RABIES (54): TIMOR-LESTE, FATALITIES
※和訳は正確を期していますが、必ず原文を参照してくださいますようお願いします。
Date: Fri 4 Jul 2025
Source: CNN Portugal [in Portuguese, machine trans., edited]
日付：2025年7月4日（金）
Rabies outbreak has killed 6 people in East Timor
Rabies has already killed 6 people in Timor-Leste, said the Timorese Government, which said it was working to prevent and mitigate the outbreak of that disease, detected in May 2023 in the Indonesian part of the island of Timor.
東ティモール政府は、2023年5月にティモール島のインドネシア側で確認された狂犬病の感染拡大の防止と軽減するために取り組んでいると述べた。
"At this time, rabies has become a concern for all of us, because it threatens public health in our country. We would like to inform you that the rabies disease has already killed 6 Timorese," says a joint circular from the authorities.
「現在、狂犬病はわが国の公衆衛生を脅かしているため、我々全員にとって懸念事項となっています。狂犬病により、すでに6人の東ティモール人が死亡しています。」と当局の共同通知で伝えられている。
The fatalities are from Oecussi (3), Bobonaro (2), and Ermera (1).
死亡者はオエクシ（3人）、ボボナロ（2人）、エルメラ（1人）である。
In the circular, the authorities ask people who own dogs, cats, and monkeys to keep them locked up and to take them to vaccination posts set up by the Ministry of Agriculture, Livestock, Fisheries and Forestry or to private veterinary clinics to be vaccinated against rabies. The Government also prohibited the transport of those domestic animals between municipalities, including to Atauro and Oecussi (an enclave on the Indonesian side of the island of Timor), and the entry of animals from abroad into the country, either by land, air, or sea.
この通知では、当局は、犬、猫、猿を飼っている人に対し、これらの動物を鎖で繋いで管理し、農業・家畜・水産・林業省が設置したワクチン接種会場又は民間の動物病院へ連れて行き、狂犬病の予防接種を受けるよう求めている。また、政府は、アタウロやオエクシ（ティモール島のインドネシア側の飛び地）を含む自治体間でのこれらの国内の動物の輸送や、陸路、空路、海路のいずれであっても、外国から国内への動物の入国を禁止した。
"In cases where the guard of the Transit Posts or the Joint Team finds them, the animals will be seized and eliminated," stresses the circular. The authorities will also slaughter unowned dogs and cats.
「検問所又は合同チームの警備員が当該動物を発見した場合、それらは押収のうえ、殺処分される」と通知は強調している。当局は所有権が不明な犬や猫も殺処分する予定である。
Rabies was first recorded in the western part of the island of Timor in May 2023 and reappeared in Timor-Leste in 2024. Between April 2024 and June, 1445 cases of dog bites were recorded in the country. Data from the Ministry of Health indicate that the geographical distribution of cases shows that Dili is the municipality with the highest number of cases, 553, (41.2%), followed by the region of Oecussi, with 425 cases (31.6%), and Bobonaro with 294 cases (21.9%).
狂犬病は、2023年5月にティモール島西部で初めて確認され、2024年に東ティモールでも再び確認された。2024年4月から6月の間に、国内では犬による咬傷件数が1,445件記録された。保健省のデータによれば、地理的分布ではディリ市が最も多く、553件（41.2%）を占め、次いでオエクシ地域が425件（31.6%）、ボボナロが294件（21.9%）であった。
About 66% of people bitten by dogs received the rabies vaccine (VAR), but many did not complete the recommended 5 doses. Only 18% of patients received rabies immunoglobulin (RIG), the Ministry of Health reported. The Government of Australia supported with 200 000 doses of the rabies vaccine, allowing the vaccination of all dogs in the national territory.
犬に咬まれた人々のおよそ66％が狂犬病ワクチン（VAR）を受けたが、多くの人は推奨されている5回接種を完了していなかった。狂犬病免疫グロブリン（RIG）を受けた患者はわずか18％にとどまったと、保健省は報告している。豪州政府は、国内すべての犬に対してワクチン接種を実施できるよう、20万ドーズの狂犬病ワクチンを提供した。
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Rabies has almost a 100% case fatality rate in humans, although a few survivors have been documented. The "touted" Milwaukee protocol from the past has been abandoned. The incubation period from exposure to first symptoms in human rabies is typically 3-8 weeks. Even what seems like minimal exposure can lead to a fatal outcome.
狂犬病は、人に感染した場合、ほぼ100％の致死率を示す疾患であり、極めてまれに生存例が報告されているものの、「有望視されていた」ミルウォーキー・プロトコル（過去の治療法）は現在では放棄されている。人の狂犬病の潜伏期間は通常3～8週間であり、わずかな曝露でも致命的な結果に至る可能性がある。
As noted in the following discussion, the availability of post-exposure prophylaxis is limited in low-income countries. Aggressively immunizing dogs and other animals who have close contact with humans is essential.
以下の議論にもあるように、曝露後予防（PEP）の入手は低所得国では制限されており、人との接触機会の多い犬やその他の動物への積極的な予防接種が極めて重要である。
The following is a good recent review of human rabies:
以下は、ヒト狂犬病に関する最新の良質なレビューである：
Swinkels HM, Koury R, Warrington SJ:Rabies. 2025. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK448076/#article-28157.s2
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Introduction
"Rabies has been a much-feared disease affecting humans and animals since antiquity due to its near-uniform fatality once symptoms appear. Following an incubation period ranging from a few days to a few years, rabies presents with a vague, febrile illness, frequently with pain and paresthesias at the wound site. Within 2 weeks, the neurological phase typically progresses into encephalitic or paralytic rabies, followed by coma. Death typically occurs within 2 to 3 days of coma onset. Once symptoms begin, treatment typically focuses on minimizing the patient's pain and suffering. In resource-poor countries, many individuals die at home.
"Rabies (RABV) and other similar viruses are zoonotic, neurotropic viruses belonging to the family Rhabdoviridae, genus Lyssavirus. These viruses cause indistinguishable clinical illnesses. Rabies is distributed worldwide, infecting various mammals, including dogs, cats, bats, livestock, and wildlife. The RABV is transmitted through the saliva of infected animals, contaminating bites, open skin, or mucous membrane, and, in rare cases, through organ transplantation. Dog bites account for 99% of rabies cases, making dogs the primary reservoir worldwide.
"Human rabies is rare in resource-rich countries but remains a significant public health concern in resource-limited regions, causing tens of thousands of deaths annually. The burden is highest in Asia and Africa, primarily affecting children in areas without large-scale preventive measures. All suspected and confirmed human and animal rabies cases must be reported to the appropriate hospital infection prevention and control programs, local public health authorities, or animal health authorities. Clinicians often overlook the diagnosis of rabies at the initial presentation. Preventing rabies is crucial, as treatment options after symptoms appear are mostly limited to palliative care.
"Following exposure, rabies postexposure prophylaxis (PEP) should be administered urgently, especially in deep or multiple bites in areas with dense nerve endings, such as the hands or regions close to the central nervous system (CNS), including the head and neck. PEP includes thorough wound cleansing, the administration of multiple cell culture-derived rabies vaccines, and human rabies immunoglobulin (HRIg) if the patient has not received prior rabies vaccination. Preexposure prophylaxis (PrEP) is available for individuals likely to be exposed to the RABV, such as veterinarians and long-term travelers or residents in endemic countries.
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"Clinicians must be familiar with local guidelines to determine appropriate PEP, as animal carriers, the prevalence of rabies, and the availability of vaccines and HRIg vary by region. In the United States, the Advisory Committee on Immunization Practices (ACIP) developed national human rabies prevention guidelines with support from the Centers for Disease Control (CDC) in 2008, updating them in 2010 to reduce the number of vaccines required for PEP. Local or state public health authorities develop guidelines specific to the region. The World Health Organization (WHO) revised its 2010 rabies vaccine position paper in 2018 to improve programmatic feasibility, simplify vaccination schedules, and improve cost-effectiveness.
地域によって感染動物種や狂犬病の流行状況、ワクチンや免疫グロブリンの入手可否が異なるため、医療従事者は地域ガイドラインに精通していることが重要である。アメリカでは2008年にCDC支援のもと、ACIPが全国的な狂犬病予防ガイドラインを作成し、2010年にはPEPに必要なワクチンの回数が削減されました。WHOも2018年にポジションペーパーを改訂し、接種スケジュールの簡素化と費用対効果の改善を図っています。
"The opportunity to provide appropriate postexposure rabies prophylaxis may be missed due to patient, clinician, or structural factors. Patients may be unaware that a specific exposure carries a risk or may not realize they were bitten, especially in cases of bat bites. Clinicians may be unaware of the local rabies epidemiology where the bite occurred or appropriate pre- or postexposure treatment. On the systemic level, a lack of PEP availability due to geographic factors or the prohibitively high cost of PEP results in lost opportunities for treatment.
適切な曝露後狂犬病予防（PEP）を提供する機会は、患者側、医療者側、または構造的な要因により失われることがある。患者は、特定の曝露がリスクを伴うことに気づいていなかったり、特にコウモリに咬まれた場合など、自分が咬まれたこと自体に気づかないこともある。医療従事者も、咬傷が発生した地域の狂犬病の流行状況や、適切な曝露前・曝露後の治療法について把握していない可能性がある。制度的な面では、地理的要因やPEPの高額な費用により、PEPの入手が困難であり、その結果、治療の機会が失われることになる。
Mass dog vaccination is the most cost-effective strategy for preventing dog-mediated human rabies worldwide.
犬への集団ワクチン接種は、人への狂犬病を防ぐうえで最も費用対効果の高い手段である。
In its 2017 Zero by 30 global strategic plan, the United Against Rabies coalition, in collaboration with the WHO and other global animal and human health organizations, aims to eliminate human rabies by 2030."
United Against Rabies（狂犬病根絶連合）は、WHO及び他の国際的な動物と人の保健機関と連携し、2017年に策定した『Zero by 30（2030年までにゼロ）』という世界戦略計画において、2030年までにヒトの狂犬病を根絶することを目指している。
Mod.LL
