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ProMED翻訳情報(211回) ~ネパールにおける野犬からの狂犬病感染による複数名の死亡~


狂犬病-ネパール(02): Jajarkot、犬、人
Date: Sun 15 Sep 2013
Source: The Himalayan Times [edited]

3 people died of rabies [virus] infection after being bitten by stray dogs in the district recently. The deceased were a 53-year-old father and his 22-year-old daughter of Dhime VDC-1 and a 48-year-old man of Dhime VDC-5.
最近Jajarkot郡で野良犬に咬まれた後、狂犬病ウイルス感染により3人が死亡した。亡くなったのはDhime VDC-1の53才の父親と22才の娘、Dhime VDC-5の48才の男性である。(注:VDC = village development committee, 村開発委員会)

More than 24 villagers have been suffering from the disease after being bitten by stray dogs at Dhime and Jagatipur VDCs. The patients died due to shortage of anti-rabies vaccine at the District Hospital.

The stock of vaccine has run out, and the hospital has demanded more vaccine from the Regional Health Office, said Dhir Jung Shah, Assistant Chief of the District Public Health Office, Jajarkot.
ワクチン在庫が底をついており、病院は地域保健所に対してワクチンの更なる供給を要求している、とJajakkot郡保健所の副主任であるDhir Jung Shah氏は述べている。

Communicated by: ProMED-mail <promed@promedmail.org>

[Rabies is a vaccine-preventable disease. The most cost-effective strategy for preventing rabies in people is by eliminating rabies in dogs through vaccination. Vaccination of animals (mostly dogs) has reduced the number of human (and animal) rabies cases in several countries, particularly in Latin America [and eliminated street rabies from the USA. – Mod.JW]. Preventing human rabies through control of domestic dog rabies is a realistic goal for large parts of Africa and Asia and is justified financially by the future savings of discontinuing post-exposure prophylaxis for people. The problem in Nepal is a consequence of inadequate provision of rabies vaccine for both pre and post exposure vaccination, no doubt ultimately due to financial constraints.

Safe, effective vaccines can be used for pre-exposure immunization (PEP). This is recommended for travellers spending a lot of time outdoors, especially in rural areas, being involved in activities such as bicycling, camping, or hiking as well as for long-term travellers and expatriates living in areas with a significant risk of exposure.
(注:通常PEPと略す場合、曝露後ワクチン(Post Exposure Prophylaxis)を指すのに使用する気がします。)

Pre-exposure immunization is also recommended for people in certain high-risk occupations such as laboratory workers dealing with live rabies virus and other rabies-related viruses (lyssaviruses), and people involved in any activities that might bring them professionally or otherwise into direct contact with bats, carnivores, and other mammals in rabies-affected areas. As children are considered at higher risk because they tend to play with animals and may receive more severe bites, or may not report bites, their immunization could be considered if living in or visiting high risk areas.

Prompt wound care and the administration of rabies immune globulin (RIG) and vaccine are highly effective in preventing human rabies following exposure. A variety of empirical schedules and vaccine doses have been recommended over time, based in part on immunogenicity and clinical experience in areas of the world with enzootic canine or wildlife rabies. As more potent vaccines were developed, the number of vaccine doses recommended for PEP has decreased, and studies aimed at further revision and reduction of PEP schedules and doses in humans have been encouraged. By the latter half of the 20th century, a 4- to 6-dose, intramuscular regimen using human diploid cell vaccine (HDCV) or purified chick embryo cell vaccine (PCECV) was being recommended.

In the USA, a 5-dose PEP vaccine regimen was adopted during the 1980s. In 2007, when human rabies vaccine was in limited supply, an ad hoc National Rabies Working Group was formed to reassess the recommendations for rabies prevention and control in humans and other animals. In 2008, a smaller Advisory Committee on Immunization Practices (ACIP) Rabies Workgroup was formed to review rabies vaccine regimen options. This report provides updated ACIP recommendations regarding the use of a 4-dose vaccination regimen, replacing the previously recommended 5-dose regimen, for rabies PEP in previously unvaccinated persons.

Jajarkot District is one of the 75 districts of Nepal. The district, with Jajarkot as its district headquarters, covers an area of 2230 square km and had a population of 171 304 in 2011. – Mod.CP
Jajarko郡はネパールの75ある郡の一つである。郡の面積は2230平方メートルで、 人口は2011年の時点で171,304人である。