Home >News > ProMED翻訳情報(396回) ~カンボジアにおける狂犬病の現状~

ProMED翻訳情報(396回) ~カンボジアにおける狂犬病の現状~




Date: Fri 26 Jun 2015   From: Arnaud Tarantola  [edited]



A young French female resident in Cambodia died of rabies last week. Diagnosis was biologically confirmed by the Virology Unit of the Institut Pasteur du Cambodge (IPC) with a positive genome detection using an RT-PCR method on 3 successive saliva samples [1]. These were prescribed by the attending clinician after exchanges with the rabies team at IPC. The patient was not known to have been vaccinated against rabies prior to exposure and received 1 post-exposure dose of vaccine of unidentified nature, outside of IPC.



This tragic event — 1 among many each year in Cambodia — is a stark reminder that, although 100 percent preventable, rabies remains a lethal but underestimated and underinformed public health burden in many developing countries. According to a model estimate, 59 000 deaths from rabies occur each year among approximately 6400 million exposed people in the World [2,3]. Cambodians, however, are at particularly high risk of rabies: Another model-based estimate of rabies deaths in Cambodia was performed by IPC epidemiologists on 2007 data, extrapolating figures from Phnom Penh to the rest of the country. This study concluded [that there were] 810 human rabies deaths in 2007 (95 percent CI: 394-1607). Assuming these published models are correct, this would translate to Cambodia suffering an estimated 1.3 percent of estimated rabies deaths worldwide, for a population of approximately 15 million, which is less than 0.2 percent of the population of affected countries [3,4]. After a potentially infective dog bite, most Cambodians face staggering financial and/or geographical challenges in accessing timely and adequate PEP [post exposure prophylaxis] [5].


この非劇的出来事--カンボジアでは毎年多く起こることの一つなのではあるが—100%予防可能であるけれど、多くの発展途上国において狂犬病は致死性で、過小評価されまた情報不足の公衆衛生的な負担を留めていることを明確に思い起こさせる。あるモデルの推定によれば、全世界で毎年64億人が狂犬病に暴露されている内の59000名が死亡している [2,3]。カンボジアでは、狂犬病のリスクが特に高い:他のモデルに基づいたカンボジアの狂犬病死亡推定がプノンペン及び国内の残りの他の地域におよぶ2007年の外挿値データからIPCの疫学者により実施された。この研究は、2007年には810の人狂犬病死亡があったと結論した(95%信頼限界:394-1607)。これらの既報のモデルが正確であるという前提で、カンボジアの(狂犬病)被害は、全世界中における推定狂犬病死亡者の1.3%と推測される。およそ1500万人のカンボジアの人口に対して、全狂犬病流行国の人口の0.2%以下である[3,4]。感染しているかもしれない犬に咬まれた後、ほとんどのカンボジア人は、タイムリーで且つ適正なPEP(暴露後予防)を受けるために経済的または地理的な課題に直面する[5]。


Between 1 Jan and 31 Dec 2014, the Rabies Prevention Center at IPC

provided intradermal post-exposure prophylaxis to a total of 21 782

persons, a 3.3 percent increase in protocols compared to Year 2013. In 2014, a total of 247 dog’s heads (98.4 percent of total N=251 animal heads), 3 cats’ heads (1.2 percent) and one monkey’s head (0.4 percent) were brought by patients to the Rabies Prevention Center. Among 250 animal heads tested for rabies (1 animal’s head was decayed and could not be tested for rabies), 138 animal heads (55.2 percent)were found positive for rabies (137 dogs and 1 cat) at IPC’s Virology unit, the reference lab for rabies diagnosis in Cambodia. These 138 rabies-confirmed animals had bitten a total of 198 persons (1.4 persons bitten per rabid animal). All received PEP and no deaths were documented at 6 months through active surveillance.



Travelers to highly endemic areas such as Southeast Asian countries are very strongly encouraged to be vaccinated before their trip or seek expert advice, as per recommendations [6-10]. They must refrain from engaging unfamiliar animals, wild or domestic. Immunity following pre-exposure vaccination is considered long-lasting and anamnestic response highly protective [10,11]. In case of a potentially infective dog bite, pre-immunized travelers or residents need not urgently seek immunoglobulin, requiring only 2 booster shots.



Cambodia, like other countries of the ASEAN +3 group, has pledged to eradicate canine rabies by 2020 [12,13]. IPC – a research and vaccine institute which is part of the Cambodian Ministry of Health – is liaising with authorities to contribute its expertise and find funding to develop a network of rabies prevention centers across the country so people throughout Cambodia can access timely, affordable and adequate PEP.



[We are very grateful to Dr. Tarantola and his colleagues for this human rabies report for Cambodia. It is very pertinent. And we fully support their intention of eradicating canine rabies in Cambodia by This is the most cost effective way of preventing human rabies. It is clear from what they write that they have a good start.

[このカンボジアにおける人狂犬病症例報告についてDr. Tarantola及び彼の仲間に感謝する。とても適切である。そして、我々は、2020年までにカンボジアの犬狂犬病を撲滅するという彼らの目的を全面的にサポートする。これは、人狂犬病を防ぐ最も費用対効果に優れた方法である。彼らが良いスタートをしたと記述したことは明白である。