Rabies medical therapy

Milwaukee protocol

The treatment that saved Jeanna Giese, a Wisconsin resident, was an innovated and experimental technique. The basics behind the treatment, which would later be called the Milwaukee protocol, were determined by Dr. Rodney Willoughby, an infectious disease specialist. The theory behind the treatment was to basically shut down her brain by medically inducing a coma. This would serve the purpose of giving her own immune system time to build up antibodies against the virus. In other words, doctors thought it would be possible for Jeanna Giese to survive if they suppressed her brain activity, while allowing enough time for her immune system to attack the rabies.

Although radical, the Milwaukee protocol was most likely the only way for Giese to have a chance for survival. It was also the first time that this method had been used.

Inducing a coma was not the only task doctors performed. They also gave her many antiviral drugs such as ribavarin and amantadine. After approximately a week, tests showed that Giese's immune system was fighting the disease, so they began to cut back on the anesthetics. Doctors also gave Giese supplements for about 6 months after initial treatment. They gave her tetrahyrdobiopterin, which is similar to folic acid. This may have been involved in improving Giese's speech, motor, and other bodily functions.

Treatment flowchart

Post-exposure prophylaxis

Treatment after exposure, known as post-exposure prophylaxis or "P.E.P.", is highly successful in preventing the disease if administered promptly, within fourteen days after infection. The first step is immediately washing the wound with soap and water, which is very effective at reducing the number of viral particles. In the United States, patients receive one dose of immunoglobulin and five doses of rabies vaccine over a twenty-eight day period. One-half the dose of immunoglobulin is injected in the region of the bite, if possible, with the remainder injected intramuscularly away from the bite. This is much less painful compared with administering immunoglobulin through the abdominal wall with a large needle, which is how it was done in the past. The first dose of rabies vaccine is given as soon as possible after exposure, with additional doses on days three, seven, fourteen, and twenty-eight after the first. Patients that have previously received pre-exposure vaccination do not receive the immunoglobulin, only the post-exposure vaccinations. Since the widespread vaccination of domestic dogs and cats and the development of effective human vaccines and immunoglobulin treatments, the number of recorded deaths in the U.S. from rabies has dropped from one hundred or more annually in the early twentieth century, to 1–2 per year, mostly caused by bat bites, which may go unnoticed by the victim and hence untreated.

P.E.P. is effective in treating rabies because the virus must travel from the site of infection through the peripheral nervous system (nerves in the body) before infecting the central nervous system (brain and spinal cord) and glands to cause lethal damage. This travel along the nerves is usually slow enough that vaccine and immunoglobulin can be administered to protect the brain and glands from infection. The amount of time this travel requires is dependent on how far the infected area is from the brain: if the victim is bitten in the face, for example, the time between initial infection and infection of the brain is very short and P.E.P. may not be successful.