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Epidemiological studies of the effectiveness and appropriateness of today's Japanese rabies prevention system

Kwan, Nigel Chun Lok 東京大学 DOI:10.15083/0002004162

2022.06.22

概要

日本では、1950年に制定された狂犬病予防法により狂犬病対策が強力に推進された結果、当時年間1000例ほど報告されていた犬の狂犬病は清浄化が進み、1956年の6頭の発生を最後に現在まで報告されていない。一方、世界的には、狂犬病がない国・地域は極めて少なく、狂犬病予防法に基づき清浄国・地域として認めてられているのは、豪州、ニュージーランド、ハワイ、フィジー、グアム、アイスランドの6カ国・地域である。

国際獣疫事務局(OIE)は、清浄国は狂犬病の侵入を防ぐため、特定の哺乳類、特に食肉目と翼手目の輸入を禁じたり、その国の獣医部局が許可した方法によってのみ輸入を認めたりする措置を講じることができるとしている。また、清浄国はサーベイランスを徹底し、狂犬病の侵入をいち早く検出できる体制を整備すべきとしている。そのほかにワクチン接種などを実施することもできるとしている。日本では、狂犬病予防法に基づき犬の所有者は年1回のワクチン接種が義務付けられるとともに、犬および猫を輸入する際には輸出国での2回ワクチン接種、抗体検査、180日間の待機からなる厳しい輸入検疫規則が適用されている。

清浄国におけるワクチン接種の必要性については、狂犬病の侵入リスク、仮に侵入した場合のまん延リスクなどを考慮して判断する必要がある。日本への狂犬病の侵入経路にはさまざまな経路がある。動物検疫所を通じて毎年約1万頭の犬・猫が輸入されているほか、在日米軍により毎年1000~2000頭の犬・猫が輸入されている。また、北海道に寄港するロシア船からの不法上陸犬についても侵入源としての危険性が指摘されている。本研究は、これらの侵入経路を通じた日本への狂犬病の侵入リスクを定量的に評価するとともに、仮に侵入した場合の狂犬病がまん延予測に有用なデータの収集、現在日本で使用されている狂犬病ワクチンの有効免疫付与期間の推定、狂犬病ワクチン接種策の経済的な効率性を明らかにすることを試みたものであり、以下の5章からなる。

第1章日本への犬および猫の輸入に伴う狂犬病侵入リスクの定量的評価
動物検疫所および米軍を通じた犬・猫の輸入に伴う侵入経路として計14の経路からなるシナリオツリーを作成し、各シナリオに関係する事象に文献調査などにより推定した確率分布を当てはめることにより、侵入リスクを推定した。その結果、現行の輸入規則が守られる限り侵入リスクは49,444年(90%予測区間(PI):19,170~94,641年)に1回であるが、遵守しない者が20%いると249年に1回であることが判明した。また、シナリオア分析の結果、輸出国でのワクチン接種回数を1回に減らしても、また、輸出国での待期期間を90日に短縮しても侵入リスクは大幅に増大しないことが確認された。

第2章北海道に寄港するロシア船からの不法上陸犬を通じた狂犬病侵入リスクの定量的評価
ロシア船は犬が海難事故防止に役立つとの迷信の下、犬を乗船させる習慣がある。狂犬病に感染した犬が乗船し、北海道の港で不法上陸し、日本の動物と接触し侵入の原因となる可能性があるとの前提の下、不法上陸犬による狂犬病侵入リスクの評価を行った。その結果、ロシア船からの不法上陸犬による侵入リスクは多数のロシア漁船が寄港していた2000年前後に比べ大幅に低下し、現状(2006~2015年のデータ)では108万年に1回程度であることが判明した)。

第3章日本の飼育犬間の接触頻度および狂犬病を想定した飼育者の行動の評価
仮に狂犬病に感染した動物が日本に侵入した場合、飼育犬間での接触が感染拡大の原因となることが予想される。そこで、飼育犬間の接触率や飼育者の行動様式に関する情報は日本での狂犬病のまん延予測に有用であるとの考えの下、これらの情報の入手するためペット保険会社を通じて被保険犬の所有者に質問票を配布したところ、全国46都道府県の犬の所有者1151人から回答を得た。その結果、散歩中に飼育犬が他の飼育犬と接触する確率は0.83(95%信頼区間(CI):0.81~0.85)であり、一日平均接触回数は2.73(95%CI:2.42~3.11)回であった。この結果を基にした多重線形回帰分析を行ったところ、犬の散歩中の接触率は飼育者の社会学的行動、犬の飼育されている地域における犬の飼育密度、犬の体型に影響を受けることが示唆された。また、散歩中に犬による咬傷事故等が発生した場合の飼育者の行動については比較的高い評価結果が得られ、狂犬病のまん延防止の観点から適切な行動をとることが予測された。

第4章日本製の狂犬病ウイルスRC-HL株犬用ワクチンの有効性評価
日本で使用されている動物用狂犬病ワクチンは、狂犬病ウイルスRC-HL株より精製された不活化ワクチンであり、1回接種による免疫付与期間は1年間として承認されている。2012~2015年に狂犬病ワクチン接種を受けた飼育犬144頭が保有する抗体価のデータを用いてロジスティック回帰分析を行った。その結果、1回のワクチン接種で12カ月間十分な抗体価を維持した犬の割合は74.7%(95%PI:51.4~90.5%)と推定された。2~4回および5回以上接種した犬が十分な抗体価を維持する確率は、それぞれ96.6%(95%PI:83.1~99.3%)および98.7%(95%PI:96.9~99.6%)であった。さらに、36カ月間十分な抗体価を維持できる確率は、1回接種の犬では33.4%(95%PI:11.4~71.6%)であるが、2~4回および5回以上ワクチン接種された犬では、それぞれ83.0%(95%PI:39.4~97.1%)および93.0%(95%PI:59.7~99.2%)と推定された。先行研究の結果を基にしたメタ解析の結果では、1回接種の犬では少なくとも12カ月間十分な抗体価を維持した犬の割合は83.8%(95%CI:66.1~97.5%)と推定され、少なくとも2回以上接種した犬では94.7%(95%CI:87.7~99.1%)と推定された。

第5章日本における狂犬病ワクチン接種義務付け政策の便益費用分析
狂犬病ワクチン接種を実施することにより侵入時のまん延を防止することができるが、毎年ワクチン接種の費用が必要となる。第1章および第2章の侵入リスク評価の結果並びに自治体関係者とのインタビュー調査結果などを基に推定した狂犬病ワクチン接種にかかる年間費用、狂犬病発生時の防疫にかかる費用をもとに便益費用分析を行った。その結果、狂犬病ワクチン接種の実施にかかる年間費用は180億円(90%PI:167~222億円)と推定された。狂犬病ワクチン接種策を継続した場合、狂犬病が発生した時の経済損失は1.9億円(90%PI:1.3~2.5億円)となり、一方で、仮にワクチン接種策を廃止した場合の経済損失は約3倍の5.6億円(90%PI:4.5~6.9億円)と推定された。狂犬病の侵入リスクを考慮すると、ワクチン接種策による年間利益の期待値は9619円(90%PI:6251~13,112円)となり、費用便益比は5.35×10−7(90%PI:3.46×10−7~7.37×10−7)と1を大幅に下回り、経済的には日本の狂犬病ワクチン接種策は非常に非効率的であることが示唆された。

以上の結果から、日本への狂犬病の侵入リスクは現行制度の下では極めて小さく、そのような中でとられている狂犬病ワクチン接種策は、侵入時の経済損失を抑える効果はあるが、経済的には非常に非効率な政策であることが判明した。このような状況の中、将来ワクチン接種回数を減らす場合には現行の毎年1回から2、3年に1回に減らしても有効な免疫を有する犬の割合はほとんど変化しないことも判明した。これらの結果は、日本における狂犬病対策の見直しの検討にあたり有用な情報を提供すると期待する。

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