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ProMED翻訳情報(376回) ~バリ島の狂犬病予防対策の現状~





Date: Wed 4 Mar 2015               Source: New York Times [edited]



The controversy began a few weeks ago when a small, cream-colored mutt named Sheila bolted unexpectedly from under a beach hammock and bit a 10-year-old Australian girl in the leg.



Kuta Beach, the most popular spot on the getaway island of Bali, is well known for good surfing, cold beer, loud music and mangy-looking beach dogs. The dogs are something of a tourist attraction and generally harmless, except when they are not.



Sheila’s bite on 27 Jan 2015 set off a chain of events that has once again plunged this community into a vigorous debate about the island’s canine cohort and what some residents say is the government’s draconian effort to control them, with prime tourist season only a few months away.



Minutes after the bite, witnesses said, members of Kuta Village’s security team, armed with clubs, arrived at the beach and surrounded the dog, which in a panic ran to the surf.



“One man chased her with what looked like a large paddle and started repeatedly hitting her on the head, and intermittently drowning her,” said Praveen Elango, a tourist from India. “Another man approached with a brick and started whacking her with it.”

「一人の男が、大きなパドルのように見えるものを携え犬を追い、繰り返し犬の頭をたたき、断続的に犬をおぼれさせ始めた。」「一方の男はレンガを携えて近づき、それで犬を殴りつけ始めた。」とインドからの旅行者のPraveen Elangoは述べた。


Tourists gaped in horror. Sheila escaped and was taken away by a surfing instructor. The Australian girl was rushed to a nearby clinic.



But the next day, the other dogs of that section of Kuta Beach, where about half a dozen strays usually roam, were gone. People who work at the beach say the government rounded them up overnight and killed them.



“Usually, the dogs are there every day, but since this happened, we have not seen any dogs on Kuta Beach,” said Dedi Suherman, 35, a surfing instructor who also said he witnessed Sheila’s beating.”People are pretty angry.”

「いつもは、犬は毎日ここにいる、しかしこの出来事以来、我々はKuta海岸で全く犬をみることが無くなった。」とSheilaが殴られたことを目撃したとも述べたサーフィンの教官のDedi Suherman(35歳)は述べた。「人々はひどく怒っている。」


Two days later, Bali’s governor, I Made Mangku Pastika, invited the public to join the government in killing every stray dog on the island, which he estimated to be 500 000 animals.

二日後、バリ知事、「I Made Mangku Pastika」は、500 000頭と見積もられる、島にいるすべての放浪犬を殺している政府に加わるように、大衆に呼びかけた。


“Please help,” he said, according to a report in Kompas, a prominent Indonesian daily newspaper. “If you see a stray dog, just kill it, eliminate it. Don’t let them hang around spreading the disease. It’s dangerous and makes people scared.”



Bali’s government provides free medical treatment, including vaccination shots, to any resident bitten by a street dog, but the governor said the province had run out of money to buy the vaccine.



On average, more than 4000 people a month were bitten by dogs on Bali, an island of 4 million people, from 2010 to 2012, according to the United Nations Food and Agriculture Organization. While few of the dogs are rabid, it is not always possible to know whether one that bites is, so treatment is usually prescribed. If not treated immediately, people can die of rabies.



The governor 1st called on the public to kill street dogs in 2008, after rabies appeared on this island.



He did so again last July [2014], complaining about the expense of the vaccines and noting that dog owners were violating the law by letting their pets run free.



“There is no need to catch them — put them in a shelter or something,” he said then, according to The Jakarta Post. “Just cull them. It is the dog owners’ fault for letting their dogs stray.”

The Jakarta Postによると、「犬を捕まえ、シェルターか何かに入れる必要は無い。」「ただ彼らを淘汰するのだ。彼らの犬を放浪させていることは犬の飼主の過失である。」と彼は述べた。


The local news media reported that more than 120 dogs were culled, mostly by animal control officers, in 2 remote districts in December[2014] and January [2015].



The most common methods the government uses include shooting dogs with strychnine-laced darts or administering fatal injections, a practice that has been denounced by animal rights groups and documented in gruesome videos on YouTube.



“It’s a terrible way to die,” said Janice Girardi, an American resident of Bali for more than 30 years and the founder of the Bali Animal Welfare Association, which has campaigned against culling.”It’s like torture.”

「それはひどい死に方である、」30年来のアメリカ人バリ居住者であり、淘汰に対して反対キャンペーンを行っているバリ動物福祉協会の創設者のJanice Girardiは述べた。「拷問の様だ。」


Animal rights groups denounced the governor’s comments as “an appeal for a pogrom,” one as likely to kill healthy vaccinated pets as rabid strays.



At Kuta Beach, locals share pictures on cellphones and by email of their missing beach dogs wearing the special collars proving that they have been vaccinated for rabies. Moreover, village officials say there has not been a reported case of rabies in dogs or humans at Kuta Beach.



Economic and religious themes also play into the debate. This being Bali, where tourism and related industries account for about 80 percent of the economy, news reports of dog bites and rabies outbreaks undermine the image of a tropical island paradise.



“Many people don’t like the idea” of killing stray dogs, said Wayan Suarsa, the chief of Kuta Village, “because it affects our image. But in some cases, they disturb tourists, and we clearly want to expand our tourism industry.”

放浪犬を殺すという「この考えは多くの人々が好きではない。」とKuta 村長のWayan Suarsaは述べた。「なぜならば、それは我々のイメージに影響をおぼすためである。しかし、いくつかの事例で、彼らは観光客の妨げとなり、我々は明らかに我々の観光業を発展させることを望む。」


But other residents argue that dogs are an important part of the culture on this historically Hindu island, as noted in the Mahabharata, an ancient Indian epic, and are worthy of respect.



Putu Sumantra, the head of Bali’s animal husbandry department, said the governor’s comments about “inviting” the public to kill stray dogs had been taken out of context.

バリ畜産部門長のPutu Sumantraは、知事が放浪犬を殺すことに大衆に「呼びかけ」についての論評は、情況から取られたと述べた。


“It was the public that asked the government to do it, either during local meetings or through government offices,” he said in a written reply to questions.



He said that the government would continue to cull dogs “selectively,” including unvaccinated semiferal dogs, but that vaccination was the government’s primary rabies-eradication strategy. The government has carried out mass vaccination operations and has plans for another one from April to July [2015].



That is the right path, public health experts say.



“Vaccination is the most effective way to stop rabies,” said Eric Brum, a rabies expert and chief technical adviser for the United Nations agriculture agency, which financed the rabies vaccination program in Bali until last year [2014] and has trained the dogcatchers there.

狂犬病の専門家で、昨年(2014年)までのバリにおける狂犬病予防接種計画に融資し、そこでの犬捕獲人の訓練をした、国連農業機関の主任技術顧問のEric Brumは「予防接種は狂犬病を止める最も効果のある方法である。」と述べた。


Culling, on the other hand, is counterproductive, he says.



Killing dogs does not reduce contact between sick and healthy animals, while vaccinating the majority of dogs — 70 percent is thought to be effective — can provide herd immunity. Without other susceptible dogs for rabid animals to pass the disease to, the disease will ultimately

die out.



“We’re trying to flood the environment with immune animals,” he said.”We want vaccinated dogs to go out and meet the virus.”



Rabies cases have dropped rapidly in Bali since the virus 1st appeared, a fact Mr. Brum attributes to the vaccination campaign,which inoculated more than 2 million dogs from 2008 to 2014, according to provincial government data.

バリで最初にウイルスが出現してから狂犬病症例は急速に低下した。事実Mr. Brumは、州政府のデータよれば、2008年から2014年に200万頭以上の犬に接種した予防接種キャンペーンによるとしている。



In 2010, there were 421 confirmed animal cases of rabies and 84 human deaths, according to United Nations data. Last year [2014], there were only 132 canine cases and no human deaths.



“The problem is not the dogs — it’s the virus,” Mr. Brum said.

「問題は犬ではなく、ウイルスである。」とMr. Brumは述べた。


Not for the Australian girl, however, who underwent treatment as a precaution but was probably never in danger of contracting the disease. Sheila had been vaccinated and was wearing her collar proving it, even as she was being beaten by village security.



The dog, who has been in hiding with a local family, should not be marked for death, advocates say, but instead should be back on the beach, her immunity helping to keep the virus from spreading.



“They are our warrior dogs,” said Ms. Girardi, the animal welfare advocate.[Byline: Joe Cochrane]

「彼らは我々の犬戦士である。」と動物福祉提唱者のMs. Girardiは述べた。


[Bali was free of rabies for decades when the fatal zoonotic virus reportedly returned to the island in November 2008. In response to 4 human deaths believed to be caused by rabies transmitted through dog bites in Ungasan village, Uluwatu, Bali Governor Made Mangku Pastika ordered, on Saturday, 29 Nov 2008, the Balinese people to conduct a mass culling of stray dogs on the island “to help the administration prevent a rabies outbreak” (ProMED-mail posting 20081204.3821). Since then, the rabies control activities have undergone several cardinal changes, moving to an attempt to eradicate the disease by a program recommended by international organisations, combining stray dog population control, vaccination of all dogs having owners, and public education. When the island-wide dog sterilization campaign was initially launched at the end of 2011, Bali’s dog population was estimated to be larger than 300 000 and the experts agreed that the ideal size of dog population on the resort island should become somewhere between 150 000 and 200 000. It will be interesting to obtain information on the current size of the dog population, 4 years later, and on the current vaccination coverage. Though considerable achievements have been attained, the complete eradication of the disease is not yet in sight. According to OIE’s data, during 2013 there were 119 deaths (humans) in Indonesia, out of 69 136 “cases”(this probably refers to number of exposures). During 2011 the numbers were 157 and 80 558, respectively. Data for 2012 were not provided; for 2014, not yet available. Information pertaining specifically to Bali will be appreciated.

うわさによると、2008年11月に致死的な人獣共通感染ウイルスが島に再侵入した時に、バリは数十年間狂犬病清浄であった。Uluwatu のUngasan 村で犬咬傷で伝播した狂犬病によると信じられた4人の死亡例への対応で、バリ知事のMade Mangku Pastikaは、2008年11月29日、土曜日に、「狂犬病流行を防止する行政当局を助けるために」バリ島の人々に島の放浪犬の大量淘汰を実施することを命じた(ProMED-mail posting 20081204.3821)。それ以来、狂犬病制御活動は、国際機関の勧告プログラムによる疾病根絶を試みるために、放浪犬数の制御、すべての飼育犬への予防接種、そして大衆の教育を組み合わせるいくつかの基本的な変革を行った。2011年の終わりに、島全域にわたる犬避妊キャンペーンが最初に着手された時に、バリの犬数は300, 000以上と推定され、リゾート島における理想的な犬数はおおよそ150,000 から200,000にすべきであると専門家達は同意した。最新の犬数、4年後の犬数、直近の予防接種率に関する情報を得ることは興味深いであろう。かなりの成果が達成されたにもかかわらず、疾病の完全な根絶はまだみられない。OIEデータによると、2013年中にインドネシアで、69,136例中119(人)が死亡した(これはおそらく多数の曝露を示す)。2011年に、その数はそれぞれ8,0558と157であった。2012年データは提供されず。;2014年は、まだ利用できない。とりわけ、バリに関係する情報は評価されるであろう。


Similar situations prevail in considerable parts of the globe. A 4-year rabies control program, implemented in 2007 in Colombo City, Sri Lanka, has recently been analysed in an exhaustive paper (Ref 1). Its abstract follows:

類似した状況は、世界のかなりの部分に普及している。Sri LankaのColombo市で2007年に実行された、4年の狂犬病制御プログラムは、近年の網羅的な論文(参考文献1)において分析された。その要旨は以下につづく:


“Background: One Health addresses complex challenges to promote the health of all species and the environment by integrating relevant sciences at systems level. Its application to zoonotic diseases is recommended, but few coherent frameworks exist that combine approaches from multiple disciplines. Rabies requires an interdisciplinary approach for effective and efficient management.



“Methodology/Principal Findings: A framework is proposed to assess the value of rabies interventions holistically. The economic assessment compares additional monetary and non-monetary costs and benefits of an intervention taking into account epidemiological, animal welfare, societal impact and cost data. It is complemented by an ethical assessment. The framework is applied to Colombo City, Sri Lanka, where modified dog rabies intervention measures were implemented in 2007. The 2 options included for analysis were the control measures in place until 2006 (“baseline scenario”) and the new comprehensive intervention measures (“intervention”) for a 4-year duration. Differences in control cost; monetary human health costs after exposure; Disability-Adjusted Life Years (DALYs) lost due to human rabies deaths and the psychological burden following a bite; negative impact on animal welfare; epidemiological indicators; social acceptance of dogs; and ethical considerations were estimated using a mixed method approach including primary and secondary data. Over the 4 years analysed, the intervention cost USD 1.03 million more than the baseline scenario in 2011 prices (adjusted for inflation) and caused a reduction in dog rabies cases; 738 DALYs averted; an increase in acceptability among non-dog owners; a perception of positive changes in society including a decrease in the number of roaming dogs; and a net reduction in the impact on animal welfare from intermediate-high to low-intermediate.

方法/主要な知見:枠組みは狂犬病の全体論的な介入の価値を評価するために提唱された。経済評価は、追加される金銭と非金銭的費用と介入の恩恵を、疫学的、動物福祉、社会的な影響と費用データを考慮して比較する。それは倫理的な評価で補完された。枠組みはSri LankaのColombo市に適用された。そこでは、改良された犬狂犬病介入対策が2007年に実施されている。解析のために含まれた2つの選択肢は、2006年までの地方での制御対策(基本的筋書きで)と4年間持続する新しい包括的な介入対策(“介入”)である。管理費用における差異;曝露後の金銭的な人の健康費用;人の狂犬病死により失う障害調整生存年(DALYs)と咬傷後の心理学的な負担;動物福祉における負の影響;疫学的指標;犬の社会的な容認;および倫理的問題は、1次と2次データを組み合わせた方法を用いることで推定された。分析された4年間で、介入には、2011年価額で(インフレを補正された)基本的筋書き以上の103万USドルの費用がかかり、犬狂犬病症例減少の原因となった。;738のDALYsが防止された;犬飼育者以外の許容性が増加した;徘徊犬数の減少を含んだ社会の陽性の変化の認知;中度より高度から低度より中間への動物福祉の影響におけるネットの縮小。


“Conclusions: The findings illustrate the multiple outcomes relevant to stakeholders and allow greater understanding of the value of the implemented rabies control measures, thereby providing a solid foundation for informed decision-making and sustainable control.”



Subscribers are referred to the full text (available free online).



During 3-5 Mar 2015, the 2nd International Conference on Dog Population Management was held in Istanbul, Turkey. The conference theme was “inter-sectoral collaboration, innovation and evidence-based solutions for dog population management.”



The International Companion Animal Management Coalition (ICAM), which convened the conference, “will be uploading all the films of the talks shortly.”






Hasler B, Hiby E, Gilbert W, Obeyesekere N, Bennani H, et al. (2014) A One Health Framework for the Evaluation of Rabies Control Programmes:A Case Study from Colombo City, Sri Lanka. PLoS Negl Trop Dis 8(10):e3270. doi:10.1371/journal.pntd.0003270. Hasler B, Hiby E, Gilbert W, Obeyesekere N, Bennani H, ら (2014年)