Milwaukee Rabies Protocol

The latest ProMed reports a case of a Brazilian boy who survived rabies.  Like all previous survivors except one, he received vaccine as prophylaxis, but prophylaxis was incompletely administered (no immunoglobulin.)  Apparently unlike the previous survivors, the virus was isolated from the patient.  He was treated with the Milwaukee protocol first tried on the non-vaccinated girl in Wisconsin who survived.  To what extent this is a result of the protocol is unclear - rabies after failed prophylaxis appears to have a higher survival rate, especially for bat rabies.
 
The ProMed report [22 Nov 2008] - Rabies, human survival, bat - Brazil (02)
 
Milwaukee Protocol 2.1 with its checklist can be obtained at the Children's Hospital of Milwaukee Rabies Registry page.

A few articles referenced in the protocol or the ProMed article or discussing the protocol:
 
Jackson AC. Rabies: new insights into pathogenesis and treatment. Curr Opin Neurol 2006;19:267-70.
PubMed link | Journal link

Wilde H. Failures of post-exposure rabies prophylaxis. Vaccine 2007;25:7605-9. Epub 2007 Sep 14.
PubMed link | Journal link

Jackson AC, Warrell MJ, Rupprecht CE, et al. Management of rabies in humans. Clin Infect Dis 2003;36:60-3. Epub 2002 Dec 11.
PubMed link | Journal link

Willoughby RE Jr, Tieves KS, Hoffman GM, et al. Survival after treatment of rabies with induction of coma. N Engl J Med 2005;352:2508-14.
PubMed link | Journal link

Hemachudha T, Wilde H. Survival after treatment of rabies. N Engl J Med 2005;353:1068-9.
PubMed link | Journal link

Jackson AC. Recovery from rabies. N Engl J Med 2005;352:2549-50.
PubMed link | Journal link

Hu WT, Willoughby RE Jr, Dhonau H, Mack KJ. Long-term follow-up after treatment of rabies by induction of coma. N Engl J Med 2007;357:945-6.
PubMed link | Journal link

Wilde H, Hemachudha T, Jackson AC. Viewpoint: Management of human rabies. Trans R Soc Trop Med Hyg 2008;102:979-82. Epub 2008 May 16.
PubMed link | Journal link

Human rabies--Indiana and California, 2006. MMWR Morb Mortal Wkly Rep 2007;56:361-5.
PubMed link | Journal link

cave canem? cave etiam vespertilionem!

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