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1 明日のために 今行動を No action today, no cure tomorrow 20 March 2016, Tokyo Takeshi KASAI Director, Programme Management, WHO Western Pacific Region
2 Key message ポイント 薬剤耐性菌の問題は 昨日の我々の行動が起こした今日の問題であり 明日の治療のため 今行動が必要な地球規模課題 増加の要因は 一つではなく 保健部門を超えて政府全体ー民間ー国民の行動が必要であり 特に保健と漁業畜産部門の行動は不可欠 この問題を理解するための 想像力 と未来のために行動を起こすための 決意 が必要
3 なぜ WHO は憂慮しているのか? 薬剤耐性菌による感染症の治療は より困難で高額 またその成績も必ずしも良くない 国境を超えて 薬材耐性菌が増加している 抗菌薬の使用量も増加しており 新興国を中心に今後さらに増加が予測される 新しい抗菌薬の市場への投入が減少している
4 薬剤耐性結核 : A man-made disaster Drug-resistance created through inappropriate treatment Patients have to undergo toxic and costly treatment for two years or more Treatment outcome is poor with high mortality 5-year survival rate of XDR-TB: 23% * MDR-TB is defined as resistance to isoniazid and rifampicin. XDR-TB is defined as resistance to at least isoniazid and rifampicin, and to any fluoroquinolone, and to any of the three
5 薬剤耐性菌による死亡の推計 European Union population 500m Thailand population 70m United States population 300m 25,000 deaths per year >38,000 deaths >23,000 deaths 2.5m extra hospital days >3.2m hospital days >2.0m illnesses Overall societal costs ( 900 million, hosp. days) Approx. 1.5 billion per year Overall societal costs US$ mill. direct >US$1.3 billion indirect Overall societal costs Up to $20 billion direct Up to $35 billion indirect Source: ECDC 2007 Source: Pumart et al 2012 Source: US CDC 2013
6 薬剤耐性菌の割合は世界で増加中 International dissemination of New Delhi metallo-ß-lactamase (NDM) producing Enterobacteriaceae Alan P. Johnson1 and Neil Woodford Journal of Medical Microbiology (2013), 62,
7 抗菌薬の使用量と薬剤耐性菌の関係 Goossens et al, The Lancet Volume 365, Issue
8 世界各地で増加する抗菌薬使用量 ( 保健部門 )
9 世界各地で増加する抗菌薬使用量 ( 漁業 畜産業 ) (A) Largest five consumers of antimicrobials in livestock in 年の使用量の上位 5カ国 2030 年の推計使用量 増加量の多い上位 5 カ国 増加の割合の多い上位 5 カ国
10 抗菌薬 : 黄金時代を経て徐々に枯渇?!
11 どのような行動を起こさなければならないのか 普及啓発 サーベイランス 感染拡大の防止 適切な抗菌薬使用 研究開発の促進
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13 保健医療をとりまく状況の変化 /Evolving landscape 人口構成の変化 /Changing demographics 急速な都市化 /Urbanization and globalization 技術進歩 /Rapid improvements in technology 情報化 /Huge increases in access to information 格差拡大 /financial crises; Poverty; Inequality 気候変動 /Climate change 感染症 /New threats and diseases
14 少数民族の住む僻地 Reach those hard to reach
15 メコン川流域での薬剤耐性マラリアの出現
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17 我々は高病原性鳥インフルエンザ から何を学んだか? 一つの部門だけでは 効果的に流行を防ぎかつ封じ込めることはできない 保健部門と畜産部門の連携が不可欠 エコシステムを含め 我々には 判っていないことが多い Photo: courtesy to FAO
18 One Health One Health EMPRES-Asia OIE PVS Pathway
19 アジア太平洋感染症対策戦略 APSED-Zoonoses Coordinated Response Surveillance information from human health sector Surveillance information from animal health sector Huma n Health Anima l Health Wildlif e Coordination Mechanism Research Analysis Research Analysis Coordinated Risk Reduction
20 モンゴルとフィリピンの事例 Ching et al. Outbreak of Henipavirus Infection, Philippines, Emerging Infectious Diseases Vol. 21, No. 2, February 2015
21 アジアは感染症のハイリスク地域 WPRO: Regional event-based surveillance Reported Events n = 206 n = 218 n = 357 n = 294 n = 222 n = 246 N = 197 Infectious diseases* Animal H5N1** Disasters and others*** Chemical Fiscal year for TAG (Technical Advisory Group meeting): July June. * Excluding animal avian influenza events. ** Based on FAO report since ** Others include pharmaceutical-related', unknown', and food-related'; monitoring and reporting of disaster events became formalized mid-2011 and in 2013 became further modified based on the official Centre for Research on the Epidemiology of Disasters (CRED) criteria.
22 持続可能な開発目標 No body left behind! 誰も取り残されることのない未来に向けて
23 世界で行動を起こすために 世界保健デー (20 11 年 4 月 ) WHO 世界行動計画 (2 015 年 5 月 ) G7 保健大臣会合 (2 015 年 1 0 月 ) G7(20 16 年 5 月 WHO 総会決議 (201 4 年 5 月 ) GHSA 国連総会 (2016 年 9 月 ) アジア保健大臣会合 (2016 年 4 月 ) 西太平洋地域委員会決議 (201 4 年 10 月 )
24 If you want to go faster, go alone, if you want to go far, go together. アフリカのことわざ Thank you! FAQs:
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プランの策定の支援などが議論されました こうした状況を踏まえ 我が国においても薬剤耐性 (AMR) 対策アクションプランを取りまとめるべく G7 ドイツ ベルリン保健大臣会合後の昨年 2015 年 11 月 厚生労働省に薬剤耐性 (AMR) タスクフォースを設置し 有識者ヒアリング等による検討を重ね
2016 年 7 月 27 日放送 わが国の薬剤耐性対策アクションプランについて 厚生労働省健康局結核感染症課長浅沼一成策定の経緯本日は わが国の薬剤耐性対策アクションプラン (AMR アクションプラン ) について お話いたします まず 策定の経緯について です 抗微生物薬の不適切な使用等を背景として 薬剤耐性菌が世界的に増加している一方 先進国における主な死因が感染症から非感染性疾患へと変化する中で
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