Home >News > ProMED翻訳情報(236回) ~インドにおける人の死亡事例~

ProMED翻訳情報(236回) ~インドにおける人の死亡事例~


Date: Fri 6 Dec 2013
Source: The Times of India [edited]
出典:タイムス オブ インディア(編集)

The rabid dog that bit an 11-year-old girl on [19 Nov 2013] had bitten 4 more people in the same area [Pune, Maharashtra state] on that day.
The girl succumbed to the infection at 9:30 pm on Wednesday, 4 Dec 2013, while the 4 others are recovering. As many as 100 dog bite cases have been reported from the area in the past few days.

“All the 5 people, including the deceased victim, were reported to my clinic between 9:30 pm and 11:30 pm on 19 Nov 2013. The 11-year old suffered an injury on her forehead and it was a deep wound. So, I advised her parents to rush her to Sassoon hospital,” said physician Vilas M Dhere, who runs a clinic in Rammya Nagari in Bibvewadi [Pune].
Among the dog bite patients who reported to Dhere that day included a 30-year-old man who suffered an injury in his right armpit; a 22-year-old man whose got a deep wound on his right earlobe; a 50-year-old man who was bitten near the eyes and a 28-year-old man who got wounds on his head. “All 4 patients are recovering,” Dhere said.
2013年11月19日の9:30から11:30の間に死亡した被害者を含め、全部で5名が私の診療所にこられた。その11歳の少女は、彼女の額に受傷しておりそれはかなり深い傷であった。私は彼女の両親にSassoon病院に急いで彼女を連れて行くようにアドバイスした。とプーネ県BibvewadiのRammya Nagariで診療所を開業している医師Vilas M Dhereは言った。同日Dhereを訪れた犬咬傷者のなかには、右わきの下を受傷した30歳の男性、右耳たぶに深い傷を負った22歳の男性、目の近くを咬まれた50歳の男性、頭部に傷を負った28歳の男性がいる。4人すべてが回復中であるとDhereは言った。

Dhere’s clinic has been offering anti-rabies vaccines at subsidized rates through a project run by the Sevadham Trust and Grahak Panchayat since 2005. There are 4 more such clinics located in Yerawada, Perugate, Kunjirwadi and Narayangaon [areas in and around Pune] that do similar work. “As anti-rabies vaccines are provided for a very nominal charge, I get dog bite cases from Bibvewadi, Dhankawadi, Kondhwa, Katraj and even Peth areas. I have overseen such cases since January this year [2013]. The deceased girl was a grade III dog bite patient. However, I only possess the vaccine for grade I and II
cases,” Dhere said.
Dhereの診療所は2005年からSevadhamトラスト及びGrahak Panchayatにより営まれているプロジェクトを通して抗狂犬病ワクチンを助成料金で提供している。プーネ県内及び周囲のYerawada,Perugate, Kunjirwadi 及びNarayangaon地区にこのような診療所がもう4箇所あり、同様な仕事をしている。“抗狂犬病ワクチンをわずかな名目上の料金で供給されるので、私は犬による咬傷事故症例をBibvewadi, Dhankawadi,Kondhwa, Katraj 及びPeth 地区からさえ受け付ける。私は、今年(2013年)1月からこのような症例を指導監督している。その死亡した少女は、グレードⅢの犬による咬傷患者であった。しかし、私は、グレードⅠ及びⅡに対するワクチンしか所持していない。”とDhereは言った。

On why such a large number of cases are reported from the Bibvewadi-Dhankawadi-Katraj-Kondhwa belt, Dhere said, “Most housing colonies in these areas have issues regarding sanitation. Packs of dog are seen roaming freely near overflowing garbage bins.” Local corporator Yogesh Tilekar said, “The Pune Municipal Corporation’s squad that catches stray dogs take the round of the area during day between 11:00 am and 5:00 pm. But the canines create problems usually after 6:00 pm. I have requested the municipal commissioner to direct the squad to catch the strays in the evening.”
Bibvewadi-Dhankawadi-Katraj-Kondhwa地帯からどうしてそんなに多くの症例が報告されるのかというと“これらの地域においてほとんどの集落は公衆衛生に関して問題を抱えている。犬の群れはあふれかえる生ごみ容器の周囲を自由に歩き回っているように見える”とDhereは言った。地方公務員のYogesh Tilekarはこう話している。”放浪犬を捕獲するプーネ県地方自治体のチームは日中11:00から午後5:00までの間に巡回している。しかし、犬が問題を起こすのは午後6:00以降である。私は自治体の局長にそのチームに夕方の放浪犬捕獲を指示するよう依頼した。”

Doctors working at the anti-rabies project at Perugate clinic also get a steady flow of cases every day. “Around 70 cases are usually reported to our clinic throughout the year,” said family physician Manoj More. S T Pardeshi, PMC medical officer of health, said, “We have intensified the work of catching stray dogs from the outskirts where most dog bite cases are reported. We hope to check the menace
Perugate診療所で抗狂犬病プロジェクトに従事している医師達は、毎日常に多くの症例を受けている。”通常年間およそ70例が私たちの診療所を訪れる”と家庭医のManoj Moreは話した。PMC衛生医療官吏のS T Pardeshiはこう話した。”我々はほとんどの犬咬傷事故が報告されている郊外で放浪犬捕獲の仕事を強化している。私たちは、すぐにでもその厄介者を抑制したい。”
Experts have highlighted the need for health education programmes for the medical community and the public. They said the importance of proper wound care and post-exposure vaccination must be reinforced to prevent rabies infection.

Communicated by:
ProMED-mail from HealthMap Alerts

[It is likely that the victim in this incident succumbed to rabies virus infection as a consequence of the site of the bite, thereby enabling rabies virus to enter the central nervous system before inactivation of the virus by administration of anti-rabies vaccine.

Regarding the management of animal bite wounds, the National Centre for Disease Control of India recommends the following:

– Since the rabies virus enters the human body through a bite or scratch, it is imperative to remove as much saliva, and thereby the virus, from the wound as is possible by an efficient wound cleaning that should not involve additional trauma.

– Since the rabies virus can persist and even multiply at the site of the bite for a long time, wound cleaning must be performed even if the patient reports late.

– This can be done by prompt and gentle thorough washing with soap or detergent and flushing the wound with running water for 10 minutes.

– If soap and detergent are not immediately available, wash with running water for at least 10 minutes.

– Avoid direct touching of wounds with bare hands.

– The application of irritants (like chilies, oil, turmeric, lime,salt, etc.) is unnecessary and damaging. In case irritants have been applied on the wound, enough gentle washing with soap or detergent to remove the extraneous material, especially oil, should be done followed by flushing with a copious amount of water for 10 minutes immediately.

– Application of antiseptics: After thorough washing and drying of the wound, any one of the following available chemical agents should be applied: povidone-iodine (Betadine), alcohol, chloroxylenol (Dettol),chlorhexidine-gluconate and cetrimide solution (Savlon — in appropriate recommended dilution), etc. – Mod.CP