If you contract rabies, your best shot of beating it is to get a vaccine before symptoms show.
Because once the virus reaches your brain, your chances of survival are next to nil. In recent years, however, doctors have devised an intensive, experimental treatment that involves putting the patient in a medically-induced coma in hopes of keeping them alive long enough for the body to fight off the virus on its own.
On Monday, Toronto Public Health confirmed the city had seen its first case of rabies in more than 80 years. The department would release little information, except to say that the victim had recently been outside of the country. It was unclear where the infection came from.
"The source is unknown," said Jennifer Veenboer. "We're waiting on tests of the strain."
Such cases are a rarity -- the last one in Toronto was a three-year-old child in 1931 -- in large part because of successful vaccination programs. A rabies vaccine was developed in the late 19th century.
The spread of the vaccine among household pets, particularly dogs, helped dramatically reduce the number of humans to contract the disease in the developed world. Many jurisdictions, including Ontario, also have programs for vaccinating wild animals -- like foxes and raccoons -- primarily by leaving an oral vaccine with food in the wilderness.
The virus is usually passed through an animal bite. When a person contracts rabies, the virus must travel through the body to reach the brain. This process can take a few days or a few months. Typically, there are few symptoms in these early stages.
But this is when it is vital to get treatment. First, the wound must be disinfected. Then, doctors administer a shot of rabies immunoglobulin into the tissue around the bite -- which can be painful -- and sometimes into the butt cheeks. Over the following days, the patient receives several injections of vaccine.
Once the virus reaches the central nervous system, the brain and spinal cord swell up. Symptoms begin with chills, fever and shooting pain from the site of the bite.
There are two forms of the disease: furious rabies is marked by hyperactivity and confusion, along with spasms brought on by water and air.
Paralytic rabies, meanwhile, causes the sufferer to gradually become paralyzed, starting at the site of the bite, and slip into a coma.
Most patients with advanced symptoms die within days, usually of respiratory failure.
Doctors in Milwaukee, however, developed an experimental treatment in 2004, when they were presented with a 15-year-old girl who had contracted the disease after she was bit by a bat. They reasoned that rabies kills by interfering with brain activity and causing it to disrupt the heart and lungs. So, they posited, if you could shut the brain off with sedatives to keep it safe and keep the patient alive, her body would eventually fight off the virus.
In that case, it worked. The treatment has been used several more times, but the patients have survived in only a few cases.