms or at times self-destroy themselves.

Fast forward to 1880s, and experiments by Louis Pasteur

Louis Pasteur was not a medical doctor, he was a scientist interested in microbes. He had previously worked with useful bacteria, and had introduced a way to preserve foods – we know as pasteurisation today. He was already a celebrated scientist by 1880s, when he made a startling discovery. Chicken, when inoculated with an attenuated (or near dead) strain of a bacteria, did not develop the disease when exposed later. This discovery led him to develop animal vaccines for chicken cholera, and sheep anthrax. By 1884, he had also developed a rabies vaccine for dogs. He could grow the attenuated contagion in rabbit spinal cord, and use its extracts to protect other canines.

Till 1885, Pasteur had not done any human rabies studies. As fate had it, on 4th July 1885 a furious dog bit Joseph Meister (age 9) in Alsace, France. Worried about a certain death, his mother brought him to Pasteur. She had heard that he only knew how to treat Rabies. Pasteur in turn consulted two physicians, Alfred Vulpain and Jacques Grancher, and all were sure that Rabies would befall Meister. Meister’s mother, desperate for a cure, agreed for a dog-rabies vaccine. On 6th July 1885, Joseph Meister was first human who got this vaccine. He received thirteen more dosages, one every day. He was saved and lived on. These injections, were administered over abdominal making a full set of “fourteen injections”.

The vaccine led to the Pasteur Institute

Three months later, in October of 1885, Jean-Baptiste Jupille, a 15-year-old shepherd was bitten by a wild dog. In the ensuing fight with the beast, he had saved six others. This time Pasteur not only administered him the vaccine, but also publicised this feat. Soon he had to set up a rabies vaccination clinic, as many bitten by ferocious animals came from far and wide. Three years later, Pasteur received funds to set up an institute in Paris. This is Pasteur institute of today. Joseph Meister was employed at Pasteur institute, and worked here till his death.

By 1890, there were rabies treatment centers in Budapest, Madras, Algiers, Bandung, Florence, Sao Paulo, Warsaw, Shanghai, Tunis, Chicago, New York, and many other places throughout the world. The vaccine was obtained from brain tissue of mice, infected with attenuated virus. The popular dosage was either 14 or 21 injections, given under the skin over the abdomen.

Over next decades, risks of such a vaccine also appeared. Some individuals would have a degenerative brain disease. By 1970s the dosages were reduced to seven. Next phase was a chick-embryo vaccine, and today we need only four injections on arm, over a one month period ( days 0, 3, 7 and 28) after the bite. We also give an immunoglobulin on the first day for added protection. Thus, today rabies vaccine given after the bite brings a person out of jaws of certain death.

Dogs are not the only carriers

While rabies is transmitted by bite of rabid dogs, they are not the only carrier. In-fact countries in North America, Western Europe, and Japan have no dog-transmitted rabies today. This is largely due to animal control and veterinary vaccination programs.Australia and New Zealand have never seen any local transmission. Beginning 2021 Sri-Lanka is on the elimination pathway, with eradication aimed in 2025. Yet, across the world about 60,000 people die of dog-transmitted rabies, a third of them are from India.

Many wild, and peri-urban animals carry rabies. These include cats, wolves, monkeys, bats, skunks, racoons, and even rabbits.

Many animals that carry rabies virus are not furious or infected themselves. In 1937, a scientist in Trinidad and Tobago, discovered that fruit-bats also carry rabies virus, without themselves becoming infected. This finding by Joseph Lennox Pawan, was initially met with skepticism. In-fact rabid dogs, monkeys, rabbits, and cats die early after getting infected. Bats can survive the virus for months, without any unusual behaviour.

In event of any animal bite, either wild or domesticated, we need a rabies vaccine. Only exception may be bite of a definitely vaccinated pet. Further, the immediate post-bite precaution is to clean the wound and also use an immunoglobulin for immediate protection. We should not delay, and neither should wait for seven days to look at pets behaviour. Those who frequently handle animals, should get themselves vaccinated beforehand. All these precautions can save our lives, as once someone has symptoms of rabies, it is still a certain death.