座長メッセージ Chairperson s Message 最近問題となった人と動物の共通感染症 Recent Topics of Zoonosis 姫野病院名誉院長 吉田博 Hiroshi YOSHIDA, Honorary Director, Himeno Hospital 感染症は生活環境の改
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1 35 Live Love Animals ICAC KOBE 2015 The 4 th Kobe International Conference on the Care for All Creatures 2015 Symposium 2 シンポジウム 2 最近問題となった人と動物の共通感染症近年 感染症は世界的規模で再び出現しつつあるが 最近30 ~40 年間の間に新しく出現した新興感染症や一旦制圧された感染症が再び出現した再興感染症が主な感染症である 本シンポジウムでは 最近問題となった人と動物の共通感染症のなかで エボラ出血熱 デング熱 重症熱性血小板減少症候群と動物由来感染症に対する厚生労働省の取り組みについて紹介する 主催 人と動物の共通感染症研究会 座長 吉田博(姫野病院名誉院長) 演者 エボラ出血熱ーリベリアにおける支援活動から学んだことー 加藤康幸(国立国際医療研究センター国際感染症センター国際感染症対策室医長) 70 年ぶりの再興~デング熱国内流行とその対策~ 高崎智彦(国立感染症研究所ウイルス第一部第2 室長) 動物を守り 自分を守る;ダニ媒介感染症SFTSの最新の研究から 前田健(山口大学共同獣医学部教授) 最近問題となった動物由来感染症に対する厚生労働省の取組みについて 宮川昭二(厚生労働省健康局結核感染症課感染症情報管理室長) Recent Topics of Zoonosis Recently, infectious diseases are spreading in world wide. These main infectious diseases are emerging infectious diseases and re-emerging infectious diseases. In this symposium, recent topics of zoonosis, Ebola hemorrhagic fever, Dengue fever, Severe fever with thrombocytopenia syndrome (SFTS) and the policies of zoonosis by the Ministry of Health Labour and Welfare will be discussed. Organizer: Society for Zoonosis Research Chairperson: Hiroshi YOSHIDA (Honorary Director, Himeno Hospital) Speakers: Ebola in West Africa: A clinician s point of view Yasuyuki KATO, MD, MPH (Chief, Division of Preparedness and Emerging Infections, Disease Control and Prevention Center, National Center for Global Health and Medicine) Re-emerging dengue epidemic and prevention in Japan Tomohiko TAKASAKI, MD, PhD (Chief, Vector-borne Virus Laboratory, National Institute of Infectious Diseases) Protect your pets, protect yourself; Lessons from recent research on tick-borne severe fever with thrombocytopenia syndrome Ken MAEDA, Ph.D., D.V.M. (Professor, Joint Faculty of Veterinary Medicine, Yamaguchi University) Measures and Actions by Japan s Health Ministry to Recent Zoonosis Events Shoji MIYAGAWA, DVM. MS. (Director, Infectious Diseases Information Surveillance Division, Health Bureau, the Ministry of Health, Labour and Welfare, JAPAN)
2 座長メッセージ Chairperson s Message 最近問題となった人と動物の共通感染症 Recent Topics of Zoonosis 姫野病院名誉院長 吉田博 Hiroshi YOSHIDA, Honorary Director, Himeno Hospital 感染症は生活環境の改善 抗菌薬やワクチンの開発により制圧できると考えられていた しかし 新しく出現した新興感染症やいったん制圧されたされたものの 再び流行し始めた再興感染症が新たな問題となっている また 海外から持ち込まれる輸入感染症も増加している 2014 年には 70 年ぶりのデング熱の国内流行やエボラ出血熱の国内上陸への懸念など 新興 再興感染症や輸入感染症の脅威と対策の重要性が再認識された年であった また 重症熱性血小板減少症候群 (severe fever with thrombocytopenia syndrome SFTS ) は 2009 年以降 中国中央部に発生しているダニ媒介性の疾患であるが 2012 年以降 我が国固有の SFTS ウイルスによる SFTS の症例の存在が確認された 2014 年 11 月の時点で 西日本の 15 県で患者 108 名が確認され 35 名が死亡している 一方 国内における犬や猫などのペットの飼育頭数も年々増加しており 動物由来感染症の報告も増加傾向である 動物由来感染症に対しては医師会と獣医師 会が協力して 厚生労働省とともに対策を進めている このシンポジウムでは 西アフリカで大流行したエボラ出血熱に対するリベリアにおける支援活動 今年の夏も再流行が懸念されるデング熱に対する対策 重症熱性血小板減少症候群の最新の知見 最近問題となった動物由来感染症に対する厚生労働省の取り組みについてお話をいただきます Infectious diseases could be contorolled by the improvement of environmental sanitation and the development of antimicrobial agents and waccines. However, emerging infectious diseases and reemerging infectious diseases can be the new subjects in Japan. An imported infections are also increasing in japan. In 2014, epidemia of dengue fever were observed in japan after 70 years interval. Possibility of the invasion of Ebora virus to Japan was worried last year. Severe fever with thrombocytopenia syndrome (SFTS) was reported from mid China from In Japan, SFTS was reported 108 cases (including 35 dead cases) from 15 prefectures of south Japan until november A number of pets are increasing in Japan, therefore patients of zoonosis are increasing now. Japan Medical Association and Japan Veterinary Association are taking a measure to meet for the zoonosis with Ministry of Health and Welfare. In this symposium, Ebora hemorrhagic fever, Dengue fever, SFTS, and the policies of zoonosis by the Ministry of Health, Labour and Welfare will be discussed. 36 りぶ らぶ あにまるず ICAC KOBE 2015 第 4 回神戸全ての生き物のケアを考える国際会議 2015
3 エボラ出血熱 リベリアにおける支援活動から学んだこと Ebola in West Africa: A clinician s point of view 国立国際医療研究センター国際感染症センター国際感染症対策室医長 加藤康幸 Yasuyuki KATO, MD, MPH, Chief, Division of Preparedness and Emerging Infections, Disease Control and Prevention Center, National Center for Global Health and Medicine エボラ出血熱 (EVD) は,1976 年にアフリカ中央部で見いだされた致死率の高い新興ウイルス感染症である コウモリが病原体を保有していると考えられるが 今回の西アフリカにおける流行においても最初の患者が動物からどのように感染したかは不明のままである この初発患者に続いて 患者をケアした家族や医療従事者に感染が伝播することにこの疾患の特徴がある 演者は世界保健機関の短期専門家としてリベリアに派遣された 2014 年 8 月に大統領による非常事態宣言が出され 首都モンロビアの主要病院は医療従事者の感染を契機に閉鎖されていた EVD の治療施設は 1 カ所しかなく 患者の急増に施設が追いつかなかった この頃には EVD の流行が保健の問題から危機管理の問題に移行したという認識が広く共有され 国際支援が大幅に強化されることになった リベリアの関係者や住民の協力により 2015 年 5 月に一旦終息宣言が出されたことは喜ばしいことである しかし 3 カ国とも未だに患者が発生しており 予断を許さない状況にある EVD の流行を征圧するには 患者の速やかな診断と隔離 接触者の調査 感染防止に配慮した遺体埋葬 疾患に対する啓発 を着実に行う必要がある 今回の流行の背景にはこれらを阻害する様々な要因があったと考えられる マラリアなど致死率の高い別の感染症も多いことや内戦から復興して間もない社会環境も影響していただろう 偏見を恐れ 患者が受診を控えるような行動も認められた 感染症の流行は医学的な問題ばかりでなく 社会的な側面も大きいことがわかる EVD に限らず 西アフリカのような公衆衛生基盤の脆弱な地域で発生した感染症がわが国に波及する可能性もあり 現地支援が最も有効な国内対策にもなりうる このような観点で 国内の専門家が海外の流行地で活動することについて 広く理解と支援を得られれば幸いである Ebola virus disease (EVD) is a highly fatal emerging viral infectious disease, which was firstly recognized in central Africa in Bats are believed to be natural reservoirs; however, in the recent epidemic in West Africa, it remains unknown how the initial patient got infected from an animal. It is surprising that except this initial case over 20,000 patients probably got infected with EVD through person-to-person transmission. The author was dispatched to Liberia as a short-term consultant on case management and infection prevention and control for the World Health Organization. In August 2014, the President of Liberia declared a state of emergency and major hospitals in the capital of Monrovia were shut down due to healthcare workers infection. There was only one Ebola treatment center, which could not keep up with the rapid increase in patients. At this time, the view that the EVD outbreak had shifted from a health problem to a crisis management issue was shared internationally, thus leading to a major intensification of international support. The outbreak was thankfully declared over in Liberia in May However, cases of EVD continue to emerge in West Africa. Control of EVD outbreak requires the proper installation of case management, contact tracing, safe and dignified burial, and social mobilization. The presence of various factors inhibiting the above measures has contributed to the recent outbreak. Every outbreak of infectious disease is not only a medical problem; social aspects are also greatly involved. There are many areas with frail public health infrastructure in the world. Conducting support activities in these areas could be the most effective way to prevent an exotic infectious disease from spreading to Japan. From this point of view, I hope that Japanese experts engagement in outbreak response abroad will win public acceptance and support. Live Love Animals ICAC KOBE 2015 The 4 th Kobe International Conference on the Care for All Creatures
4 70 年ぶりの再興 ~ デング熱国内流行とその対策 ~ Re-emerging dengue epidemic and prevention in Japan 国立感染症研究所ウイルス第一部第 2 室長 高崎智彦 Tomohiko TAKASAKI, MD, PhD, Chief, Vector-borne Virus Laboratory, National Institute of Infectious Diseases デング熱は蚊によって媒介されるウイルス感染症であり 熱帯や亜熱帯地域で流行する デング熱は 決して新しい感染症ではない デング熱 デング出血熱は世界的にも非常に重要な再興感染症と考えられている 年の流行以前に我が国においても大正時代にすでに研究されていた感染症である デングウイルスには 4 つの血清型が存在する デング熱は突然の高熱で発症し その多くは関節痛 筋肉痛 頭痛を伴う 発疹は約半数で発症からやや遅れて出現する 解熱傾向とともに 出血傾向を呈し重症化することがある 1942 年の 8 月に長崎市で突然デング熱流行が発生し 佐世保や大阪 神戸でも発生したが 11 月には終息した しかし翌年の夏には再流行し 1945 年まで夏季にデング熱流行が発生した その後 国内流行はなく非流行地であったため 医師のデング熱に対する認識は高くなかった 2014 年 8 月下旬に 69 年ぶりに海外渡航歴のないデング熱患者が報告され 東京の代々木公園で感染したと考えられる流行が発生し 162 例のデング熱患者が報告 された 流行の原因となったウイルスはデングウイルス 1 型であった 媒介蚊はネッタイシマカとヒトスジシマカであるが ヒトスジシマカは広く日本に生息している ヒトスジシマカの分布域は 70 年前は福島県にはまだ定着していなかったが 現在では青森県を除く東北地方に定着している Dengue fever is a mosquito-borne viral disease. Dengue virus (DENV) infections occur in most of the tropical and subtropical areas of the world. DENV infection with any of four serotypes leads to a broad spectrum of clinical symptoms and their severity, including asymptomatic infection, dengue fever (DF) and fatal dengue hemorrhagic fever (DHF). The common symptoms of dengue fever are high fever, headache and muscle pain are shown on the onset day and later petechial rashes will be appeared. Some cases show bleeding signs and become severe dengue. DF/DHF is considered to be one of the most important re-emerging infectious diseases. Physicians and pediatricians in non-endemic countries are often unfamiliar with the symptoms and unaware of the potential importation of patients with DF/DHF. In August of 1942, an epidemic occurred suddenly in Nagasaki city and then in Sasebo city, Osaka and Kobe city. The epidemic in 1942 was subsided in November, but in the next summer it broke out again and recurred every summer until There were no dengue endemics since In late August of 2014, three autochthonous dengue cases were reported in Japan. Since then, as of 31 October 2014, a total of 162 autochthonous cases have been confirmed. While cases were reported from throughout Japan, the majority was linked to visiting a large park or its vicinity in Tokyo, and the serotype detected has been serotype 1. The vector is Aedes albopictus, now widespread in Japan. Aedes albopictus, can transmit the dengue viruses and now has a northern range extending to Akita and Iwate prefectures because of global warming. 38 りぶ らぶ あにまるず ICAC KOBE 2015 第 4 回神戸全ての生き物のケアを考える国際会議 2015
5 動物を守り 自分を守る ; ダニ媒介感染症 SFTS の最新の研究から Protect your pets, protect yourself; Lessons from recent research on tick-borne severe fever with thrombocytopenia syndrome 山口大学共同獣医学部教授 前田健 Ken MAEDA, Ph.D., D.V.M., Professor, Joint Faculty of Veterinary Medicine, Yamaguchi University 犬におけるダニ媒介感染症として バベシア感染症が重要です 一方 ヒトではこれまで日本紅斑熱 ライム病 ツツガムシ病などが報告されています 2011 年に中国から 2012 年末には国内でダニ媒介性感染症である重症熱性血小板減少症候群が報告されました 致死率が高く 周辺に存在するダニが媒介するということで ダニ媒介性感染症に対して不安になったと思います しかし 特別に恐れる必要はないです 改めてダニ媒介感染症を知り ペットを守り そして自分を守る ことが重要です 対策の概要 1. ペットにはダニの忌避剤を投与してください 2. 散歩にいったペットは家に入る前にブラッシングをしてください 3. ペットにダニが付いていれば動物病院で取ってもらってください 4. 歩き回るダニを見つけたらガムテープなどにつけて捨ててください 5. 山歩き 農作業を始める際は ダニやカなどの忌避剤をつけてください 6. 可能な限り肌の露出を少なくしてください 7. 農作業や山に入ったときは家に入る前にダニが服に付着していないかチェックしてください 8. 農作業や山に入ったときは入浴時にダニが付着していないかチェックしてください 9. ダニが付着していればすぐに病院に行ってダニをとってもらってください 10. ダニに刺咬されたあとは 1 2 週間発熱がないかチェックしてください 11. ダニに刺されてしばらくした後に発熱があった場合は 速やかに病院に行って 医師にダニに刺咬された旨を伝えてください In tick-borne infectious diseases, babesiosis is one of the most serious problem in dogs and Japanese spotted fever, lyme disease and Tsutsugamushi disease have been reported in human. In 2011 and 2012, cases of tick-borne severe fever with thrombocytopenia syndrome SFTS were reported in China and Japan, respectively. Since SFTS shows high mortality and is transmitted by ticks which are surrounding our life, we got nervous to this disease and ticks. For protection of your pets and yourself from these diseases, it is the most important to learn again about tickborne infectious disease Prevention of tick-borne diseases 1. Protect your pets by mite repellents. 2. Brush your pets hair to remove ticks on their surface. 3. Remove ticks on your pets as soon as possible, if you find biting ticks. 4. Let ticks fix with gummed tape, if you find moving ticks. 5. Protect yourself by mosquito and mite repellents before walking around the bush, forest and mountain. 6. Wear long sleeves, long pants, and socks when outdoors 7. Examine gear before coming inside home. 8. Conduct a full-body tick check using a mirror. 9. Remove ticks by a fine-topped tweezers as soon as possible. 10. Examine a fever by yourself for one-two weeks after tick-bite. 11. If you develop a rash or fever within several weeks of removing a tick, see your doctor. Be sure to tell the doctor about your recent tick bite, when the bite occurred, and where you most likely acquired the tick. Live Love Animals ICAC KOBE 2015 The 4 th Kobe International Conference on the Care for All Creatures
6 最近問題となった動物由来感染症に対する厚生労働省の取組みについて Measures and Actions by Japan s Health Ministry to Recent Zoonosis Events 厚生労働省健康局結核感染症課感染症情報管理室長 宮川昭二 Shoji MIYAGAWA, DVM. MS., Director, Infectious Diseases Information Surveillance Division, Health Bureau, the Ministry of Health, Labour and Welfare, JAPAN 昨年の西アフリカでのエボラ出血熱の流行や韓国での中東呼吸器症候群 (MERS) など感染症の脅威は 日本で暮らす一般の人々にも様々な影響を及ぼしている 人における感染症のなかには 動物での感染症や動物が保有する病原体などによる例も多く 動物由来感染症対策は人での感染症対策を推進する上で重要な分野である 人と動物がともに暮らす社会においては 動物に由来する感染症に十分な注意を払う必要がある 本講演では 鳥インフルエンザや中東呼吸器症候群 (MERS) など最近話題となった動物由来感染症と厚生労働省の取り組みを紹介する Global threat of infectious diseases like Ebola endemic in West Africa and Recent events of Middle East Respiratory Syndrome (MERS) in Republic of Korea has great impacts to ordinal citizen even in Japan. Among the serious infectious diseases in human there are several instances which those infectious diseases are originally from infectious diseases or pathogens found in animal population. Therefore it is important to emphasize prevention and control on zoonotic infectious diseases when we strengthen the overall infectious diseases prevention and control in human. Like modern living setting where human and animal live together closely we should pay substantial attention to infectious diseases from animals. In this presentation, recent zoonotic events like avian influenza and Middle East Respiratory Syndrome (MERS) Coronavirus infection and Japan s Health Ministry s measures and actions to those events are presented. 40 りぶ らぶ あにまるず ICAC KOBE 2015 第 4 回神戸全ての生き物のケアを考える国際会議 2015
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