Mother Child W Physician

Welcome to the Rabies Registry Website

Kaplan-Meier survival curves of the first 70 attempts using the Milwaukee protocol, using intention-to-treat. Approximately half of the attempts met 2 assumptions (normal immunity without immunomodulation, no major end organ damage) and included key drugs. Included for comparison (in dark blue) are rabies cases restricted to Western Europe, Japan, Canada and United States published in PubMed or ProMED from 2000-2017. Survival using any version of the Milwaukee protocol is significantly longer than for contemporary controls.
rabiessurvivors20618

Milwaukee Protocol

The materials made available at this site are intended as general medical information and are not intended to constitute a recommendation as to a course of medical treatment for any specific patient. They are provided for the limited purpose of assisting clinicians as they evaluate available treatment options. These materials represent the insights and opinions of physicians involved in treatment of patients with rabies and are not the result of activities pursuant to an approved research protocol, and they should be evaluated on that basis. The information provided at this site is based on a very limited experience and therefore may not be applicable in any other situation. Each rabies patient is unique, and factors such as general good health, excellent and adaptive medical intensive care, and careful avoidance of mistakes and complications of intensive care may prove to be essential to positive outcomes.

The information, including the identification of key issues, and the recommendations provided remain preliminary in nature. As noted, they do not constitute the current standard of care. These materials will be modified as additional data is accumulated. The risks associated with the course of treatment described generally in these materials must be understood and carefully evaluated by physician and patient before treatment decisions are made. Any additional information that other clinicians or researchers may provide related to the treatment of rabies in other patients is greatly appreciated.

Milwaukee Protocol (PDF)

All materials ©2005 The Medical College of Wisconsin, Inc.

Rabies Links

Alliance for Rabies Control
Centers for Disease Control and Prevention
Rabies in the Americas
One Health Commission

Publications

  1. Johnstone J, Saxinger L, McDermid R, Bagshaw S, Resch L, Lee B, et al. Human Rabies -- Alberta, Canada, 2007. MMWR 2008;57(8):1-4.
  2. Rubin J, David D, Willoughby RE, Jr., Rupprecht CE, Garcia C, Guarda DC, et al. Applying the Milwaukee Protocol to treat canine rabies in Equatorial Guinea. Scand J Infect Dis 2009;41(5):372-5.
  3. Hunter M, Johnson N, Hedderwick S, McCaughey C, Lowry K, McConville J, et al. Immunovirological correlates in human rabies treated with therapeutic coma. J Med Virol 2010 Jul;82(7):1255-65.
  4. Aramburo A, Willoughby RE, Bollen AW, Glaser CA, Hsieh CJ, Davis SL, et al. Failure of the Milwaukee protocol in a child with rabies. Clin Infect Dis 2011 Sep;53(6):572-4.
  5. O'Sullivan A, Willoughby RE, Mishchuk D, Alcarraz B, Cabezas-Sanchez C, Condori RE, et al. Metabolomics of cerebrospinal fluid from humans treated for rabies. J Proteome Res 2013 Jan 4;12(1):481-90.
  6. Caicedo Y, Paez A, Kuzmin I, Niezgoda M, Orciari LA, Yager PA, et al. Virology, immunology and pathology of human rabies during treatment. Pediatr Infect Dis J 2015 May;34(5):520-8.
  7. Willoughby RE, Jr. Rabies: Rare Human Infection - Common Questions. Infect Dis Clin North Am 2015 Dec;29(4):637-50.
  8. Wiedeman J, Plant J, Glaser C, Messenger S, Wadford D, Sheriff H, et al. Recovery of a patient from clinical rabies--California, 2011. MMWR Morb Mortal Wkly Rep 2012 Feb 3;61(4):61-5.

Contact Us

We are very interested in hearing constructive comments on the Milwaukee protocol, but it is much more important that patients receiving the Milwaukee protocol or its components be registered so that this information can be shared openly with the international medical community. We are also happy to share experiences on the management of patients with rabies. Please recognize that the website and email links are operated under minimal budget and by few individuals. We cannot guarantee 24 hours daily / 7 days weekly responses to emails, but will try our best to respond quickly. The Centers for Disease Control, Rabies Branch (404) 639-1050; after hours: (770) 488-7100 always has experts on call to assist in the diagnosis and management of rabies.