Rabies--"Milwaukie Protocol".

M of JAPI readers are familiar with the c l inical features and have witnessed the pathetic outcome despite best attempts at treatment. This is because the patients have not received early PEP & arrive at the hospital once the full blown symptoms have set in. Dog vaccination programs have decreased the risk of rabies in a number of regions in the world. In 2010, an estimated 26,000 died of rabies, down from 54,000 in 1990 in the world. India has the highest incidence of human rabies in the world, with more than 20,000 people dying of rabies every year. That is a third of the global toll. This is primarily because of stray dogs, whose numbers have greatly increased since 2001, as law forbids killing of stray dogs and sterilization is ineffective. Rabies virus is a prototype of Lassavirus of the of Rabdoviridae family. It is a bullet shaped virus containing a single strand of RNA with a nucleoprotein that forms a helical coil. The virus travels in the nerves and is carried centripetally to dorsal root ganglion and thence to the brain where massive replication occurs. Negri bodies can be detected within nerve cytoplasm, mainly in hippocampus and cerebellum. Usual incubation period is 4 Rabies – “Milwaukie Protocol”