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

T Lampejo; M Bruce; A Teall; M Dall'Antonia; E Crawley-Boevey; P Grant; S Polhill; D Pillay; D Brown; M Brown; E Nastouli

doi:10.1016/j.jhin.2017.04.018

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

J Hosp Infect. 2017 Aug;96(4):385-391. doi: 10.1016/j.jhin.2017.04.018. Epub 2017 May 2.

Authors

T Lampejo¹, M Bruce², A Teall³, M Dall'Antonia³, E Crawley-Boevey⁴, P Grant², S Polhill², D Pillay⁵, D Brown⁶, M Brown⁷, E Nastouli⁸

Affiliations

¹ Department of Clinical Virology, Hospital for Tropical Diseases and Intensive Care Unit, University College London Hospitals NHS Foundation Trust, London, UK. Electronic address: tlampejo@gmail.com.
² Department of Clinical Virology, Hospital for Tropical Diseases and Intensive Care Unit, University College London Hospitals NHS Foundation Trust, London, UK.
³ Department of Clinical Microbiology, Queen Elizabeth Hospital NHS Trust, Woolwich, London, UK.
⁴ South East London Health Protection Unit, London, UK.
⁵ Department of Infection and Immunity, University College London, London, UK.
⁶ Public Health England, Colindale, Viral Zoonosis Unit, London, UK.
⁷ Department of Clinical Virology, Hospital for Tropical Diseases and Intensive Care Unit, University College London Hospitals NHS Foundation Trust, London, UK; London School of Hygiene & Tropical Medicine, London, UK.
⁸ Department of Clinical Virology, Hospital for Tropical Diseases and Intensive Care Unit, University College London Hospitals NHS Foundation Trust, London, UK; NIHR University College London Hospitals Biomedical Research Centre, London, UK.

PMID: 28559126
DOI: 10.1016/j.jhin.2017.04.018

Abstract

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.

Keywords: Infection control; Milwaukee protocol; Public health; Rabies.

Publication types

Case Reports

MeSH terms

Disease Management
Disease Transmission, Infectious / prevention & control*
Female
Humans
Infection Control / methods*
Middle Aged
Practice Guidelines as Topic
Rabies / therapy*