Rabies treatment debate turns against the Milwaukee Protocol

Rabies treatment is getting a harder reset. A January 12, 2026, Worms & Germs post by Scott Weese highlighted a 2025 Clinical Infectious Diseases viewpoint arguing that the Milwaukee Protocol, the aggressive coma-based regimen made famous after the 2004 survival of Jeanna Giese, should be abandoned because it hasn't shown credible, reproducible benefit beyond that index case. The paper says there are at least 64 reported failures, no antiviral in the protocol has demonstrated efficacy, and many later survivors were managed with intensive supportive care rather than the protocol itself. A published rebuttal from protocol creator Rodney Willoughby disputed that conclusion and said aggregate data support benefit, but he also acknowledged that long-term survival statistics will require a clinical trial. (wormsandgermsblog.com)

Why it matters: For veterinary professionals, this is another reminder that rabies remains a prevention story, not a treatment story. CDC says rabies is nearly universally fatal once symptoms begin, while post-exposure prophylaxis is highly effective if given before symptom onset. Globally, CDC estimates nearly 70,000 people still die from rabies each year, and international partners continue to push the “Zero by 30” goal of ending human deaths from dog-mediated rabies by 2030. That keeps the veterinary role squarely on vaccination, bite prevention, surveillance, client education, and rapid public health coordination after suspect exposures, especially involving bats in the U.S. and dogs in endemic regions. (cdc.gov)

What to watch: Watch for whether the 2025 debate leads to any formal guideline changes, registry data release, or clinical trial efforts, but for now the practical message is still early exposure management and prevention, not faith in rescue therapy. (academic.oup.com)