Rabies

Daniel and Kelly talk about rabies, which results in very few deaths in the United States but is a neglected tropical disease - taking approximately 60,000 lives globally each year. See omnystudio.com/listener https://omnystudio.com/listener for privacy information.

Speaker names marked ? are inferred from speaking time and the show’s known hosts — they are not voice-verified.

• 0:00Speaker 00

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• 1:02Kelly Weinersmith?

  Hey there, extraordinaries! Heads up, today's episode is about rabies, so we'll be touching on topics related to death and animal testing. Please decide if that content sounds like a good fit for you or for any children that might be hanging out in earshot. Thanks!

• 1:25Kelly Weinersmith?

  In 2025, rabies made the news in the United States. A kitten transplant recipient had passed away from rabies, and it was determined that their organ donor had had an undiagnosed case of rabies. Humans rarely transmit rabies to each other, and organ and tissue transplants are pretty much the only way it happens. But how does someone end up with undiagnosed rabies? Well, the man who would go on to become the organ donor was holding a kitten in an outbuilding when a skunk came in. The skunk approached the man, who perceived that the skunk was trying to kill the kitten because the skunk was very hungry. The man knocked the skunk unconscious—they're made of pretty stern stuff out in the country—

• 2:10Kelly Weinersmith?

  and got a scratch on his shin in the process. In hindsight, he should have thoroughly washed out that wound and immediately gone to see a doctor for rabies treatment. But he dismissed the scratch and didn't think he had been bitten. He just chalked it all up to an unfortunate interaction with a hungry, but not necessarily rabid, skunk. Five weeks later, he began hallucinating, he had trouble swallowing, and two days after that, he appeared to have suffered a cardiac arrest. He never regained consciousness and was eventually declared brain-dead. His family did report the skunk interaction, but cardiac arrest seemed a more likely cause of death.

• 2:51Kelly Weinersmith?

  His kidney and three cornea tissue grafts were eventually given to recipients. And as you now know, the kidney recipient passed away. When it was determined that the kidney recipient had rabies, some sleuthing determined that the organ donor had originally died of rabies as well. At that point, the cornea tissue grafts were removed, and all three recipients were given treatment for rabies. Thankfully, they all remained symptom-free. This scenario, where an organ donor transmitted rabies to organ and tissue recipients, has only happened four times since 1978 in the United States. But it makes the news in the United States because rabies deaths are so incredibly rare here. But globally, they're not rare.

• 3:35Kelly Weinersmith?

  Around 60,000 people die each year from rabies, and many of them are children. And these deaths happen despite the fact that we have a vaccine that could save them, if only it was administered soon after the initial rabies exposure. So today, we're going to talk about rabies, how you can get it, how you can avoid it, the history of vaccine development, and what vaccines we have available today. Welcome to Daniel and Kelly's Rabid Universe.

• 4:16Daniel Whiteson?

  Hi, I'm Daniel. I'm a particle physicist and I expected, based on childhood cartoons, to worry a lot about quicksand and rabies when I was growing up.

• 4:26Kelly Weinersmith?

  Hi, I'm Kelly Wiener-Smith. I study parasites and space. And yeah, I also thought that quicksand was going to be a much bigger problem as an adult than it ended up being.

• 4:34Daniel Whiteson?

  All right. Well, then my question for you today, Kelly, is have you ever stepped in quicksand or had a serious concern about getting rabies?

• 4:42Kelly Weinersmith?

  Hmm. I never stepped in quicksand, although I did almost get stuck in a salt marsh once in some mud. I had a moment where I was out there by myself and I was like, am I going to be able to get my foot out? Or is this, this the end as the tide is coming in? And it wasn't the end because here I am.

• 4:57Daniel Whiteson?

  Well, probably in that case, it's just bye bye boot, right?

• 5:00Kelly Weinersmith?

  Yeah, yeah, I did. I did lose that boot, but whatever.

• 5:03Daniel Whiteson?

  You donated it to future archaeology is what you did.

• 5:06Kelly Weinersmith?

  Yeah, yes. Or I polluted that estuary with some microplastics. I'm so sorry.

• 5:11Daniel Whiteson?

  No, in 5,000 years, some PhD student is going to write a whole thesis about the ritual processes surrounding your boots.

• 5:18Kelly Weinersmith?

  Okay, sure. I wouldn't want to read that thesis, but I hope they pass.

• 5:22Daniel Whiteson?

  Well, what about rabies?

• 5:24Kelly Weinersmith?

  Yeah. So when we moved to this property, there were two barn cats on the property and the woman was moving to a place that didn't have a barn. And so we offered to keep the barn cats. And every once in a while, they'll catch a bird. And when they catch a bird, I keep it. This is the Wiener-Smith family equivalent of poop in the fridge. My husband is not thrilled when I do this, but I do it. And so I reached down once because I thought the birds, and this was on my birthday, I reached down, I thought the cats had caught a bird. And as soon as I picked it up, I shouted in expletive because I realized they hadn't caught a bird. They had caught a bat.

• 5:58Daniel Whiteson?

  Oh, boy.

• 5:59Kelly Weinersmith?

  And I had picked up that bat with a bare hand. And so immediately I was like, oh, no, do I need to go get a rabies vaccine? And so I called the poison control center and they ended up deciding, no, it's probably fine. You probably don't need a vaccine. And I was like, I don't want to hear the word probably. I want to hear 100%. There is zero chance you're going to get rabies.

• 6:23Daniel Whiteson?

  You're talking to a worrier here, people.

• 6:24Kelly Weinersmith?

  That's right. Again, I did say, I was like, look, I have severe anxiety. If the answer isn't 100%, I want to come in and get the rabies shot. And they're like, lady, you're fine. And I was like, all right.

• 6:36Daniel Whiteson?

  Speaking your language.

• 6:37Kelly Weinersmith?

  That's right. That's right. What about you?

• 6:39Daniel Whiteson?

  Well, I didn't have to worry about rabies, but growing up in northern New Mexico, you do have to worry about the plague.

• 6:45Kelly Weinersmith?

  Oh.

• 6:45Daniel Whiteson?

  And I remember one time seeing a dead squirrel and poking it and then going home excitedly telling my mom how I saw this dead squirrel and played with it. And she was like, "Ugh, you what? Oh, no." And from then on, I was sure that I was going to get the bubonic plague, which existed, you know, medieval Europe and New Mexico.

• 7:02Kelly Weinersmith?

  Yeah, well, and in like mountains in California.

• 7:07Daniel Whiteson?

  We don't talk about that.

• 7:08Kelly Weinersmith?

  Oh, I do. I do. But there but for both of these, there are treatments if you catch it pretty soon. There's antibiotics for the plague that does not plague us anymore. And we have vaccines for rabies, which we'll be talking about today.

• 7:21Daniel Whiteson?

  Well, that's why we joke that New Mexico is home of the flea, land of the plague.

• 7:26Kelly Weinersmith?

  Yeah, that doesn't doesn't make me want to move there.

• 7:29Daniel Whiteson?

  No. The land of entrapment. Anyway, there's a lot of wonderful things about New Mexico, but you don't really appreciate them growing up there as a teenager.

• 7:37Kelly Weinersmith?

  I felt the same way about Ohio, but I guess I feel the same way as an adult about Ohio. I'm so sorry.

• 7:42Daniel Whiteson?

  Well, speaking of not appreciating things, I don't appreciate getting rabies, but I do appreciate our listeners' curiosity.

• 7:50Kelly Weinersmith?

  Yes, me too. And we got a request for an episode topic from Gurdjie. They wanted to know about rabies. And so I was happy to oblige because rabies is an absolutely horrible topic, but also fascinating. And so that is Kelly's Venn diagram of favorite things to talk about.

• 8:06Daniel Whiteson?

  That's right. We don't exploit true crime on this podcast, but we do talk about gooey biological pain and suffering.

• 8:13Kelly Weinersmith?

  We do. And I came across what I thought was a fun fact while I was doing the research, which is that an old treatment that did not work, so treatment is in quotes here, an old treatment for rabies was that you would take the hair of the dog that bit you and put it on the wound and you would hope that that would save you from actually getting the disease.

• 8:35Daniel Whiteson?

  Is that the origin of the phrase?

• 8:36Kelly Weinersmith?

  That is the origin of the phrase.

• 8:37Daniel Whiteson?

  Now mostly used to justify mimosas at brunch.

• 8:40Kelly Weinersmith?

  Yes, right. And we will see that many of our extraordinaries have an extraordinary desire to continue drinking in the morning.

• 8:49Kelly Weinersmith?

  So let's go ahead and see what the extraordinaries had to say when we asked the phrase hair of the dog came from an ineffective treatment for what disease?

• 9:01Daniel Whiteson?

  Brachiosis.

• 9:02Kelly Weinersmith?

  Brachiosis.

• 9:04Daniel Whiteson?

  Wow, what a good question. I'm gonna be ignorant and say alcoholism. I've never heard the phrase before. Hmm. What disease would be associated with dog hair? I'm gonna say Lyme disease due to ticks.

• 9:19Speaker 04

  The hair of the dog originally refers to the prevention of rabies and is of course false. Probably has something to do with the old principle of like cures like and a myth would spread very rapidly in an environment of wishful thinking and despair.

• 9:33Speaker 05

  With dog in the phrase, I'm gonna go with rabies.

• 9:38Speaker 06

  I guess it's probably something related to tuberculosis.

• 9:41Speaker 07

  Basically a hangover and it's so shameful that you have to walk home and then you find a dive bar on the way home and you make even more terrible life choices.

• 9:54Speaker 08

  It might be a reference to rabies, the hair of the dog that bit you, based on magical thinking, like cures like or some such. Pity it doesn't work.

• 10:03Speaker 09

  In these parts, it means if whiskey caused the hangover, whiskey'll sort it. But I think it refers to an old cure for rabies.

• 10:13Speaker 10

  Since hair of the dog refers to a hangover remedy, maybe alcoholism, but for some reason I'm thinking tuberculosis and I don't know why, but I'm sure it hasn't always referred to that Bloody Mary the next morning.

• 10:26Speaker 05

  I'm thinking the ineffective treatment of being hungover by drinking more.

• 10:32Speaker 07

  I don't know, um, psoriasis or something?

• 10:35Kelly Weinersmith?

  Right. So it seems like there was a pretty nice split here between folks who were definitely like, this has to do with alcohol and folks who were like, yeah, alcohol maybe, but definitely rabies.

• 10:45Daniel Whiteson?

  And so did you go down a rabbit hole and figure out if whiskey is actually good in the morning if you have hangover?

• 10:51Kelly Weinersmith?

  Hmm, I did not. I'm guessing that just delays the inevitable, but, but I, I know I didn't look into that. That was a little too far afield of the topic of the day.

• 10:59Daniel Whiteson?

  I see. So for those of you looking for a scientific reason to day drink, you're not gonna find it on the show today.

• 11:05Kelly Weinersmith?

  I'm not helping you with that. No, that's not what I'm here for.

• 11:09Daniel Whiteson?

  You are here to tell us all the gooey details about rabies. So what is rabies, anyway, other than a reason for cartoon dogs to froth at the mouth?

• 11:18Kelly Weinersmith?

  Yeah, so rabies is a viral disease that we think has been plaguing us for at least 4,000 years. There are these 4,000 year old tablets that we found in Iraq that has a law written on it that essentially says, "If a dog becomes rabid and the ward authority makes that known to its owner, but he does not watch over his dog so that it bites a man and it causes his death, the owner of the dog shall pay 40 shekels of silver. If it bites a slave and causes his death, he shall pay 15 shekels of silver."

• 11:49Daniel Whiteson?

  Kelly, I love your Old Testament audiobook voice. That's awesome.

• 11:55Kelly Weinersmith?

  Well, here you can see that for 4,000 years, we've been putting dollar values on the value of human, or shekel values, on the value of human life, and we have been ranking the value of human beings. Not, not a good look for humanity, but the point is, rabies has been, you know, a thing that we have been aware of for a really long time.

• 12:15Daniel Whiteson?

  But in this case, is the word rabid, obviously a translation describing behavior of a dog, or was it already understood that the dogs were ill and that's where the word rabid comes from?

• 12:26Kelly Weinersmith?

  Yeah, that's a great question. So I was listening to, you know, to research this, I was listening to a bunch of different, like, history podcasts, veterinarian podcasts, blah, blah, blah. And almost everybody referenced this story, but I was able to find, like, you know, history reference that was dealing with this exact quote. And it said that another translation, instead of translating it as rabid, translated it as like furious or angry. So like, is it really saying, if your dog is a jerk, and we tell you your dog's a jerk, and you need to like chain that dog up, you know, we're gonna, we're gonna find you if that dog bites somebody. But references from the same time period note that it seems to be that people recognize that it is saliva that is transmitting something that will kill people. So it suggests to me that they do recognize that there is some disease that

• 13:11Kelly Weinersmith?

  is being passed by the dog through a bite, and saliva has something to do with it, which sounds like it's not just, there's a dog that's angry and they realize some dogs are jerks and jerks should be tied up. They actually recognize that some dogs carry diseases and those diseases get transmitted.

• 13:27Daniel Whiteson?

  Before we understood the microbiology of it all, of course.

• 13:30Kelly Weinersmith?

  Yes.

• 13:30Daniel Whiteson?

  I'm noting that the Oxford English Dictionary says that the earliest use of the word rabbit is from the late 1500s by George Chapman. And so obviously the Iraqis didn't use the word rabbit itself. But the idea is translated to the modern word rabbit. Fascinating.

• 13:47Kelly Weinersmith?

  Yeah, yeah. And if you look throughout time, you know, from 4,000 years ago onwards, there are lots of different cultures who have things where you're like, oh, it really sounds like they're talking about rabbit animals from the point that dogs were domesticated onwards.

• 13:59Daniel Whiteson?

  That was my other question. Is this a disease that arises because of domestication, urbanization of civilization, the way many diseases come from like, you know, animals in close quarters? Or is this something that existed and exists among like wild wolves?

• 14:14Kelly Weinersmith?

  Yeah, great question. This is a disease that exists in the wild and has probably existed in the wild long before animal domestication. So for example, in the United States, it's very common in bats, skunks, raccoons and foxes. You can find it in coyotes sometimes also. So it's in a lot of wildlife. It happens to also do really well in dogs when they aren't vaccinated. And so when we started living with dogs, we were bringing it closer to us and in contact with us more often. But this is definitely something that you could have gotten from wild animals. For example, when you were hunting before that.

• 14:45Daniel Whiteson?

  I see. And so if it's an ancient disease, there must be a lot of hilarious ancient treatments for it.

• 14:50Kelly Weinersmith?

  Yeah, right. So hair of the dog was one of them. Another one that I came across was you would take a rooster. You would pull the feathers off of the rooster's anus.

• 15:03Daniel Whiteson?

  It's still alive while you're doing this?

• 15:04Kelly Weinersmith?

  Yeah, yeah. And I'll note, it's actually, you know, it's called an anus, but it's actually a cloaca, which is a word for sewer because for chickens, everything comes out of the same hole. But anyway. And then you would put it on the bite. And if the anus swelled up, you could assume that like the poison had been sucked out by the anus. This did not work.

• 15:23Daniel Whiteson?

  Wait, what do you put on the bite? The feathers or the anus?

• 15:25Kelly Weinersmith?

  The anus, yeah.

• 15:26Daniel Whiteson?

  Oh, wow. I totally misunderstood that.

• 15:28Kelly Weinersmith?

  Yeah, right. And so now maybe you have like whatever bacteria was on the chicken's butt in your wound, which doesn't sound good.

• 15:33Daniel Whiteson?

  How long do you have to have the chicken butt on your wound?

• 15:36Kelly Weinersmith?

  Ah, I don't know, as long as it takes for it to swell up, I guess. I don't know. And then there was another one that unfortunately was like, oh, if the dog bit you, you have to like, take some of the dog's brain and put that in the wound. And so like, if you didn't have rabies before, you probably have rabies now.

• 15:49Daniel Whiteson?

  Yeah.

• 15:50Kelly Weinersmith?

  So that's unfortunate. But some of these methods probably seemed to work because, first of all, not every angry animal that bites you has rabies. And so maybe you get bit, you try the thing, you don't get rabies and you're like, oh, that's great that, you know, the chicken butt thing worked. But like, you weren't going to get rabies anyway because that dog was just a jerk. It didn't have rabies. And not every bite or scratch actually probably has enough rabies virus in it to give you rabies.

• 16:17Daniel Whiteson?

  These are not randomized controlled trials. They're very hard to interpret. Yeah.

• 16:20Kelly Weinersmith?

  Yes. Right, right. Yeah. So, but I mean, you know, you can laugh and be like, oh, ha, ha, ha, what idiots. How could they ever think the chicken butt thing would work? But, you know, there were probably a couple of instances where they were like, hey, you know, Fred got bit by a dog and then he didn't get rabies after he did the chicken butt thing. And you could be like, well, you know, it's worth a shot.

• 16:37Daniel Whiteson?

  Anytime something good happens after a human does something weird, you like create some mythology and you're like, better put a chicken butt on your wrist before you go outside. If you want gold to fall from the tree or whatever, it's amazing how these things just reinforce themselves. We are like bad at statistics natively.

• 16:55Kelly Weinersmith?

  Well, I mean, what's the downside?

• 17:00Kelly Weinersmith?

  I guess if you ask the chicken, there'd be a pretty clear downside.

• 17:02Daniel Whiteson?

  Wow. You know, I haven't been to Virginia in a while, but the culture there has really gone off the deep end.

• 17:08Kelly Weinersmith?

  We got rid of our chickens, so we're not so into that kind of stuff, but.

• 17:12Daniel Whiteson?

  Got rid of? Wow.

• 17:13Kelly Weinersmith?

  Well, we gave them to our brother and sister in law.

• 17:15Daniel Whiteson?

  I see.

• 17:15Kelly Weinersmith?

  We had enough gold falling from the sky after doing the chicken butt thing. So we moved on.

• 17:20Daniel Whiteson?

  As one does. Yeah.

• 17:22Kelly Weinersmith?

  Yeah.

• 17:22Daniel Whiteson?

  So rabies is a disease. What does it cost by? You said it's a virus.

• 17:25Kelly Weinersmith?

  It's a virus. And in the United States, we are pretty lucky. This virus is not something humans need to worry about so much. So about less than 10 people in the United States die from rabies every year.

• 17:37Daniel Whiteson?

  Oh, wow.

• 17:37Kelly Weinersmith?

  That's pretty good odds.

• 17:39Daniel Whiteson?

  That's like fewer than shark attacks.

• 17:40Kelly Weinersmith?

  Yeah. Yeah, I guess I don't actually know how many shark attacks there are, but that sounds about right.

• 17:45Daniel Whiteson?

  It's close to shark attacks, or like struck by lightning or something. It's like, that's very rare.

• 17:49Kelly Weinersmith?

  Yeah, super rare. But about 100,000 people every year are vaccinated after they have a potential rabies exposure. And so these are probably people like veterinarians who had a stray cat brought in that then went on to bite them, animal control people who had to go out and get an animal that was presumed to be rabid, something like that. So there are a lot of people exposed to animals that might be rabid. But because we have great control measures and great vaccines, very few people die from this.

• 18:15Daniel Whiteson?

  Right. And those two numbers are closely linked, right? It's not like, why are we doing this? Hardly anybody dies. It's like, oh, we're not feeling the rain because we're holding an umbrella. The reason few people die is because we vaccinate people, right?

• 18:28Kelly Weinersmith?

  Right. And that's not true around the world. So globally, 60,000 people die of rabies every year. And this is considered a neglected tropical disease because there are parts of the world that can't afford vaccines or can't handle the kinds of mass vaccination efforts you need to keep cats and dogs that are around people vaccinated year after year. And so we are very lucky. Science has a solution to this. And in the United States, we have the infrastructure and the money to make sure it gets where it needs to go. But in other parts of the world, that's not the case.

• 18:59Daniel Whiteson?

  So we vaccinate all the pets, and then humans, if they've been exposed, we vaccinate them. We don't just vaccinate humans across the board?

• 19:06Kelly Weinersmith?

  Yeah, so it depends on who you are. So we have a vaccine that you can give to people who are likely to get exposed. So if you are a veterinarian, you probably get a prophylactic vaccine. Veterinarians get it. Vet techs get it. People who work in animal control get it. If you like to go spelunking, I think in the United Kingdom, this is called potholing.

• 19:27Daniel Whiteson?

  What? No.

• 19:28Kelly Weinersmith?

  Yeah.

• 19:31Daniel Whiteson?

  Let's go for an afternoon in that pothole.

• 19:33Kelly Weinersmith?

  That's right.

• 19:33Daniel Whiteson?

  Nobody ever.

• 19:35Kelly Weinersmith?

  Well, unless you're in the UK. Said plenty of UK people, I think. And the idea there is that caves are places where you find a lot of bats. And bats could be spreading rabies either through bites or through, you know, like saliva. You could breathe it in in an aerosolized sort of way. If you're a hunter, you might want to consider getting vaccinated, depending on what kind of animals you're going after, because when you are skinning those animals, if you have a cut, you can maybe get some stuff in that cut that could transmit rabies to you. So there are certain activities that can increase your risk and you are able to get vaccinated for rabies ahead of time. And then if you engage in another behavior where you think, okay, this time I was definitely exposed to rabies, you'll go in and get some more vaccines to boost your immunity.

• 20:17Daniel Whiteson?

  And what kind of infrastructure is required? Is rabies one of the vaccines that like needs to be chilled and is really complicated? And that's why it's not easily available everywhere?

• 20:26Kelly Weinersmith?

  Yeah, so the way that we make this vaccine now, and we can talk about the history of the vaccine later, but the way that we make the vaccine now is we essentially grow it in human cells in the lab. Or we can grow it in like chicken embryos in the lab. Either way, we're not like growing this in live animals or anything like that. You extract the virus, you kill it, and then you suspend it. And it is kind of expensive. That is part of it. But I think a bigger problem with the vaccine is that this vaccine does have some side effects. So for example, some people will have a reaction called anaphylaxis, where you, you know, have trouble breathing. Some people have like an allergic sort of response to it. The rate of these reactions is pretty low. And what you really need to know here is that once you start showing symptoms for rabies,

• 21:12Kelly Weinersmith?

  you are nearly 100% sure to die from rabies.

• 21:16Daniel Whiteson?

  Oh, wow.

• 21:17Kelly Weinersmith?

  And so if you are exposed to an animal that has rabies, the risk of any of these issues pales in comparison to your risk of dying of rabies. And so you are definitely going to go ahead and get the vaccine.

• 21:29Daniel Whiteson?

  I see. Okay. So this is not the kind of vaccine you just give everybody because there are side effects. But if you've been exposed, then it's definitely a gamble worth taking.

• 21:38Kelly Weinersmith?

  Yes, right. So between the costs and the potential side effects, we don't want to go and vaccinate everyone, especially because in the United States, most of us probably are not going to encounter a rabid animal. So it seems not worth the risk. But for people in risky professions, it might be.

• 21:52Daniel Whiteson?

  So I was surprised by what you said earlier about exposure, like just going for a hike in a cave where there are bats that have rabies might be enough, like aerosolized? I thought you had to get bitten by some cartoon animal.

• 22:05Kelly Weinersmith?

  Yeah. Well, so let's take a break. And when we come back from the break, we'll go through the various ways that you can get infected by rabies.

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• 23:31Daniel Whiteson?

  Okay, we're back and we are taking a bite out of rabies today, furiously understanding the nature of this disease. So tell us, Kelly, how does one get exposed to rabies? What do we have to watch out for? Spelunkers and potholers alike?

• 23:47Kelly Weinersmith?

  Well, the most common way, let's start with the most common way that you get exposed to rabies, and that's through bites and scratches from rabid animals. And in the United States, the most common way you're going to get exposed to a bite or a scratch from a rabid animal is by interacting with a bat. And so if you are in the sort of unlucky situation where a bat accidentally ends up in your house and you, that bat bites you when it's trying to get out, or you wake up in the middle of the night and there's a bat in your room.

• 24:14Daniel Whiteson?

  What, Kelly? You can't just drop that.

• 24:18Kelly Weinersmith?

  That has happened to me.

• 24:21Daniel Whiteson?

  What?

• 24:21Kelly Weinersmith?

  I know, I know. I didn't know at the time, but you might, in those situations, might want to call a medical professional to be like, I found a bat in my room. I was listening to a podcast of people who are studying for their medical boards, and they noted that in that instant, you're supposed to give people vaccines for rabies because you can't be sure they didn't get bitten while they were sleeping? And I was like, oh, man, I didn't call anyone when that happened. I just like opened the window and shooed the bat out. But anyway, I'm still here, so that's good news.

• 24:49Daniel Whiteson?

  Does the fact that that happened, is that the origin of like vampire myths?

• 24:53Kelly Weinersmith?

  Hmm.

• 24:54Daniel Whiteson?

  Like vampires fly in on the wings of a bat, bite you, and then fly out again?

• 24:58Kelly Weinersmith?

  Could be, but there are also like vampire bats that actually suck human blood when they have trouble getting access to other mammals.

• 25:05Daniel Whiteson?

  Oh, boy.

• 25:06Kelly Weinersmith?

  I'm guessing that's.

• 25:07Daniel Whiteson?

  So you could wake up in the middle of the night with a bat on your face, or what else?

• 25:11Kelly Weinersmith?

  But we hope not. But you, you could also, so if, if that animal bites you, its saliva gets into your body, and that's one way that the rabies virus can get into you. Also, if an animal scratches you, you know, maybe they like licked their hand and then they scratch you and that gets the virus in your body. Bats, skonks, raccoons, and foxes, which we talked about already, in the United States, those are animals that are most frequently found to have rabies. That doesn't mean that most of those animals in the wild have rabies. But in the United States, the animals that are most likely to have rabies are those four kinds of animals.

• 25:43Daniel Whiteson?

  And is rabies a kind of virus that doesn't last very long in saliva outside the body? Like if a bat spits on a rock and then you lick that rock like a week later, are you okay? Or is that rock like dangerous forever?

• 25:56Kelly Weinersmith?

  Yeah, right. That is a question only Daniel would ask, and that is. And you would probably be fine. And I'm under the impression that that is why I was told I didn't need to get a rabies vaccine when I picked up that dead bat. I think they were like, that bat's probably been long dead. You're probably fine.

• 26:12Daniel Whiteson?

  Fascinating. It's amazing to me when viruses are so fragile and yet so able to spread anyway. It's incredible.

• 26:18Kelly Weinersmith?

  It is, it is. And I just want to really highlight here, I am not a medical doctor. So if you're like, oh, Kelly said that that bat had been dead for a while that she touched, so I don't need to call the doc. Always call the doctor. If you have any question about rabies, if you've been exposed to anything that puts you at risk of rabies, call your doctor.

• 26:36Daniel Whiteson?

  And I don't suggest licking any rocks. I'm also not a medical professional.

• 26:39Kelly Weinersmith?

  Yeah, yeah. No, actually, you should probably never do anything Daniel suggests. It's just a bad idea.

• 26:44Daniel Whiteson?

  I keep telling my kids that also, yeah.

• 26:46Kelly Weinersmith?

  Yeah, yeah. Well, so and if you live in Africa and Asia, you're most likely to get rabies from dog bites. People encounter dogs a lot. There's in a lot of countries, there's not good programs to regularly vaccinate dogs. And unfortunately, the majority of the bites happen to children who just want to pet a dog and then they get bit.

• 27:03Daniel Whiteson?

  No.

• 27:04Kelly Weinersmith?

  I know. And so, yeah, so saliva from rabid animals is the most common way. Now, it's worth noting that livestock animals like horses can also get rabies. And so you want to be careful and vaccinate as many animals as you're able to.

• 27:16Daniel Whiteson?

  Right.

• 27:16Kelly Weinersmith?

  Very rarely, the virus can be aerosolized for short periods of time. And so that's why, you know, if you're spelunking or potholing in a cave and there's a bunch of bats and there's not a lot of sunlight in there, so sunlight is something that kills the rabies virus pretty quickly, you might be able to breathe in some of the rabies virus. And that is why sometimes spelunkers will get vaccinated. Or if they're going into an area with a lot of bats and they're worried they're going to get bit, then they'll get vaccinated as well. And a very rare way that does sometimes result in rabies is organ transplants. If it was missed that a donor had rabies, and then you can transmit it that way. Again, very rare. We talked about that in the opening.

• 27:58Daniel Whiteson?

  So there's no way to get rabies by like, listening to a podcast about rabies? Our listeners are safe.

• 28:03Kelly Weinersmith?

  That's right. That's right. And you know, I actually, I feel like the more you learn about this kind of stuff, like, yes, it's scary initially, but once you understand how it's transmitted, you can say, okay, I know what I need to worry about. And then I know when I need to call a medical professional. Yes, I still worry because I am me, but I feel like, you know, the scope of my worrying has narrowed a little bit because now I understand when I need to worry and why I need to worry. And I feel like that gives me a little bit of control over the situation.

• 28:29Daniel Whiteson?

  Yeah, although, you know, statistics doesn't help anxiety. I mean, you can look at the numbers and be like, well, on average, that's pretty rare. It doesn't happen to very many people, these terrible scenarios, et cetera, et cetera. On the other hand, you're like, yeah, but there are 10 people out there who do die of rabies every year. And those are real people who also looked at the numbers and they were like, yeah, I'll probably be fine. So there's sort of two ways to look at it, you know, from a public health perspective on average. And then also from the like, am I that one outlier case perspective? Which is the one I always use as of we're here.

• 29:00Kelly Weinersmith?

  Yeah, okay, I do see your point, but like, so in the intro, we talked about a guy who got scratched by a skunk and bled. Presumably what he thought was, uh, it's just a scratch. I probably didn't get bit. And I think this skunk was just trying to eat the kitten and wasn't actually rabid. And so they made some choices that if you knew enough about rabies, or if you were enough of a worrier, could have caused that person to have made a different decision, to at least call the doctor and been like, I don't know, what do you think? I got scratched by a skunk that was angry and was willing to approach me to try to eat a kitten. What would you do? I suspect that doctor would have said, we're gonna go ahead and give you some shots because rabies is 100% fatal, so let's not take any risks.

• 29:41Daniel Whiteson?

  Yeah, although if you are a worrier and you want to be informed by statistics, as you just suggested, then you would be shocked at like, how dangerous it is to drive anywhere. And you should probably just never get in a car and how dangerous household accidents are. So you shouldn't, for example, try to do your kitchen by yourself.

• 29:58Kelly Weinersmith?

  But we don't want Kelly to become a shut-in, so we're gonna talk about what happens once the virus gets in your body. Daniel, what are you trying to do here?

• 30:08Daniel Whiteson?

  I'm just saying statistics-informed decisions are not the way we live our lives.

• 30:11Kelly Weinersmith?

  Yeah, you're right. You're right.

• 30:13Daniel Whiteson?

  But anyway, tell us about the microbiology here. What happens when the virus gets in your body, Kelly?

• 30:17Kelly Weinersmith?

  All right. So the virus gets in your body and it gets into your muscle tissue. And what we've talked about how viruses replicate. They essentially hijack the machinery inside your cell and they tell the cell that it needs to start replicating the virus's genetic material and start making proteins for the virus. So it essentially, the cell becomes like a little factory that starts making more viruses. And then it spits the viruses out and the viruses go out to infect more cells. So that's generally how viruses work.

• 30:44Daniel Whiteson?

  If this sounds familiar to you, reminiscent of how like computer viruses work, that's not an accident. That's why they call computer viruses viruses, not the other way around. Biological viruses didn't steal this idea from hackers.

• 30:57Kelly Weinersmith?

  Yes. And keep that in your head because we're going to come back to that comparison a little bit later. All right. So it starts by getting into like muscle tissue near the site of the bite. And for reasons we don't totally understand, it has the period where it replicates sort of slowly in those muscle tissues. And thank goodness for that because that means there's a period where we can sort of get a leg up on the virus. And this is why we're able to give people a vaccine after they get bitten that can still save their life. And this is another part of why we don't need to mass vaccinate everybody. Because it still works if you just give it to someone afterwards, which doesn't work, you know, quite as well with some other things that we vaccinate against.

• 31:35Daniel Whiteson?

  That seems pretty unusual, right?

• 31:36Kelly Weinersmith?

  Yeah.

• 31:36Daniel Whiteson?

  In almost all cases, you have to vaccinate first for it to take effect, right?

• 31:40Kelly Weinersmith?

  Yeah, no, we are amazingly lucky that this virus has this period where it like sort of sluggishly replicates in muscles for a while before it starts heading for the nervous system. But eventually it will start finding nervous system cells and it will start following nerves to your spinal cord and then start moving up to your brain. And when it starts getting towards its final location, you are going to start getting symptoms like fever, flu-like stuff, gastrointestinal symptoms, and sort of eerily, the location that you got bit will start like tingling or having a prickly sensation. And the reason that's eerie is that this is usually happening about two months after your exposure to the virus. So that site has like long since

• 32:25Kelly Weinersmith?

  healed. And now all of a sudden, you're starting to feel tingling there again. By the time you start having these symptoms, which again, like take two months for the virus to go from that bite site up to the point where, you know, essentially, it's too late. When you start getting those symptoms, there's more or less no way to stop the virus at that point. It's in your central nervous system, and we don't have good treatments for it. At that point, rabies enters one of two forms. The furious form, which is about 80% of the cases, average survival time for this is about six days. Symptoms include like you kind of come in and out of consciousness. Sort of strangely, you become very afraid of water. So this is

• 33:06Kelly Weinersmith?

  called hydrophobia. There are some videos online that I've got to admit, I don't recommend looking up. I watched them once a couple of years ago, and they're just incredibly upsetting to watch. But you know, someone will try to take a drink of water because they're very thirsty. But they'll start having these like gagging reflexes. And it's like they're really afraid of the water and they, you know, kind of can't figure out why, you know, it's like they're be hit, you know, they like they've been hijacked, which essentially, you know, their brains have been. They start to hallucinate.

• 33:34Daniel Whiteson?

  And so help me understand what's happening here. This is all due to brain inflammation as the immune system responds to the rabies? Or is this something rabies is doing to your brain directly?

• 33:44Kelly Weinersmith?

  Yeah. So one of the interesting things about doing the research for this is that places like the World Health Organization say that there's a bunch of inflammation in the brain and that death occurs due to cardio respiratory arrest. And you know, you go into coma and essentially things shut down. But other sources that I read were like, there's surprisingly little inflammation happening in some of these cases. And so we seem a little bit confused. It looks like there's, or maybe not confused, but maybe there's a couple of different ways that rabies can lead to death. It seems like there's a couple of different competing hypotheses. It might depend on exactly what rabies is doing. It seems to take a couple of different forms and maybe it depends on what part of the brain the rabies ends up in.

• 34:27Kelly Weinersmith?

  And in just a second, we're going to talk about a hypothesis that relies on there not being inflammation in the brain. So, hold that thought for just a second. We will circle back to that. There's another form of rabies that happens about 20% of the time called paralytic. Where essentially, starting at the scratch or bite site, the muscles start to become essentially paralyzed and that gradually spreads over the course of the body. And over about 11 days, the person tends to go into a coma and they die. This form tends to be misdiagnosed as a bunch of other things, so it might be under-reported. But one way or another, a rabies death is really an unpleasant death and we don't have a really good way of treating people once symptoms start showing.

• 35:11Kelly Weinersmith?

  But, you may remember around 2004, long time ago, there was in the news, this Milwaukee Protocol where a young girl who started showing symptoms of rabies was brought back from rabies. Do you remember hearing about this?

• 35:26Daniel Whiteson?

  No, tell me.

• 35:27Kelly Weinersmith?

  Okay, so there was this girl who was at church and there was a bat flying around the church and it like was trying to get out the window, but it couldn't get out the window. I think somebody hit it with a broom and it kind of fell down and the girl was trying to help and so she like picked it up and kind of tried to fling it out the window and it bit her on the way out. But she didn't think anything of it. She didn't end up going to see a medical professional to get the rabies vaccine or anything. And like weeks later, she started like going down the tube.

• 35:54Daniel Whiteson?

  You know, all of your stories here, which aren't very dramatic, are also substantiating a lot of mythology. You got like bats in bedrooms, now you've got bats in Belfries. Maybe these cartoons were accurate, I don't know.

• 36:06Kelly Weinersmith?

  Maybe.

• 36:06Daniel Whiteson?

  Alright, so what happened to this girl?

• 36:07Kelly Weinersmith?

  Yeah, so, so she started showing a bunch of symptoms and the doctors just like could not figure out what was happening. And her mom, at one point, like, you know, she was having a chat with the pediatrician and her mom thought to mention like, uh, maybe it was that bat. There was, there was a bat that bit her and I guess the pediatrician like just went pale. When the mom said something about like, oh, there was the bat that bit her. And the pediatrician was like, ah, I'll be right back and made a phone call. And it was confirmed pretty soon after that it was rabies.

• 36:36Daniel Whiteson?

  Oh, no.

• 36:36Kelly Weinersmith?

  And I know. And so they talked to this other doctor and I listened to an interview with the doctor. And the doctor was like, OK, so while we were waiting for the results, I started going through a bunch of case reports for rabies. And there were a bunch of folks who were saying that actually, surprisingly, a bunch of brains didn't show evidence of massive inflammation. The brains looked pretty good, even in people who were dead. So if you do an autopsy, it was kind of amazing how good the brain looked. And so there were some folks who were guessing that actually what was happening wasn't that the virus was like smashing the brain to pieces. Like, you know, I know the brain gets compared to a computer a lot. And that that metaphor falls down in a lot of ways, but we're going to go with it here. We're going to go with the computer and the virus metaphor, you know?

• 37:20Kelly Weinersmith?

  It's not like the virus is smashing the computer with a bat and totally destroying it. It's more like the virus is messing up the way the computer communicates with the different parts of the computer. And it's sort of messing up the way that it, you know, runs. And so what if you could essentially put somebody on life support to get them through a period where the immune system has a chance to catch up? Because some other autopsies found that there wasn't a lot of virus left in the brain, which suggested that the immune system was starting to catch up, but it just didn't have enough time.

• 37:57Daniel Whiteson?

  Oh, interesting.

• 37:58Kelly Weinersmith?

  If you could get someone through, then, you know, maybe their immune system would catch up and they'd be OK. So they ended up putting this girl in a chemical-induced coma. And they put her on life support so her brain didn't have to worry about, you know, breathing or, you know, making her heartbeat or anything like that. That was all done with machines. And amazingly, she lived.

• 38:18Daniel Whiteson?

  How does going into a coma help the immune system catch up? Why does the coma slow down the virus but not the immune system?

• 38:24Kelly Weinersmith?

  As far as I understand it, it's not that it's slowing anything down. It's just that the brain no longer has to worry about keeping the girl alive. That's all being done by a machine. And so even if the brain is no longer like communicating like it's supposed to. That's okay. Machines are taking care of all of that. So the immune system can just have the time that it needs to catch up.

• 38:46Daniel Whiteson?

  Oh, I see.

• 38:46Kelly Weinersmith?

  The machines are playing the role of the brain until the brain is cleared of the virus. And without the virus, the brain will start acting normal again. And I guess his biggest fear was that she might end up with like locked in syndrome where she would sort of never quite be the same again, or might never be able to like communicate again, but she'd still be kind of locked in inside of there. But she ended up making an almost complete recovery.

• 39:10Daniel Whiteson?

  Wow.

• 39:10Kelly Weinersmith?

  And so this was heralded as maybe we finally figured out a way to save people from rabies. And this made the news and was absolutely huge. But in the approximately 20 years since.

• 39:23Daniel Whiteson?

  Here comes Kelly's wet blanket.

• 39:24Kelly Weinersmith?

  Yeah, I know. Of course. Right? How could it be any other way?

• 39:29Kelly Weinersmith?

  Loads of attempts have been made using this protocol. And now you see papers called things like the demise of the Milwaukee Protocol, because it doesn't seem to work in most cases. And it looks like the girl for which this worked, her immune system had started making some antibodies to rabies pretty early on. And we're not quite sure why. It looks like maybe there's some variability. Some people, I don't know, maybe she got exposed to something rabies ish early in her life. Like, there's some subset of people who just seem to be able to mount a quick response. And maybe she just was one of those people and putting her on life support might have given her a little bit of an edge. But it looks like

• 40:09Kelly Weinersmith?

  it just doesn't help the majority of people. And so it's possible that this this protocol takes the probability of death once symptoms for rabies start and brings it from 100% to like 99.5%. And I guess I'll be honest, if my kids got rabies and they were like, what do you think about going to extraordinary measures to increase their probability by 0.5%? I'd be like, yes.

• 40:31Daniel Whiteson?

  Smash that button. Yeah.

• 40:32Kelly Weinersmith?

  Yeah, I don't have to think about that. Let's do it. But you know, the problem is, you know, this is going to come up like maybe 10 times a year in the United States. And for those families, no doubt, you know, that would be important to have some options. But in areas, you know, the areas where you're getting those 60,000 cases of rabies death, it's not really. Be feasible to do these kind of procedures. It's not even feasible in a lot of cases to have vaccine available for these people. And so, you know, I think if in general, we're worried about trying to reduce the number of people who die globally from this disease, what we want to be focusing on is getting vaccines, you know, affordable and distributed throughout the world. So there's some people still working on tinkering with this protocol. Hopefully this can be used to bring the numbers of rabies deaths to zero.

• 41:17Kelly Weinersmith?

  But there's a lot of people who don't believe in this technique anymore. And Kelly has wet-blanketed her way through segment two. And it is time for a break. And when we come back, we'll talk about the history of the rabies vaccine.

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• 42:48Daniel Whiteson?

  All right, we're back and we're talking about rabies today. Kelly, we ended the last segment with a little bit of a wet blanket about the prospects for surviving rabies. So let's make everybody feel good by talking about another glorious story of vaccine development, science in action, saving lives. How did this all happen? When did we get started trying to make a vaccine against rabies?

• 43:08Kelly Weinersmith?

  Okay, yay, science. All right, so around the early 1800s, we started to figure out that saliva was important for transmitting the virus from organism to organism. And that was important because that meant we could start keeping this virus in labs and in lab animals. And if you are not comfortable with animal research, you might want to skip the last part of this episode. So Louis Pasteur starts working in his lab in the 1880s and they decide that they're going to tackle a rabies vaccine. They had already developed two different vaccines. One was for foul cholera. I didn't realize that chickens got cholera, but you know, maybe that's because we've got a vaccine for it now. And another for anthrax. So there were some other vaccines. They had experience with that.

• 43:52Kelly Weinersmith?

  And at the same time, Emile Roux, do you know how to say that, Daniel?

• 43:57Daniel Whiteson?

  I think you said that correctly, yeah.

• 43:58Kelly Weinersmith?

  Yes, nice. All right. Emile Roux had developed a technique for inoculating dogs with rabies.

• 44:05Daniel Whiteson?

  Did it start with butter and flour all mixed together into a thick sauce?

• 44:11Kelly Weinersmith?

  That was a food joke, of course. A delicious food joke.

• 44:16Daniel Whiteson?

  Everything delicious starts with a roux. That's what I learned.

• 44:18Kelly Weinersmith?

  Yeah, no, I'm not going to go into too many details because what it involved was much less appetizing than that. But, but he found a way to keep a series of animals with rabies in the lab and a technique for starting to dry out the virus. As you noted earlier, if the virus dries out, it sort of stops being able to infect people. And actually, we had a series of really great questions from the extraordinaries where they sent us emails and they're like, well, in the polio episode, you were saying that there was a live virus version and a dead virus version. But then in another episode, you told us that viruses aren't even alive. So what do you mean by that?

• 44:57Daniel Whiteson?

  Good question.

• 44:58Kelly Weinersmith?

  Yeah, such a fantastic question. Got me to rethink. You know, the way I was explaining it and the way it gets explained in like the, you know, literature in general. And so I think essentially what it means is like, viruses are able to infect you, but if you mess them up a little bit, they lose some function that allows them to infect you. And one way that you can mess up the rabies virus is by drying it out. And whether we understand what's happened to the virus or not, once you've dried it out a little bit, something that it was able to do before, it now can't do. So it can't complete the process of getting into one of your cells, forcing your cells to make copies of it, and then getting out of the cell so that it can go and infect additional cells. Something about that no longer works when it gets dried

• 45:42Kelly Weinersmith?

  out. But the virus still looks virus enough, like enough of it is still sort of like, present to be recognizable by your immune system. So your immune system can produce antibodies so that the next time it sees it, it can attack it. Does that make sense?

• 46:00Daniel Whiteson?

  Yeah, that makes sense.

• 46:01Kelly Weinersmith?

  Okay, so Emile Roux had figured out how you can keep animals in the lab with rabies and how you can start drying out parts of these animals after you euthanize them. They call it attenuating the virus. So essentially, start making it so that the virus can't infect people as well anymore. And I mention this just because Pasteur often seems to get credit for like, coming up with the rabies vaccine, as though nobody had done any prior work at all. But just like just about all scientific advances, he was building on the work that other people were doing at the time.

• 46:31Daniel Whiteson?

  Right.

• 46:31Kelly Weinersmith?

  Okay, so Pasteur gets to work, and he starts working in rabbits, because working with rabid dogs is probably absolutely petrifying, and working with rabid rabbits is probably much less petrifying. And so he creates a series of rabbits that have rabies. He works on the system where essentially he takes out the rabbit's nervous systems, he dries them out for different lengths of time, and now he essentially has virus that has been inactivated because he has the nervous system cells that the rabbit had, and he has dried them out to kill the virus.

• 47:05Daniel Whiteson?

  And how does a rabid rabbit react? I mean, anybody who has seen Monty Python, for example, knows to be terrified.

• 47:12Kelly Weinersmith?

  Right, that they can jump at your neck, and they know where the jugular is, and you're like, ah!

• 47:17Daniel Whiteson?

  Is that also medically accurate?

• 47:18Kelly Weinersmith?

  Yeah, probably. Yeah, and you know, the way the the knight was able to survive with like, no limbs. Yeah.

• 47:27Kelly Weinersmith?

  That's what Pasteur looked like when the experiments were done.

• 47:29Daniel Whiteson?

  I would love to have been a science consultant for Monty Python.

• 47:33Kelly Weinersmith?

  Oh, my gosh, me, too. Me, too. I read a variety of different sources and I did not find descriptions of how the rabbits were behaving. I think they were much less interested in rabbit behavior and much more interested in just accessing something they could use for a vaccine.

• 47:49Daniel Whiteson?

  Sure.

• 47:50Kelly Weinersmith?

  And so they actually were able to show that if you gave a dog some of this material from the rabbits that had been dried out, and then you exposed the dog to rabies, a dog would not get rabies. And so they were like, holy cow, this vaccine thing seems to be working. This works in dogs. But they were not ready to start testing it in people. In June of 1885, a child who was already starting to show signs of rabies, which we've already said it's too late at that point, was brought in. They tried to give her the vaccine. She passed away. That didn't work. That wasn't a great sign, but they kept doing the work. And then a little bit later in 1885, a boy named Joseph Meister came in. He was a nine-year-old boy. He was bit by a rabid dog a bunch of times, like more than

• 48:34Kelly Weinersmith?

  10 times. This kid had initially been brought to Emile Roux, who we talked about a little bit earlier. And Emile was like, I do not feel comfortable giving this kiddo the vaccine. He wasn't 100% clear about his reasons, but based on what he wrote in other places, we think that it's because he was like, look, and I've tested it in dogs. My vaccine seems pretty good in dogs, but I just don't feel comfortable giving it to people yet. It could be way too dangerous.

• 48:57Daniel Whiteson?

  Yeah, that's a terrifying decision to have to make.

• 49:00Kelly Weinersmith?

  Yes, absolutely. Right? Because you know, if this kid was actually bitten by a rabid dog, you might be the only one who can save his life. But if he was just bitten by some dog that's a jerk, you might kill him with your vaccine.

• 49:12Daniel Whiteson?

  Oh, boy.

• 49:13Kelly Weinersmith?

  And so he passed, but Pasteur's lab decided to go for it. Pasteur was a chemist, so he couldn't do the injection. But his colleague, Jacques Joseph Grancher, why couldn't it just be people with boring English names that make scientific advances? I don't know, but my apologies to the French-speaking world. Anyway, he administered the rabies vaccine they had been working on. And then he gave this kid 12 additional doses that had a vaccine that had been dried for less and less time. So essentially, he gave him stronger and stronger versions of the virus each time. And this kid survived.

• 49:51Daniel Whiteson?

  Oh.

• 49:52Kelly Weinersmith?

  He's the first person we know of to survive being exposed to rabies, get a vaccine, and now he lives, which is amazing. And then they pulled this trick off again a little bit later with a kid who was a shepherd. Around this point, they also had the first, what we call prophylactic vaccine, which is where you get a vaccine before you get exposed. And this was essentially because while they were administering the vaccine, somebody accidentally injected themselves with the vaccine. And they were like, well, now we're gonna see how that goes.

• 50:23Daniel Whiteson?

  I guess so.

• 50:24Kelly Weinersmith?

  I guess now we know about that.

• 50:26Daniel Whiteson?

  Accidental experiment.

• 50:27Kelly Weinersmith?

  That's right. But that turned out OK. And so that was, that was the start of our vaccine procedure with rabies. And then a bunch of labs around the world, you know, came to see how this worked and they started growing, you know, rabbits in their labs and trying this procedure. And then the rabies vaccine, you know, a bunch of different labs popped up around the world that produce these rabies vaccines. And that's how it started.

• 50:49Daniel Whiteson?

  My favorite thing is when science can develop a treatment that helps save children's lives. You know, like, how many children were bitten by dogs or scratched by dogs and then died a horrible, painful, excruciating death of rabies? Like, anytime when we can reduce childhood suffering, yay, science.

• 51:06Kelly Weinersmith?

  Yes, and that's part of, like, why this story also makes me so upset, because there are children dying around the world in the tens of thousands.

• 51:15Daniel Whiteson?

  Yeah.

• 51:16Kelly Weinersmith?

  That shouldn't be, because science has the solution.

• 51:19Daniel Whiteson?

  Yeah.

• 51:20Kelly Weinersmith?

  But we haven't found a way to get them access to it.

• 51:23Daniel Whiteson?

  It's a political or financial or an engineering issue?

• 51:25Kelly Weinersmith?

  Yeah, right. And that stinks when science has the answer and it's, it's not getting to them. So let's, let's go ahead and talk real quick about what happens today.

• 51:33Daniel Whiteson?

  Yeah.

• 51:34Kelly Weinersmith?

  We talked about how if you have a job where you know you're gonna get exposed regularly to animals that might have rabies, you can get the vaccine ahead of time. So the vaccine is grown up in cell cultures. So you don't need, like, whole humans. We just have figured out how to keep some subset of human cells alive in, like, a Petri dish or some, you know, chicken embryos alive. We grow up the virus in there.

• 51:57Daniel Whiteson?

  Right.

• 51:57Kelly Weinersmith?

  We extract the virus, we kill it, and then you get that vaccine. That starts giving you some immunity. Then if you subsequently get exposed to rabies, you'll get some boosters.

• 52:08Daniel Whiteson?

  Wait, I just realized I didn't understand something basic. When my dog gets a rabies vaccine, it's not the same vaccine as I get, is it? Is there a human and a dog version? Or is it the same thing?

• 52:18Kelly Weinersmith?

  I did not do extra research on the dog version. I do know that there's a couple of different versions of vaccines. So for example, sometimes if there's a lot of rabies in a wild population, they will put some vaccines in food and essentially drop the food from plains and like feed coyotes. And that is a totally different version than what humans get because it's way less regulated. And so I know that depending on what animal the vaccine is getting, there's different regulations and so they can give different kinds of vaccines.

• 52:48Daniel Whiteson?

  But the same principle should apply, right? That if you have this weakened vaccine, it should help a dog's immune system or a human's immune system, even if those immune systems and the biology are different.

• 52:56Kelly Weinersmith?

  Yeah, I mean, they might grow it up in dog cell cultures rather than human cell cultures so that you don't get like allergic reactions or something, but probably the idea is is pretty similar. But again, I want to reiterate, I didn't actually research how those vaccines are made. I was focusing on human stuff for this episode. Okay, so if you you're a veterinarian, you got your vaccines ahead of time, then you get bit by a rabid cat. You'll get a couple of extra vaccines after you know you've gotten bitten just to boost your immune system. And that is almost 100% effective and you are very unlikely to die from rabies in that situation, which is absolutely amazing. Yay, science. Okay, if you have never gotten a rabies vaccine before, we do something a little bit different. And this is pretty awesome, I think.

• 53:39Kelly Weinersmith?

  So we have something called rabies immune globulin. So essentially what they do is they immunize either people or horses with the rabies vaccine.

• 53:50Daniel Whiteson?

  Okay.

• 53:50Kelly Weinersmith?

  And then they draw blood and they extract the plasma. We've talked about plasma before when we were talking about making synthetic blood and stuff. In the plasma, you have antibodies. We've talked about antibodies. They bind to something on, in this case, the rabies virus and they inactivate it. For example, maybe they make it so that the virus can no longer bind to a muscle cell and get into it. And so they essentially make it so that the the virus can't do what it needs to do to replicate.

• 54:18Daniel Whiteson?

  Right.

• 54:19Kelly Weinersmith?

  They neutralize it in some way. And so they take out the antibodies that the human or horse immune system made. And then they inject that into you near the bite site. So essentially you outsourced the initial immune response from some other organism.

• 54:37Daniel Whiteson?

  Right.

• 54:37Kelly Weinersmith?

  And that gives you a head start. So while your immune system is responding to the vaccine and is trying to make its own response to rabies, you're borrowing someone else's immune response to give you a head start. You know, maybe that will do the trick. Maybe that will bind to all of the viruses that are trying to get into muscles initially. And then just in case your, you know, your body will start making your own antibodies and you'll get a series of, I think it's something like three vaccines. It used to be you'd get a bunch of vaccines in like your abdominal region. And I think there's a little bit of folklore where people used to think it was like 20 vaccines that all had to go through your abdominal wall into your stomach and it was super painful. And it wasn't like that. Like it was painful.

• 55:19Kelly Weinersmith?

  It was like in your sort of tummy region, but it didn't need to go like into your stomach through your abdominal wall. But now it is way less uncomfortable. It's like two or three shots, usually in like the muscle in your arm. We also have like a version that goes just like right under your skin now, way less painful. Yes, the next day you probably feel pretty sore, especially after the third shot, but you're probably not going to die of rabies. So yay.

• 55:47Daniel Whiteson?

  Definitely worth it.

• 55:48Kelly Weinersmith?

  Definitely worth it. Yeah. So those are our treatments. But so in the United States, about 100,000 people need to get those series of shots after they get exposed to an animal that might be rabid. But the main thing that we do that protects us is we have this system where each state has a series of laws where you have to vaccinate your dogs and your cats. And that's the main thing that protects us because globally, most of the people who get bit are getting bit by dogs.

• 56:14Daniel Whiteson?

  Not by bats in their bedroom.

• 56:15Kelly Weinersmith?

  Not by bats in their bedroom. Yeah, dogs are a much bigger risk. And so if we could just have similar programs where everybody like had to vaccinate their dogs and maybe there's some cultural problems, you know, cultural difficulties, hurdles to get across. But I think a lot of it is like having the infrastructure, the ability to get the vaccines there, the ability to like make sure that you've got records so that you're giving the vaccines every single year. But if you could get that stuff in place, we could have a lot fewer deaths. And the few times that people do get bit by rabid animals, if you could have the human vaccines available, we wouldn't have to have about 60,000 people every year dying from this horrible disease.

• 56:52Daniel Whiteson?

  Yeah, let's hope that the folks in charge of that figure it out.

• 56:56Kelly Weinersmith?

  Yeah, I hope so. So should we end for anybody who I know we've discussed? Statistics isn't how we live our lives, but do we want to end on a couple of notes about how to try to prevent rabies in your life?

• 57:09Daniel Whiteson?

  Yeah.

• 57:09Kelly Weinersmith?

  Okay.

• 57:09Daniel Whiteson?

  Exactly. Other than vaccinating your pets and closing the windows in your bedroom, what should you do to avoid rabies?

• 57:15Kelly Weinersmith?

  All right. Well, so I'll note, this was a little bit surprising. You're supposed to vaccinate your cats and dogs, also your ferrets. I guess there are some places that have rules about vaccinating ferrets.

• 57:25Daniel Whiteson?

  All right.

• 57:25Kelly Weinersmith?

  You can also vaccinate things like horses. My recommendation, anything you can vaccinate, vaccinate. Keep your pets from interacting with wild animals. So, you know, maybe don't just let your animals run wild. I am mostly talking to me. I live on a farm. Sometimes I just let my dog out and I'm like, oh, have fun. See you in a few hours.

• 57:42Daniel Whiteson?

  Yeah.

• 57:43Kelly Weinersmith?

  Maybe I should be more careful about that. Report stray animals to local authorities. You shouldn't touch wild animals. Like if you see a skunk that looks sick, call animal control or something. Don't touch them on your own. That poor animal could be rabid. They could give it to you. Keep bats out of your house. Make sure you have like screens on your windows if possible. If you are going to do a high risk activity like spelunking in a cave that has a lot of bats, consider trying to get the vaccine preventatively. You can talk to your doctor. And if you think you've been exposed to the rabies virus, wash the area thoroughly and then immediately go seek medical attention. And if you are ever unsure, call a doctor or go see a doctor. For me, I think I'm supposed to call my local

• 58:24Kelly Weinersmith?

  poison control center for advice, but like call 911, figure out who you have to talk to. Don't worry about, you know, looking silly or something. This is a serious disease. Don't mess around.

• 58:36Daniel Whiteson?

  That's right. Don't worry about finishing this podcast before you call your doctor. Pause it right now and call your doctor.

• 58:41Kelly Weinersmith?

  Yes, right. And Kelly is not a medical doctor. Kelly is not the kind of doctor that most people recognize as being a doctor. When they ask, is there a doctor on the plane? They don't mean me. So don't take medical advice from me. Talk to a medical doctor.

• 58:56Daniel Whiteson?

  But thank you, Kelly, for that tour of the history of rabies. And thank you, Gurjeet, for sending us your curious question. If there are things you want to hear a deep dive about, please don't hesitate to write to us. We want to hear from you. [email protected].

• 59:11Kelly Weinersmith?

  Thanks, everyone. Have a good day. Avoid skunks.

• 59:22Kelly Weinersmith?

  Daniel and Kelly's Extraordinary Universe is produced by iHeartRadio. We would love to hear from you.

• 59:27Daniel Whiteson?

  We really would. We want to know what questions you have about this extraordinary universe.

• 59:33Kelly Weinersmith?

  We want to know your thoughts on recent shows, suggestions for future shows. If you contact us, we will get back to you.

• 59:40Daniel Whiteson?

  We really mean it. We answer every message. Email us at [email protected].

• 59:47Kelly Weinersmith?

  Or you can find us on social media. We have accounts on X, Instagram, Blue Sky, and on all of those platforms, you can find us at D and K Universe.

• 59:56Daniel Whiteson?

  Don't be shy. Write to us.

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