Short report| Volume 96, ISSUE 4, P385-391, August 2017

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Caring for a patient with rabies: implications of the Milwaukee protocol for infection control and public health measures


      This article discusses the infection control and public health measures taken whilst managing a case of laboratory-confirmed rabies, and the challenges faced in implementing these measures. Case management requires intensive multi-disciplinary co-ordination. The Milwaukee protocol, which to date has five reported human rabies survivors associated with its use, has been suggested as a potential management pathway for human rabies. Consensus among hospital and public health clinicians would aid future deployment of this approach in selected cases.


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        • Public Health England
        The public health management of a suspected case of human rabies.
        PHE, London2004 ([updated 2009])
        • Smith A.
        • Morris J.
        • Crowcroft N.
        Bat rabies in the United Kingdom: we need to put the risk in context.
        BMJ. 2005; 330: 491-492
        • Fooks A.R.
        • McElhinney L.
        • Pounder D.J.
        • Finnegan C.J.
        • Mansfield K.
        • Johnson N.
        • et al.
        Case report. Isolation of a European bat Lyssavirus type 2a from a fatal human case of rabies encephalitis.
        J Med Virol. 2003; 71: 281-289
        • Pathak S.
        • Horton D.L.
        • Lucas S.
        • Brown D.
        • Quaderi S.
        • Polhill S.
        • et al.
        Diagnosis, management and post-mortem findings of a human case of rabies imported into the United Kingdom from India: a case report.
        Virol J. 2014; 11: 63
      1. Children's Hospital of Wisconsin. Rabies registry home page. Milwaukee, MI: Children's Hospital of Wisconsin; 2009. Available at: [last updated November 2016].

        • Willoughby Jr., R.E.
        • Tieves K.S.
        • Hoffman G.M.
        • Ghanayem N.S.
        • Amlie-Lefond C.M.
        • Schwabe M.J.
        • et al.
        Survival after treatment of rabies with induction of coma.
        N Engl J Med. 2005; 352: 2508-2514
        • Department of Health
        Memorandum on rabies prevention and control.
        DoH, London2000
        • Kumar S.
        Textbook of microbiology (New Delhi). Chapter 66: Rhabdoviruses.
        JP Medical, 2012
        • Health and Safety Executive
        Safe working and the prevention of infection in the mortuary and post-mortem room.
        2nd ed. HSE, London2003
        • Public Health England
        Guidelines on rabies post-exposure treatment.
        PHE, London2016
        • Public Health England
        The Green Book (immunisation against infectious disease). Rabies: Chapter 27.
        Department of Health, London2013 (Available at: [last accessed May 2017].)
        • Advisory Committee on Dangerous Pathogens
        Biological agents: managing the risks in laboratories and healthcare premises.
        (Appendix 1.2) ACDP, London2005
        • Public Health England
        The public health management of a suspected case of human rabies.
        PHE, London2004
        • Waggoner J.J.
        • Soda E.A.
        • Deresinski S.
        Rare and emerging viral infections in transplant recipients.
        Clin Infect Dis. 2013; 57: 1182-1188
        • Kan V.L.
        • Joyce P.
        • Benator B.
        • Agnes K.
        • Gill J.
        • Irmler M.
        • et al.
        Risk assessment for healthcare workers after a sentinel case of rabies and review of the literature.
        Clin Infect Dis. 2015; 60: 341-348
        • Sureau P.
        • Portnoi D.
        • Rollin P.
        • Lapresle C.
        • Lapresle C.
        • Chaouni-Barbich A.
        Prevention of inter-human rabies transmission after corneal graft.
        C R Seances Acad Sci III. 1981; 293: 689-692
        • Twabela A.T.
        • Mweene A.S.
        • Masumu J.M.
        • Muma J.B.
        • Lombe B.P.
        • Hankanga C.
        Overview of animal rabies in Kinshasa Province in the Democratic Republic of Congo.
        PLoS One. 2016; 7: 11
        • Zhu J.
        • Pan J.
        • Lu Y.
        A case report on indirect transmission of human rabies.
        J Zhejiang Univ Sci B. 2015; 16: 969-970
        • Lodmell D.L.
        • Dimcheff D.E.
        • Ewalt L.C.
        Viral RNA in the bloodstream suggests viremia occurs in clinically ill rabies-infected mice.
        Virus Res. 2006; 116: 114-118
        • World Health Organization
        Rabies bulletin Europe.
        WHO, Geneva2012 (Available at: [last accessed May 2017].)
        • Health Protection Network
        Rabies: guidance on prophylaxis and management in humans in Scotland.
        Health Protection Scotland, Glasgow2013