Rabies is a viral disease that causes acute inflammation of the brain (encephalitis) in humans and other mammals. Once the virus enters the central nervous system and clinical symptoms begin to appear, the infection is almost universally fatal, with a mortality rate approaching 100%. This devastating prognosis makes rabies one of the deadliest infectious diseases known, claiming approximately 59,000 lives globally each year, predominantly in Asia and Africa. The standard medical approach, called post-exposure prophylaxis, is only effective if administered promptly before the onset of neurological symptoms. The rare survival of a person with symptomatic rabies, without prior preventative treatment, challenged decades of understanding about the disease’s inevitability.
The Unprecedented Case of Survival
In 2004, a 15-year-old girl named Jeanna Giese was bitten by a bat inside her church but did not immediately seek medical attention for the small wound. The potential exposure was not initially considered severe enough to warrant the standard post-exposure vaccination series. Approximately a month later, she began exhibiting concerning neurological symptoms. These initial signs included a persistent tingling sensation in her left index finger, followed by double vision, slurred speech, and increasing difficulty with motor control.
Her condition deteriorated rapidly, progressing to generalized weakness and an inability to stand or sit without assistance. Doctors were initially baffled, but when Jeanna’s mother recalled the bat encounter, the focus immediately shifted to a possible rabies infection. Analysis of her cerebrospinal fluid confirmed the devastating diagnosis, confirming the rabies virus was already replicating within her central nervous system. Since the virus was established in the brain tissue, traditional prophylaxis was no longer an option. Physicians faced a choice between palliative care and an extremely risky experimental intervention.
The Milwaukee Protocol Explained
Jeanna Giese’s physician, Dr. Rodney Willoughby, quickly devised an experimental induction protocol, later dubbed the Milwaukee Protocol. The central theory was to mitigate the severe damage caused by the virus’s effect on brain neurotransmitter function. It was hypothesized that suppressing brain activity could limit the excitotoxicity and dysautonomia—the uncontrolled swings in heart rate and blood pressure—that often lead to death in rabies patients.
The core of the strategy involved chemically inducing a deep coma using medications like midazolam and ketamine. The coma was designed to put the brain into a state of minimal activity, effectively shielding it from the virus’s destructive effects. The second component involved administering antiviral drugs, including ribavirin and amantadine, though combinations have varied. This combination of neuroprotection and antiviral agents would slow the virus’s progression.
The goal of the induced coma was to buy time for the patient’s own immune system to recognize the threat and generate neutralizing antibodies. The protocol aimed to allow the natural immune response to clear the virus by providing maximum supportive care during the acute phase of peak viral activity and brain inflammation.
Outcomes and Broader Application
Jeanna Giese’s recovery was protracted; she remained in the hospital for 76 days after her admission. As the first documented person to survive rabies without prior vaccination, her case initially sparked widespread optimism about a potential treatment for the disease. Survival came with a significant cost, requiring extensive physical and occupational therapy to regain basic motor and cognitive functions. She experienced lasting neurological and physical impairments, demonstrating that recovery was not complete.
The experimental nature of the protocol meant its initial success was difficult to replicate globally. Since Giese’s survival, variations have been attempted on dozens of other symptomatic patients, resulting in at least 64 documented failures. While some sources claim a small number of other survivors, these cases are often disputed, had less severe forms of the virus, or involved patients who had received some form of vaccination before symptom onset.
The overwhelming lack of success led the medical community to conclude that the Milwaukee Protocol is not a reliable, standard treatment. Current medical consensus suggests that the original survival may have been a unique biological anomaly, possibly due to a less virulent strain of the bat rabies virus or an unusual immune response in the patient. Global health organizations emphasize that prompt post-exposure prophylaxis—involving wound cleaning and a series of vaccinations—remains the only highly effective and predictable defense against this deadly disease.