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On 6 July 1885 Joseph Meister, a 9 year old boy who had been severely bitten 2 days before by a rabid dog, was treated in Paris with the rabies vaccine developed in Louis Pasteur’s (1822–95) laboratory after years of brilliant scientific research and experimentation on animals.1,2 Before this, no one who had developed the symptoms of rabies had survived. Meister was at the highest risk of developing symptoms but, after 10 days of vaccinations, he was fine and lived for many years. The results of this and a second case were so dramatic compared with previous experience that, by October, speakers at the French Academy of Sciences stated that it was “necessary to organize this treatment for everyone” and “This is a memorable day in the history of medicine”. Philanthropic contributions poured in and by 1888 the Pasteur Institute was founded. By then about 1200 patients had been vaccinated with a mortality rate of 1%.3
Transmitted to humans by animal bites, rabies has always been a rare event. A biting animal may not have rabies. Verification that an animal is rabid is not always possible if the animal cannot be caught and watched. A rabid animal that bites does not always transmit the rabies virus. If the person is infected, the incubation period is about 20–60 days before symptoms develop leading to a painful and certain death.4 Today there are occasional reports of survival but these are so rare as to make headlines.5 The rarity of rabies and the long incubation period led to Pasteur’s novel approach of not vaccinating everyone preventively. The incubation period allowed time for his 10 days of vaccination to build immunity.
Would you—having been infected by a rabid dog—be willing to participate in a randomized controlled trial (RCT) when …