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

(1)

DCCでの症例の比較

デング熱

(n=85)

マラリア

(n=86)

腸チフス

(n=31)

渡航先

アフリカ

1(1.2%)

61(70.9%)

0(0%)

東南アジア

58(68.2%)

7(8.1%)

9(29.0%)

南アジア

18(21.2%)

8(9.3%)

21(67.7%)

オセアニア

6(7.1%)

5(5.8%)

0(0%)

南アメリカ

2(2.%4)

4(4.7%)

0(0%)

その他の地域

0(0%)

1(1.2%)

1(3.2%)

渡航期間

1 ヶ月未満

68(81.0)

36(43.4%)

13(48.1%)

1 ヶ月以上

16(19.0)

47(56.6%)

14(51.9%)

Kutsuna et al. ID week 2013

日本におけるマラリア

✤

年間60∼80例前後（全て海外感染例）。!

✤

現在でも年間1~2人程度死亡例がみられる。診断・治療の

(2)

● 約10日間∼30日間。まれに、半年以上の場合もあります。

● 旅行が1週間以内であれば、現地で発病することはありません。

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%

(3)

ヒトに感染するマラリア

病名

病原体名

熱帯熱マラリア

熱帯熱マラリア原虫 Plasmodium falciparum

三日熱マラリア

三日熱マラリア原虫 P. vivax

四日熱マラリア

四日熱マラリア原虫 P. malariae

卵形マラリア

卵形マラリア原虫 P. ovale

（サルマラリア、二日熱マラリア）

P. knowlesi

http://www.dcc-ncgm.info/resource/

(4)

マラリアの治療

✤

マラリアと診断されたら速やかに抗マラリア薬で治療を行う!

✤

熱帯熱マラリアという種類のマラリアは、治療せずに放っておくと命

に関わる！

メフロキン 

（メファキン）

アトバコン/プログアニル 

(マラロン)

（ビブラマイシン）

ドキシサイクリン 

国内での承認

○

○ ☓

服用方法

1錠(275mg) 

を

1週間に1回

1錠(A250mg/P100mg) 

を1日1回

1錠(100mg) 

を1日1回

服用開始時期

渡航の1-2週前から

渡航の1-2日前から

服用の終了時期帰国から4週間後まで

帰国から1週間後まで

帰国から4週間後まで

用量の調整

体重45kg未満の場合

体重40kg以下の場合

体重45kg未満の場合

薬価

851.6円/錠

498.1円/錠

21.60円/錠

主な副反応

_{精神神経症状}

消化器症状 

_頭痛

消化器症状、日光過敏

副反応の発現率医療相談11%/中止4%

医療相談7%/中止2%

医療相談6%/中止3%

使用禁忌

精神疾患、痙攣、過敏症

腎障害、過敏症

過敏症

妊婦の適応

なし（海外ではOK）

なし

小児の適応

_{（海外では6か月以上）}

なし 

_{（海外では5kg以上）}

なし 

適応

長期の渡航

短期の渡航

マラリア以外の予防

使用注意

ワーファリン、シクロスポリン!_{パイロット、運転手など}

(5)

どういうときにマラリアを疑う？

✤

マラリア流行地域（特にアフリカ、オセアニア）渡航後に熱が出た場

合。!

✤

特にマラリア予防内服をしていなかった場合。

防蚊対策

✤

蚊が多い時間・時期・場所を避ける!

✤

衣服：長袖長ズボン!

✤

防虫剤：DEET含有製品、Picaridin含有製

品、 PERMETHRIN含有衣類など!

✤

蚊帳を使用する

Keystone, 3rd ed

(6)

16

· N Engl J Med, Vol. 347, No. 1

· July 4, 2002

· www.nejm.org

The New England Journal of Medicine

and Fite Bite Plant-Based Insect Repellent (Travel

Medicine). We evaluated this type of repellent using

the same testing methods in six subjects (five men and

one woman). In one subject, a localized cutaneous

re-action developed after the first test, and the subject

discontinued the study. All other subjects completed

three tests each of the repellent. The repellent had a

mean (±SD) complete-protection time of 120.1±44.8

minutes, with a range of 60 to 217 minutes.

DISCUSSION

Protection against arthropod bites is best achieved

by avoiding infested habitats, wearing protective

cloth-ing, and applying insect repellent.

11,12

_{The insect}

re-pellents that are currently available to consumers are

either synthetic chemicals or are derived from plants.

The most widely marketed chemical-based insect

re-pellent is DEET, which has been used worldwide since

1957. DEET is a broad-spectrum repellent that is

ef-fective against many species of mosquitoes, biting flies,

chiggers, fleas, and ticks.

17

_{The protection provided}

by DEET is proportional to the logarithm of the dose;

higher concentrations of DEET provide longer-lasting

protection, but the duration of action tends to plateau

at a concentration of about 50 percent.

18

Most

com-mercially available formulations now contain 40

per-cent DEET or less, and the higher conper-centrations are

most appropriate to use under circumstances in which

the biting pressures are intense, the risk of

arthropod-transmitted disease is great, or environmental

condi-*Plus–minus values are the means ±SD of the times to the first bite in the tests of all 15 subjects. DEET denotes

N,N-diethyl-3-methylbenzamide (formerly known as N,N-diethyl-m-toluamide), HOMS Home Operations and Manage-ment Systems, and IR3535 ethyl butylacetylaminopropionate.

†The mean complete-protection time of each repellent was significantly different (P<0.05 by analysis of variance and Tukey’s tests13_{) from those of all repellents in different categories of protection (A, B, C, D, E, F, G, and H).}

‡The complete-protection time also differed significantly from those of Buzz Away, So-Soft Bug Guard, and Skin-So-Soft Bath Oil.

§The complete-protection time also differed significantly from those of Skin-So-Soft Bug Guard and Skin-So-Soft Bath Oil.

¶This product contains mineral oil, isopropyl palmitate, dicapryl adipate, fragrance, dioctyl sodium sulfosuccinate, bu-tylated hydroxytoluene, and carrot oil.

T

ABLE

1. P

ROTECTION

T

IMESOF

I

NSECT

R

EPELLENTS

.*

PRODUCT

ACTIVE INGREDIENT

AND CONCENTRATION COMPLETE-PROTECTION TIME

CATEGORYOF

PROTECTION†

MEAN RANGE

min

OFF! Deep Woods (SC Johnson) DEET, 23.8% 301.5±37.6 200–360 A

Sawyer Controlled Release (Sawyer) DEET, 20% 234.4±31.8 180–325 B

OFF! Skintastic (SC Johnson) DEET, 6.65% 112.4±20.3 90–170 C

Bite Blocker for Kids (HOMS) Soybean oil, 2% 94.6±42.0 16–195 D

OFF! Skintastic for Kids (SC Johnson) DEET, 4.75% 88.4±21.4 45–120 D Skin-So-Soft Bug Guard Plus (Avon) IR3535, 7.5% 22.9±11.2 10–60 E‡

Natrapel (Tender) Citronella, 10% 19.7±10.6 7–60 E‡

Herbal Armor (microencapsulated)

(All Terrain) Citronella, 12%; peppermint oil, 2.5%; cedar oil, 2%; lemongrass oil, 1%; gera-nium oil, 0.05%

18.9±13.3 1–55 E§

Green Ban for People (Mulgum Hollow

Farm) Citronella, 10%; peppermint oil, 2% 14.0±11.3 1–45 E

Buzz Away (Quantum) Citronella, 5% 13.5±7.5 5–30 E

Skin-So-Soft Bug Guard (Avon) Citronella, 0.1% 10.3±7.9 1–30 E

Skin-So-Soft Bath Oil (Avon) Uncertain¶ 9.6±8.8 1–30 E

Skin-So-Soft Moisturizing Suncare (Avon) Citronella, 0.05% 2.8±3.4 1–15 F Gone Original Wristband (Solar

Gloooow) DEET, 9.5% 0.3±0.2 0.17–1.33 G

Repello Wristband (Repello Products) DEET, 9.5% 0.2±0.08 0.17–0.63 H Gone Plus Repelling Wristband (Solar

Gloooow) Citronella, 25% 0.2±0.09 0.17–0.48 H

The New England Journal of Medicine

N Engl J Med. 2002;347(1):13.

16

· N Engl J Med, Vol. 347, No. 1

· July 4, 2002

· www.nejm.org

The New England Journal of Medicine

and Fite Bite Plant-Based Insect Repellent (Travel

Medicine). We evaluated this type of repellent using

the same testing methods in six subjects (five men and

one woman). In one subject, a localized cutaneous

re-action developed after the first test, and the subject

discontinued the study. All other subjects completed

three tests each of the repellent. The repellent had a

mean (±SD) complete-protection time of 120.1±44.8

minutes, with a range of 60 to 217 minutes.

DISCUSSION

Protection against arthropod bites is best achieved

by avoiding infested habitats, wearing protective

cloth-ing, and applying insect repellent.

11,12

_{The insect}

re-pellents that are currently available to consumers are

either synthetic chemicals or are derived from plants.

The most widely marketed chemical-based insect

re-pellent is DEET, which has been used worldwide since

1957. DEET is a broad-spectrum repellent that is

ef-fective against many species of mosquitoes, biting flies,

chiggers, fleas, and ticks.

17

The protection provided

by DEET is proportional to the logarithm of the dose;

higher concentrations of DEET provide longer-lasting

protection, but the duration of action tends to plateau

at a concentration of about 50 percent.

18

_Most

com-mercially available formulations now contain 40

per-cent DEET or less, and the higher conper-centrations are

most appropriate to use under circumstances in which

the biting pressures are intense, the risk of

arthropod-transmitted disease is great, or environmental

condi-*Plus–minus values are the means ±SD of the times to the first bite in the tests of all 15 subjects. DEET denotes

N,N-diethyl-3-methylbenzamide (formerly known as N,N-diethyl-m-toluamide), HOMS Home Operations and Manage-ment Systems, and IR3535 ethyl butylacetylaminopropionate.

†The mean complete-protection time of each repellent was significantly different (P<0.05 by analysis of variance and Tukey’s tests13_{) from those of all repellents in different categories of protection (A, B, C, D, E, F, G, and H).}

‡The complete-protection time also differed significantly from those of Buzz Away, So-Soft Bug Guard, and Skin-So-Soft Bath Oil.

§The complete-protection time also differed significantly from those of Skin-So-Soft Bug Guard and Skin-So-Soft Bath Oil.

¶This product contains mineral oil, isopropyl palmitate, dicapryl adipate, fragrance, dioctyl sodium sulfosuccinate, bu-tylated hydroxytoluene, and carrot oil.

T

ABLE

1. P

ROTECTION

T

IMESOF

I

NSECT

R

EPELLENTS

.*

PRODUCT

ACTIVE INGREDIENT

AND CONCENTRATION COMPLETE-PROTECTION TIME

CATEGORYOF

PROTECTION†

MEAN RANGE

min

OFF! Deep Woods (SC Johnson) DEET, 23.8% 301.5±37.6 200–360 A

Sawyer Controlled Release (Sawyer) DEET, 20% 234.4±31.8 180–325 B

OFF! Skintastic (SC Johnson) DEET, 6.65% 112.4±20.3 90–170 C

Bite Blocker for Kids (HOMS) Soybean oil, 2% 94.6±42.0 16–195 D

OFF! Skintastic for Kids (SC Johnson) DEET, 4.75% 88.4±21.4 45–120 D Skin-So-Soft Bug Guard Plus (Avon) IR3535, 7.5% 22.9±11.2 10–60 E‡

Natrapel (Tender) Citronella, 10% 19.7±10.6 7–60 E‡

Herbal Armor (microencapsulated)

(All Terrain) Citronella, 12%; peppermint oil, 2.5%; cedar oil, 2%; lemongrass oil, 1%; gera-nium oil, 0.05%

18.9±13.3 1–55 E§

Green Ban for People (Mulgum Hollow

Farm) Citronella, 10%; peppermint oil, 2% 14.0±11.3 1–45 E

Buzz Away (Quantum) Citronella, 5% 13.5±7.5 5–30 E

Skin-So-Soft Bug Guard (Avon) Citronella, 0.1% 10.3±7.9 1–30 E

Skin-So-Soft Bath Oil (Avon) Uncertain¶ 9.6±8.8 1–30 E

Skin-So-Soft Moisturizing Suncare (Avon) Citronella, 0.05% 2.8±3.4 1–15 F Gone Original Wristband (Solar

Gloooow) DEET, 9.5% 0.3±0.2 0.17–1.33 G

Repello Wristband (Repello Products) DEET, 9.5% 0.2±0.08 0.17–0.63 H Gone Plus Repelling Wristband (Solar

Gloooow) Citronella, 25% 0.2±0.09 0.17–0.48 H

The New England Journal of Medicine

N Engl J Med. 2002;347(1):13.

DEET 20%以上含有した防虫剤!

が望ましい。!

24%であれば5時間毎!

20%であれば4時間毎!

10％であれば2時間毎!

に塗り直す。!

汗をたくさんかいたり、雨に濡れたり水に浸かればその都度塗り直す。!

20% picaridinが代替製品となりうるが持続期間が短い

24

(7)

DEET使用時の注意点

✤

泳ぐ、発汗が多い、雨に濡れる、など皮膚表面から防虫剤

が失われやすい状況では早めに塗り直す。!

✤

日本の虫除けではDEET含有濃度は12％が最高。これを2

時間ごとに塗るか、海外旅行の際には現地で20％以上のも

のを使用する。

PERMETHRIN

✤

ダニ、スナノミ、蚊、ハエなどに有効!

✤

衣類に直接使用できる!

✤

衣類や蚊帳に塗布する場合は4週間、また

は6回洗濯するまで有効!

✤

あらかじめペルメトリンを塗りこんである

衣類は70回洗濯するまで有効

(8)

蚊でうつる感染症

✤

これまで日本では蚊による感染症の脅威はなかったため防蚊対策の意

識は希薄であった。!

✤

今年以降もデング熱の流行は起こる可能性があり、日頃から蚊に刺さ

れないように気をつける!

✤

デング熱以外にもチクングニア熱が日本でも流行る可能性がある!

✤