Home >News > ProMED翻訳情報(290回) ~コウモリからの狂犬病暴露の可能性(アメリカ)~

ProMED翻訳情報(290回) ~コウモリからの狂犬病暴露の可能性(アメリカ)~




Date: 9 july, 2014   Source: CNY Central.com



Tompkins County Health Officials still looking for children found poking rabid bat in Dryden



Tompkins County Health Officials are still looking for 3 children who were playing with a rabid bat on [30 Jun 2014] in Dryden.



The 3 kids were seen playing with the bat at Montgomery Park between 1:30 and 2:30 pm. The children are described as being a girl, about 7 or 8-years-old and 2 younger boys.



The health department says it is imperative that they find the children so they can test them for rabies.



Anyone with information about the identity of the 3 children should call 315-274-6688.




[While the media report mentions the children will be 〝checked” for rabies, what will be check for is the need for post exposure prophylaxis. The Advisory Committee on Immunization Practices (ACIP) recommendations on Rabies vaccination is very detailed vis a vis exposures to bats:

メディアは、この子どもたちが狂犬病かどうか〝チェック”するといっているが、チェックされるのは、暴露後予防(接種)が必要かどうかである。Advisory Committee on Immunization Practices (ACIP) (免疫業務に関する諮問委員会)は、狂犬病のワクチン接種において、コウモリとの接触に対し、非常に詳細な勧告を述べている。


“The most common rabies virus variants responsible for human rabies in the United States are bat-related; therefore, any potential exposure to a bat requires a thorough evaluation. If possible, bats involved in potential human exposures should be safely collected and submitted for rabies diagnosis…..



“The risk for rabies resulting from an encounter with a bat might be difficult to determine because of the limited injury inflicted by a bat bite (compared with more obvious wounds caused by the bite of terrestrial carnivores), an inaccurate recall of a bat encounter that might have occurred several weeks or months earlier, and evidence that some bat-related rabies viruses might be more likely to result in infection after inoculation into superficial epidermal layers. For these reasons, any direct contact between a human and a bat should be evaluated for an exposure. If the person can be reasonably certain a bite, scratch, or mucous membrane exposure did not occur, or if the bat is available for testing and is negative for presence of rabies virus, postexposure prophylaxis is not necessary. Other situations that might qualify as exposures include finding a bat in the same room as a person who might be unaware that a bite or direct contact had occurred (e.g., a deeply sleeping person awakens to find a bat in the room or an adult witnesses a bat in the room with a previously unattended child, mentally disabled person, or intoxicated person).

These situations should not be considered exposures if rabies is ruled out by diagnostic testing of the bat, or circumstances suggest it is unlikely that an exposure took place. Other household members who did not have direct contact with the bat or were awake and aware when in the same room as the bat should not be considered as having been exposed to rabies. Circumstances that make it less likely that an undetected exposure occurred include the observation of bats roosting or flying in a room open to the outdoors, the observation of bats outdoors or in a setting where bats might normally be present, or situations in which the use of protective covers (e.g., mosquito netting) would reasonably be expected to preclude unnoticed contact.

Because of the complexity of some of these situations, consultation with state and local health departments should always be sought. If necessary, further guidance can be sought from CDC and experts in bat ecology.


〝コウモリとの遭遇による狂犬病のリスクを決定するのは難しいかもしれない。なぜなら、コウモリによる噛み傷は、(陸生の食肉目の咬みつきによる明らかな傷と比較しても)浅いものだし、数週間か数ヶ月もたてば、コウモリと遭遇した記憶は不確かなものとなってしまうし、さらに、コウモリに関連した狂犬病ウイルスの一部は、皮膚の浅い個所に注入されただけでも感染が成立するらしいという証拠もある。これらの理由のため、ヒト-コウモリ間の、いかなる直接的な接触でも、(狂犬病に)暴露したとみなすべきである。もし、明らかにその人に、(コウモリに)噛まれた、引っかかれた、粘膜への接触などの事実がない、あるいはそのコウモリを用いた試験が可能で、その結果、狂犬病ウイルス陰性であったなら、暴露後の予防処置は必要ではない。その他の状況として、噛まれたか、あるいは直接の接触があったかどうか分からないという人がいた同じ部屋の中でコウモリが見つかった場合(例えば、よく眠っていた人が朝目覚めて、部屋の中でコウモリを見つけた時や、付き添いのない子供や、精神障害を持つ人、酔っぱらった人が以前にいた部屋の中で、コウモリが見つかった場合など)は、暴露があったとみなされるだろう。もし、コウモリを診断することで狂犬病が除外された、あるいは状況が暴露は起こっていそうもないことを示唆しているときは、暴露は考慮に入れるべきではない。家族の他の人々がコウモリと直接接触したことがない場合、あるいは彼らがコウモリと同じ部屋にいて起きているか意識があった場合、(彼らに対しても) 暴露があったと考えるべきではない。気づかれていない暴露があったとは考えにくい状況として、屋外に開け放たれている部屋の中でコウモリが飛び回っていたり、巣食っていたりする場合や、外で、あるいはコウモリが通常いるような環境でコウモリを見かけた場合などが挙げられる。さらには、保護カバー(例えば、蚊帳など)類を使用している状況も、気づかなかった(コウモリとの)接触を除外するに合理的だと考えられる。このような状況のうちのいくつかが複雑に絡み合うため、州と地域の保健当局との協議は常に求めるべきだ。もし必要であれば、CDCあるいはコウモリの生態学においての専門家から、さらなる指導が得られるだろう。


“During 1990–2007, a total of 34 naturally acquired bat-associated human cases of rabies was reported in the United States. In six cases, a bite was reported; in two cases, contact with a bat and a probable bite were reported; in 15 cases, physical contact was reported (e.g., the removal of a bat from the home or workplace or the presence of a bat in the room where the person had been sleeping), but no bite was documented; and in 11 cases, no bat encounter was reported. In these cases, an unreported or undetected bat bite remains the most plausible hypothesis because the genetic sequences of the human rabies viruses closely matched those of specific species of bats. Clustering of human cases associated with bat exposures has never been reported in the United States (e.g., within the same household or among a group of campers where bats were observed during their activities).”