As someone who spends an inordinate amount of time reviewing stories about vaccines, I read way too many tragic ones about children dying from vaccine-preventable diseases. But a recent story, about a six-year-old boy named Ryker Roque who died from a rabies infection, was particularly sad and devastating. He could have avoided rabies, and its horrific consequences, with just a couple of better choices from his parents. If only they had used the rabies vaccine immediately, this would not be a story.
Let’s be clear – I don’t know if the parents of Ryker are anti-vaccine or not, but they made a choice about the rabies vaccine that led to their son’s death. That makes the story tragic and sad. I know his parents are incredibly distraught, and probably wish they had made better choices – but maybe their story will prevent future tragedies. I hope.
All about rabies and the rabies vaccine
The rabies virus is slow to infect a human, although the course of infection is highly variable, depending on how much virus was transmitted from the infected mammal. The incubation period (the period between initial infection to first symptoms) is about 1-3 months in humans, but can be as short as four days and as long as six years.
The initial signs and symptoms of rabies are nonspecific – it includes fever and headache which can be misdiagnosed as many other diseases. As the infection progresses and causes meningoencephalitis, an inflammation of the brain and/or meninges, it leads to more severe symptoms. These signs and symptoms can include paralysis, anxiety, insomnia, confusion, agitation, paranoia, terror, and hallucinations. This eventually leads to coma and death, usually 2 to 10 days after first symptoms appear.
Once someone presents with the earliest symptoms or rabies, they have an extremely poor prognosis – more than 90% will die. The “Milwaukee protocol” treatment has been used to treat patients who have become symptomatic, although its success rate is limited, and many researchers dispute that it even works at all (see Note 1).
The only prevention and treatment for rabies is the rabies vaccine. Although the vaccine is strongly recommended (and probably legally mandated) for your pets, it is generally not given to humans prior to infection except when someone is frequently in contact with rabies-infected mammals.
However, the CDC’s Advisory Committee on Immunization Practices (ACIP) has established a postexposure prophylaxis protocol to treat a rabies infection. The recommendation needs to be implemented immediately after exposure from an infected animal (either confirmed or suspected) – once again when symptoms appear, it’s too late.
This protocol includes the following steps:
- Thorough cleansing of the wound site with a virucidal soap and water.
- A proper injection dose (based on the weight of patient) of human rabies immunoglobulin, which attacks the rabies virus.
- Four doses of the rabies vaccine, at days 0, 3, 7, and 14, which boosts the immune system to destroy the rabies virus.
The old method of several painful injections in the abdomen is long gone. All of these injections are done intramuscularly in the deltoid muscle. The success rate of this protocol, if done immediately after exposure, approaches 100%.
Thus, if you get immediate treatment for rabies after a bite or scratch from a confirmed or suspected rabies-infected mammal, your chances of living are quite large. If you wait until symptoms appear, the chances of survival drop to almost nothing. This should not be much of a choice.
The story of Ryker Roque
This story begins with a rabies-infected bat. Apparently, the father, Henry Roque, found a sick bat on a walk. According to Mr. Roque,
(I) found a bat, put it in a little bucket, put it on the porch and I had asked my son, ‘don’t touch it under any circumstances’. So, apparently he put his hand in there and touched it and he said it only scratched him, so I frantically googled it real quick and it says to wash his hands with soap, hot water for five minutes.
This is the first major error by Ryker’s parents. Although it may have been a good thing to try to save the life of a bat, a major vector of rabies virus, it was actually quite dangerous. The father should have called animal control immediately, so they could remove the bat and determine if it had rabies.
The second major error was putting the bat in a place where his child could get access to the bat. Kids are naturally curious about animals, and they would be tempted to pet the little animal. And remember, Ryker was only six years old, an age where good decisions are sometimes kind of rare.
At this point, the parents just made bad decisions, not deadly ones. I would probably give them a piece of my mind about rabies, and then tell them to get Ryker to the hospital immediately for prophylaxis treatment.
And this is the point where the parents made a wrong, and ultimately deadly, choice. One that is extremely difficult to rationalize.
Young Ryker complained about getting shots, and the parents shockingly relented to his complaints – they did not get him proper medical treatment. And no, Ryker’s parents were not ignorant, they had contacted medical professionals who were rightfully concerned about the bat and the scratch. But despite that information, they chose to not get their son the prophylactic shots.
Eventually, Ryker presented with more severe symptoms, and he was taken to a hospital in Orlando, Florida. By that time, it was too late to use the standard prophylaxis on the child, and his prognosis was poor. He died on Sunday.
My thoughts about Ryker and the rabies vaccine
I empathize with how much Ryker had to suffer in his final few days. He was placed in an induced coma, which probably minimized his pain.
I empathize with the parents who watched their son die. The one nightmare that all of us parents have is the loss of any of their children. Children should never die before their parents.
However, I am beyond angry about the choices the parents made. Yes, attempting to save the bat is probably righteous, although they put their child at risk in doing so.
But not getting the vaccine because of Ryker’s complaints? I cannot overlook that horrific lack of judgment. Rabies immunoglobulin and the rabies vaccine would have given Ryker a nearly 100% chance of living a normal life. And again, I wouldn’t be writing about this story.
As of today, there is no evidence that Ryker’s parents are anti-vaccine. They chose to not get the critical prophylaxis because a child made a fuss about the shots. A six-year-old child does not have the capacity to understand or comprehend the consequences of rabies. The parents should have stood their ground (and I can only imagine that they wish they had) and gotten the rabies vaccine and immunoglobulin shots.
I hope this story, and how to deal with rabies, is impactful to parents who have to make the same choice. And let’s hope that tragic stories like Ryker’s are few and far between.
- The hospital attempted to use the Milwaukee Protocol, a method to treat patients who are symptomatic for rabies after the prophylaxis protocol is no longer indicated. The treatment involves placing the patient into a chemically induced coma and administering antiviral drugs until the patient recovers. At best, the protocol has an 8% effectiveness rate. Many scientists that research rabies infection in humans are highly critical of the Milwaukee Protocol, and have urged hospitals to abandon it. Basically, there is little solid evidence that the protocol is effective. Because some individuals can survive the disease, it appears that the effectiveness rate for the protocol is essentially random – those that recover probably would recover irrespective of the use of the protocol.
- Jackson AC. Human Rabies: a 2016 Update. Curr Infect Dis Rep. 2016 Nov;18(11):38. Review. PubMed PMID: 27730539.
- Manning SE, Rupprecht CE, Fishbein D, Hanlon CA, Lumlertdacha B, Guerra M, Meltzer MI, Dhankhar P, Vaidya SA, Jenkins SR, Sun B, Hull HF; Advisory Committee on Immunization Practices Centers for Disease Control and Prevention (CDC).. Human rabies prevention–United States, 2008: recommendations of the Advisory Committee on Immunization Practices. MMWR Recomm Rep. 2008 May 23;57(RR-3):1-28. PubMed PMID: 18496505.
- Rupprecht CE, Briggs D, Brown CM, Franka R, Katz SL, Kerr HD, Lett SM, Levis R, Meltzer MI, Schaffner W, Cieslak PR; Centers for Disease Control and Prevention (CDC). Use of a reduced (4-dose) vaccine schedule for postexposure prophylaxis to prevent human rabies: recommendations of the advisory committee on immunization practices. MMWR Recomm Rep. 2010 Mar 19;59(RR-2):1-9. Erratum in: MMWR Recomm Rep. 2010 Apr 30;59(16):493. PubMed PMID: 20300058.
- Zeiler FA, Jackson AC. Critical Appraisal of the Milwaukee Protocol for Rabies: This Failed Approach Should Be Abandoned. Can J Neurol Sci. 2016 Jan;43(1):44-51. doi: 10.1017/cjn.2015.331. Epub 2015 Dec 7. Review. PubMed PMID: 26639059.
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