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ProMED翻訳情報(371回) ~ネパールで発生した人の麻痺型狂犬病~





Date: 15 Apr 2015     From: Dr. Sher Bahadur Pun <drsherbdr@yahoo.com>


A 49-year-old, previously healthy male from Hetauda (Makwanpur district, [Narayani zone]) presented with hydrophobia, aerophobia, AND difficulty in swallowing and has been admitted (on 13 Apr 2015) to Sukraraj Tropical and Infectious Disease Hospital (STIDH). He later developed numbness and muscle weakness of the left leg.

49歳の、以前健康であった、Hetauda(Makwanpur郡、Narayani県)の男性が、恐水症、恐風症、そして嚥下障害の症状を見せ、2015年4月13日にSukraraj Tropical and Infectious Disease Hospital(STIDH)に入院した。彼は、後に左足の麻痺や筋力低下を示した。


An unprovoked stray dog had bitten the dorsal surface of both his hands 4 weeks back, but [the man] did not receive either anti-rabies vaccine (ARV) or rabies immunoglobulin (RIG), despite his family’s suggestion to get rabies vaccination. Other patients (more than 4 patients) who were bitten by the same street dog have received ARVs following this incident.

遡ること4週間前に、特に挑発してもいないのに、彼は野良犬に両手の背面を咬まれた。しかし、彼の家族が狂犬病ワクチンの接種を勧めたにも関わらず、(その男は)抗狂犬病のワクチン(anti-rabies vaccine:ARV)や、免疫グロブリン(rabies immunoglobulin:RIG)のどちらの接種も受けることはなかった。同じ野良犬に咬まれた(4人以上の)他の患者は、この事故の後にARVの接種を受けている。


No paralytic rabies case has been described previously in Nepal, perhaps due to under-reported/misdiagnosed or not being included in the differential diagnosis. This case shows an overlapping clinical form of furious and paralytic rabies (dumb). The patient left hospital against medical advice on 14 Apr 2015. A total of 9 patients (including this case) have died from rabies in the past 10 months alone (since June 2014).



RIG is not readily available or administered throughout the country; thus this availability refers to STIDH for the management of category III bites, although it is not free of cost or provided by the government. A few weeks ago, there had been a shortage of RIG for more than 6 months in Nepal. The government sometimes does not provide ARVs despite recommendations from physicians (which are on a case-by-case basis). No national rabies management guidelines are available in Nepal.



Poor knowledge (among both health care workers and the general public), self negligence regarding wound treatment, inadequate supplies of RIG and ARVs, unknown post vaccination titre, and a lack of political commitment are major challenges to eliminating rabies disease in Nepal.



Communicated by  Dr.Sher Bahadur Pun Sukraraj Tropical and Infectious Disease Hospital Kathmandu, Nepal


[Our thanks to Dr Pun for his excellent description of this recent case of human rabies. But yet again it points up a One Health problem: unless one can effectively control canine rabies, one will see an ongoing stream of human cases. This control is more cost effective than struggling with the retroactive treatment of exposed individual humans, which is collectively not cheap. Though demanding in organisation, the vaccination and marking of vaccinated dogs is straightforward and within 3 years can demonstrate its success. Starting with known high-risk areas it is demonstrably cost effective, and this will foster public awareness and government financial support. And then regional programmes are possible.


Dr Punによる、近年のヒト狂犬病の事例に関する優れた記述に対して、感謝する。しかし、ここで再び、One Healthにおける問題点を指摘させていただきたい。すなわち、人がイヌの狂犬病を効果的に制御できない限り、人はヒトの狂犬病の事例を延々と見続けることになるだろうということである。(狂犬病のイヌに)暴露した人々を遡って治療を行うことは、有り体に言って安くつくものではなく、これに取り組むよりも、これ(イヌ)を対象にしたほうがより効果的である。組織化に多大な努力が必要であるが、ワクチン接種と、接種したイヌを標識することの効果は直接的であり、3年以内にその成功が明らかになるだろう。(狂犬病の)既知の危険性が高い地域から始めれば、明らかに費用対効果が高い。公衆の意識を変え、政府から資金援助を引き出すことにもつながるかもしれない。そうなれば、さらに地方向けのプログラムが可能になる。