2014/10/16
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1 2014/10/16
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3 Actual Forecasts Million South Asia Middle East Africa East Asia/Pacific Americas Europe mn 1 bn 1.6 bn Year Travel Medicine, Third Edition
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5 DCC 4% 2% n = 2381; % 25% 65%! 65%! 25%! 4%! 4%! 2%!
6 DCC 5% 5% VFR! 7% 13% 32% 38% n = 672; ! 38%! 32%! VFR 7%! 5%! 5%! 13%! Yamauchi et a. IDSA 2010
7 DCC n = 2381; ,
8 ! GeoSentinel!! 1.! Diagnosis All Regions (N = 17,353) 2.! 3.! Systemic febrile illness 226 Acute diarrhea 222 Dermatologic disorder 170 Spectrum of disease and relation to place of exposure among ill returned travelers. N Engl J Med Jan 12;354(2):
9 DCC n = 2381; / / %! 674 /
10 knowlesi !!
11 ! 150!!
12 ! !!
13 100% Traveler's diarrhea 10% 1 Travel Medicine, Third Edition Influenza A or B Dengue infection (symptomatic) Animal bite with rabies risk PPD conversion Malaria (overall West Africa) Hepatitis A Typhoid (South Asia, N/W/Central-Africa) Tick borne encephalitis (rural Austria) Hepatitis B Typhoid (other areas) HIV-infection Malaria (overall Central America/Carib.) Fatal accident Cholera Legionella infection Japanese encephalitis Meningococcal disease Poliomyelitis 1% 0.1% 0.01% 0.001% %
14 Culex Aedes Anopheles!!!! / Jong Travel and Tropical Medicine Manual, 4th ed.
15 !! DEET Picaridin PERMETHRIN! Keystone, 3rd ed
16 ! Aedes aegypti!!! Aedes aegypti Anopheles
17 TABLE 1. PROTECTION TIMES OF INSECT REPELLENTS.* PRODUCT ACTIVE INGREDIENT CATEGORY OF DEET 20%! AND CONCENTRATION COMPLETE-PROTECTION TIME PROTECTION MEAN RANGE OFF! Deep Woods (SC Johnson) DEET, 23.8% 301.5± A Sawyer Controlled Release (Sawyer) 24% 5! DEET, 20% 234.4± B OFF! Skintastic (SC Johnson) DEET, 6.65% 112.4± C Bite Blocker for Kids (HOMS) Soybean oil, 2% 94.6± D OFF! Skintastic for Kids (SC Johnson) DEET, 4.75% 88.4± D 20% 4! Skin-So-Soft Bug Guard Plus (Avon) IR3535, 7.5% 22.9± E Natrapel (Tender) Citronella, 10% 19.7± E Herbal Armor (microencapsulated) (All Terrain) Green Ban for People (Mulgum Hollow Farm)! Citronella, 12%; peppermint oil, 2.5%; cedar oil, 2%; lemongrass oil, 1%; geranium oil, 0.05% Citronella, 10%; peppermint oil, 2% min 10 2!! 18.9± E 14.0± E Buzz Away (Quantum) Citronella, 5% 13.5± E Skin-So-Soft Bug Guard (Avon) Citronella, 0.1% 10.3± E Skin-So-Soft Bath Oil (Avon) Uncertain 9.6± E Skin-So-Soft Moisturizing Suncare (Avon) Citronella, 0.05% 2.8± F 20% picaridin Gone Original Wristband (Solar DEET, 9.5% 0.3± G Gloooow) Repello Wristband (Repello Products) DEET, 9.5% 0.2± H Gone Plus Repelling Wristband (Solar Citronella, 25% 0.2± H Gloooow) N Engl J Med. 2002;347(1):13.!
18 DEET! α PS ! DEET DEET DEET! J Am Acad Dermatol 2000;43: Aust N Z J Public Health 2009;33(5): DEET! Regul Toxicol Pharmacol 2010;56: DEET 4% DEET Am J Trop Med Hyg 2001;65:285 9.
19 50!!!!! 25 Freedman, et al. N Engl J Med 2006;354:
20 DCC (n=85) (n=86) (n=31) 1(1.2%) 61(70.9%) 0(0%) 58(68.2%) 7(8.1%) 9(29.0%) 18(21.2%) 8(9.3%) 21(67.7%) 6(7.1%) 5(5.8%) 0(0%) 2(2.%4) 4(4.7%) 0(0%) 0(0%) 1(1.2%) 1(3.2%) 1 68(81.0) 36(43.4%) 13(48.1%) 1 16(19.0) 47(56.6%) 14(51.9%) Kutsuna et al. ID week 2013
21 CDC Traveller s Health: WHO: Fit for travel: FORTH : : ja/from-idsc.html
22 Fit For Travel
23 Short (<10 days) Medium (11 21 days) Long (>30 days) / ( P. falciparum) (A, B, C, E) Mellioidosis HIV Q Assessment of travellers who return home ill. Lancet 2003; 361:
24 ! Q Q A E ETEC sick contact HIV HBV HCV HPV EBV
25 !!!!!!!!!! sick contact!
26 Critical Common Critical Common
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28 Tanizaki et al. Malaria Journal 2013, 12:128 CASE REPORT Open Access First case of Plasmodium knowlesi infection in a Japanese traveller returning from Malaysia Ryutaro Tanizaki 1*, Mugen Ujiie 1, Yasuyuki Kato 1, Moritoshi Iwagami 2, Aki Hashimoto 1, Satoshi Kutsuna 1, Nozomi Takeshita 1, Kyoko Hayakawa 1, Shuzo Kanagawa 1, Shigeyuki Kano 2 and Norio Ohmagari 1
29 Rapid communications Salmonella enterica serotype Paratyphi A carrying CTX-M-15 type extended-spectrum beta-lactamase isolated from a Japanese traveller returning from India, Japan, July 2013 M Mawatari (mawatamo@gmail.com) 1, Y Kato 1, K Hayakawa 1, M Morita 2, K Yamada 3, K Mezaki 3, T Kobayashi 1, Y Fujiya 1, S Kutsuna 1, N Takeshita 1, S Kanagawa 1, M Ohnishi 2, H Izumiya 2, N Ohmagari 1 1. Disease Control and Prevention Center, National Center for Global Health and Medicine, Tokyo, Japan 2. Bacteriology I, National Institute of Infectious Diseases, Tokyo, Japan 3. Clinical Laboratory, National Center for Global Health and Medicine, Tokyo, Japan Citation style for this article: Mawatari M, Kato Y, Hayakawa K, Morita M, Yamada K, Mezaki K, Kobayashi T, Fujiya Y, Kutsuna S, Takeshita N, Kanagawa S, Ohnishi M, Izumiya H, Ohmagari N. Salmonella enterica serotype Paratyphi A carrying CTX-M-15 type extended-spectrum beta-lactamase isolated from a Japanese traveller returning from India, Japan, July Euro Surveill. 2013;18(46):pii= Available online: Article submitted on 30 October 2013 / published on 14 November 2013
30 Rapid communications Two cases of Zika fever imported from French Polynesia to Japan, December 2013 to January 2014 S Kutsuna (sonare.since1192@gmail.com) 1, Y Kato 1, T Takasaki 2, M L Moi 2, A Kotaki 2, H Uemura 1, T Matono 1, Y Fujiya 1, M Mawatari 1, N Takeshita 1, K Hayakawa 1, S Kanagawa 1, N Ohmagari 1 1. National Center for Global health and Medicine, Disease Control and Prevention Center, Tokyo, Japan 2. Department of Virology 1, National Institute of Infectious Diseases, Shinjukuku, Tokyo, Japan Citation style for this article: Kutsuna S, Kato Y, Takasaki T, Moi ML, Kotaki A, Uemura H, Matono T, Fujiya Y, Mawatari M, Takeshita N, Hayakawa K, Kanagawa S, Ohmagari N. Two cases of Zika fever imported from French Polynesia to Japan, December 2013 to January Euro Surveill. 2014;19(4):pii= Available online: eurosurveillance.org/viewarticle.aspx?articleid=20683 Article submitted on 19 January 2014 / published on 30 January 2014
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34 PPE
35 CDC
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37 Take Home Message 3!!!! ESBL
マラリアの臨床症状 潜伏期間は12 35日! 発熱以外の症状は多彩! 頭痛 関節痛 黄疸 吐気 下痢など! 症状が発熱と下痢だけのこともあり 旅行者下痢症と判 断され診断が遅れ重症化することがある 重症マラリア の死亡率は15-20% 20
DCC (n=85) (n=86) (n=31) 1(1.2%) 61(70.9%) 0(0%) 58(68.2%) 7(8.1%) 9(29.0%) 18(21.2%) 8(9.3%) 21(67.7%) 6(7.1%) 5(5.8%) 0(0%) 2(2.%4) 4(4.7%) 0(0%) 0(0%) 1(1.2%) 1(3.2%) 1 68(81.0) 36(43.4%) 13(48.1%)
講演 Ⅰ 蚊が媒介する感染症 講師 : 国立研究開発法人国立国際医療研究センター病院 忽那賢志氏 1
講演 Ⅰ 蚊が媒介する感染症 講師 : 国立研究開発法人国立国際医療研究センター病院 忽那賢志氏 1 2 蚊が媒介する感染症 国立国際医療研究センター国際感染症センター忽那賢志 人類最大の敵は? 3 2015 年に動物に 殺された人間の数 蚊 全世界でのデング熱の推定年間感染者数 3 億 9000 万人 Nature. 2013 Apr 25;496(7446):504-7. 4 蚊媒介性感染症は世界の脅威に!
ジカ熱の広がり2005 2014 Zika virus: following the path of dengue and chikungunya? globally, similar to dengue (DENV) time and caused an epidemic on Yap Island in the Federated States of and chikungunya (CHIKV)
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