台湾における狂犬病の疫学と我が国における診断能力向上の取り組み

抄録

Taiwan has been considered canine rabies free for 52 years after the elimination of endemic dog rabies in 1961. However, three ferret-badgers (Melogale moschata) were confirmed as rabies and reported to OIE by Taiwan government on July 17, 2013. This was the first rabies positive during rabies test under the surveillance of animals from 1999 in Taiwan. Through inter-ministerial collaboration by the Rabies Control Central Epidemic Command Center established on August 1, 2013, there have been no human infections reported according to the increased health education, vaccination of dogs and cats, and the use of preand postexposure prophylaxis in humans. Interestingly, rabies virus isolated from Taiwan ferret badgers has been a distinct lineage within the group of lineages from Asia, phylogeographically. It was also reported that the most recent common ancestor was originated 91-113 years ago. This was a strong impact for the consideration of a rabies free status in Japan. The last case of indigenous human and animal rabies in Japan was reported in 1956 and 1957, respectively, and, since then, there has been no report about animal rabies. Until now, under the Rabies Prevention Law (MHLW, 1950), the Infectious Diseases Control Law (MHLW, 1998) and the Domestic Animal Infectious Diseases Control Law (MAFF, 1951) substantive efforts to prevent rabies have been adopted by the central and local governments, veterinarians, and physicians (e.g. registration and control of stray dogs, rabies diagnosis in suspected cases, appropriate PEP for human, import and export quarantine of animals, notification system for the importation of animals, rabies vaccination of dogs). However, three imported human cases were reported. In 1970, a college student suffered from rabies in Tokyo after a trip to Nepal where he had been bitten by a stray dog. Two patients returned from the Philippines were coincidentally reported in Kyoto and Yokohama in November 2006 after a 36-year absence (http://idsc.nih.go.jp/iasr/28/325/tpc325.html). Two cases in 2006 were dealt in accordance with The Guideline for Rabies in 2001 (MHLW) in terms of the initial response and medical practice. This guideline played a successful role in those two cases and was result of the follow-up amendment and drill of measures and contingency plan had been deemed because of any inappropriate public health response or delay at an early stage of rabies cases, even in doubt, leading to unnecessary, excessive social anxiety. In addition, the Guideline for Rabies Control in Japan 2013 was come out focusing on an action plan after the confirmation of rabid animals. In reaction to the outbreak of rabies in ferret-badgers in Taiwan, the Guideline for Animal Rabies Survey was also reported on March 2014 for the capacity building of rabies diagnosis and report system on animal rabies in the local government of Japan.