Pieter van Thiel, MD. PhD

Infectious disease physician 
Academic Medical Center, University of Amsterdam, The Netherlands
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Honorary consultant Division of Infectious Diseases, Center for Tropical and Travel Medicine
Academic Medical Center, University of Amsterdam, The Netherlands
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Hon.visiting physician Departm. of Medicine, College of Medicine, Univ. of Malawi, Blantyre, Malawi

Your experience with rabies:

What is your education? How long have you been working with rabies? Why did you start working with rabies?

In the last 10 years I worked as infectious disease physician and consultant at the University hospital of Amsterdam, I was involved in the management of 3 unfortunate cases of rabies in Dutch travelers or workers who were infected in low-income countries with a high endemicity of rabies (know that the last imported caseof rabies in the Netherlands was 20 years earlier!).

In the period 1979-1985, I worked as a Government medical officer in a district hospital in Malawi, where I have seen 4 or 5 patients with rabies.

WORLD RABIES DAY

September 28th is the World Rabies Day (WRD), a day dedicated to rabies prevention. What is the role of the rabies scientific community in increasing awareness about rabies? What is its significance to you? Are you doing something to increase awareness about rabies?

As consultant in travel medicine in the Netherlands, I coach the staff in travel medicine clinics in how to make travelers to endemic countries aware of rabies and of the prevention measures. Furthermore, as a consultant in the teaching hospital of the College of Medicine in Malawi, I was involved in teaching doctors, clinical officers and other health professionals on how to bring the message of prevention to the rural areas by promoting the availability of a rabies vaccine in district hospitals and the distribution of the guidelines of post-exposure prophylaxis.

Awareness:

Do you think people, in general, know what rabies is? Do you think there is a need to increase awareness among the general population?

There is a great need to increase the awareness under the population in the rural areas, e.g. by posters in villages, messages via cell phones, so that immediately after a likely rabies contact, a victim visits the nearest health facility for post-exposure prophylaxis.

Awareness among people living in countries where rabies is not endemic such as the Netherlands is definitely needed.

Burden:

The global burden of rabies is estimated to be around 60.000 death per year. Do you think the global burden of rabies might be higher?

From my experience in Malawi, there is underreporting of rabies. So the burden is likely to be much higher.

Symptoms:

What are the signs of rabies in infected humans?

Rabies comes initially with general malaise, headache, later fear or anxiousness, fever, then increasing difficulty in swallowing, over-production of saliva, agitation, neurological deficit signs and finally coma and death.

Personal experience:

Do you have a personal experience with a rabies victim? 

The 1st case I saw in 1980 in Malawi. I was astonished to see a patient with the full clinical picture of which I only read in study books during my medical training and that at the time seemed to me ‘’a thing far away, I never should encounter’’. I WILL NEVER FORGET! SEEING A PREVIOUSLY HEALTHY BOY OF 10-YEARS-OLD, going through a dreadfully short illness, which finally ended in death, for which the medical staff only could give supportive care. And, to see the helplessness of his father and mother trying to comfort the son as much as possible.

Recently, in all 3 patients in the Netherlands, the same feeling of helplessness was present by family members and the medical staff involved, as the presumed treatment did not work out. Before these patients were brought into coma for treatment purpose, anxiety was present for the fact that they knew that the treatment option was unlikely to work out. For both, the family and the medical team involved, this experience had an enormous impact. Mental coaching had to be provided thereafter!

Research agenda:

What in your opinion should scientists focus their research on?
Finding the ‘’trick’’ how to tackle the rabies virus when it has entered the brain (or central nervous system). That can only can be achieved by co-operation of the different scientific groups, already working on the subject. Organizations as the EU, philantropic organization such as e.g. the Bill & Melinda Gates foundation should invest more in funding further research of this neglected and underreported disease, mainly a problem in resource poor settings.

Experimental treatment:

One girl infected with rabies received treatments under the Milwakee protocol. Do you believe there is a medical explanation why this protocol would or would not work?

I think this case is difficult because this girl was not a typical rabies case!

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