No Rabies Treatment After All: Failure of the Milwaukee Protocol

By Chris Healey

Doctors are abandoning the only treatment for rabies.

The Milwaukee protocol, a procedure reported to prevent death after the onset of rabies symptoms, has been performed over 26 times since its inception in 2004 but has only saved one life. Overwhelming failure has lead health officials to label the protocol a red herring.

Rabies is caused by the rabies virus, an RNA-based virus in the genus Lyssavirus. Transmission typically occurs when virus-laden saliva from a rabid animal enters a wound or mucous membrane. Infection typically occurs from a rabid animal bite. The virus travels along peripheral nerves until it reaches the brain and salivary glands. A characteristic rabies symptom is aversive behavior toward water or water consumption called hydrophobia. Individuals demonstrating hydrophobia will generally avoid water and resist drinking it. Other symptoms include anxiety, nerve pain, itching, impaired sensation of touch, convulsions, paralysis, and coma. Cases among unvaccinated individuals almost always result in death.


The Milwaukee protocol was conceived in 2004 by a team of medical professionals, led by Dr. Rodney Willoughby, after a 15-year-old girl was admitted to a Milwaukee hospital after a rabies diagnosis.

After consulting with researchers at the Centers for Disease Control and Prevention in Atlanta, the team formulated and implemented a novel procedure. The patient was placed in a drug-induced coma and given an antiviral cocktail composed of ketamine, ribavirin, and amantadine. Considering the theory that rabies pathology stems from central nervous system neurotransmitter dysfunction, doctors hypothesized suppressed brain activity would minimize damage while the patient’s immune system developed an adequate response.

The patient was discharged from the hospital 76 days after admission. She demonstrated speech impediment and difficulty walking during a clinic visit 131 days after discharge. It is unclear how long those conditions persisted. In subsequent years, the patient attended college. She remains the only Milwaukee protocol success.


There has been confusion regarding the efficacy of the Milwaukee protocol. A 2009 report published by Dr. Willoughby in the journal Future Virology described the efficacy and promise of the procedure. In that article, Dr. Willoughby cited two new instances of rabies patient survival following Milwaukee protocol implementation. Those two cases brought the total number of rabies patients saved by Milwaukee protocol procedure to three. However, those survivor reports were rebuked by a 2013 article published in the journal Antiviral Research. That article explicitly states Dr. Willoughby’s claims in Future Virology are misleading because the two patients mentioned actually succumbed to rabies.

Overwhelming Milwaukee protocol failure has been attributed to anomaly in the initial patient. For example, she was bitten by a bat, but that bat was not recovered. Without the bat, it is impossible to test the causative rabies agent to rule out a less virulent variant. A mild version could be fought off more easily and could help explain her survival. Additionally, researchers cannot rule out the possibility the patient possessed extraordinary physiology that somehow impaired the rabies progression.

Health officials claim Milwaukee protocol repetition impedes efforts to find new treatments. Instead of exploring new techniques, doctors fall back on the Milwaukee protocol because it was once successful. Crushing failure has prompted the health community to place a taboo on the protocol, encouraging experimentation that may lead to different treatment options.

 

Image Credit: CDC

15 thoughts on “No Rabies Treatment After All: Failure of the Milwaukee Protocol

  1. You should research a little better: try Marciano Menezes, 2008, in Brazil and Precious Reynolds, 2011, in California, both saved by Milwaukee Protocol. These cases are well documented. There are others, with little information.

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    1. Seriously, a brief internet search yielded two other survivors. And there was a third boy who survived the rabies but died from ventilator complications. 4 out of 26 is actually pretty damn good considering it used to be zero.

      Liked by 1 person

    2. The 2013 article “Current and Future Approaches to the Therapy of Human Rabies” by Alan C. Jackson published in the journal Antiviral Research provides the following explanation for why those cases no longer count as Milwaukee Protocol success stories:

      “In particular, assessment of the protocol’s true efficacy has been obscured by claims of survival in two cases in Colombia and Peru that were actually fatal and by the inclusion of a patient who received rabies vaccine before the onset of illness (Ministerio da Saude in Brazil, 2008) and of a young patient in California who never developed neutralizing anti-rabies virus antibodies in the serum of CSF and recovered quickly form the illness (Wiedeman et al., 2012), and likely did not have rabies.”

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  2. Emm… Please do learn before you write because 6 people have been already saved and it is much better than leaving people to die.

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  3. To Chris – I assume for you, the author you quote, in your eyes, is some kind of God-like person, assuming you quote his article several times, and anyone else’s opinion or source claiming the opposite is non relevant for you.

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  4. Rabies specialists successes = 0 (Zero) saved lives since the dawn of time.

    Milwaulkee Protocol = 1 (one) saved life…. and possibly others.

    It would seem to me, that unless an antibody response has occurred and the immune system is responding, the Protocol will not achieve the desired result….. Perhaps vaccination post infection to try and kickstart the immune response is one avenue of treatment, once antibodies are being produced, an induced coma may then be effective?

    As for inducing comas…. This may be a more humane treatment for end stage Rabies infection anyway. Why allow cognitive suffering in someone who is doomed. Induce the coma and allow the disease to ravage the body but not the psyche.

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  5. I think Dr. Willoughby is due so much credit and I believe other doctors should keep his protocol active and begin researching the possibilities of stronger antibiotics and blood transfusions along with keeping the patient in a coma. I think he was amazing and I enjoyed seeing the YouTube Video on him. We need more doctors like him fighting for the cure.
    God Bless you Doc!

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