Jpn. J. Infect. Dis., 53, 93197, 2000

Review
Rabies Control in J叩anNaohide Takayama *Deparlment of Pediatrics, Too/o MetrlDPOlitan Komagome Hospital

Honkomagome 3‑18‑22, Bunk,0‑ku, Too,0 113‑8677, Japan(Received May 22, 2000. Accepted June 28, 2000)

SUMMARY: In 1957 Japan succeeded in eradicating rabies, which had been endemic since the 1 8th century,
due to the reglStration and confinement of family dogs, the elimination of stray dogs, and the compulsory vaccina‑tion of dogs. At present, however, vaccination coverage of family dogs is far lower than the required level of
70%. The facilities that are presently able to investlgate rabies are limited in number. In addition, few medica)
institutions keep rabies vaccine in stock or offer postexposure vaccination to travelers bitten by animals in rabies
endemic areas･ Moreover, rabies iTlワunoglobulin (RIG) cannot be given to such individuals because RIG is notproduced at present in Japan, nor lS lt authorized to be imported. To keep Japan free from any rabies deaths, animprovement in vaccination coverage among dogs and in the supply of postexposure prophylaxis is required,
and the establishment of a rabies surveillance system is also considered to be essential.

reported. Non‑bite rabies has also occu汀ed in reclplentS Of

1. Features of rabies

comeal transplantation from undiagnosed rabies patients (7‑Rabies is a preventable, but incurable infectious disease

1 1), and after a butcher skinned a calf that died ofundiag‑caused by the rabies virus, which is an enveloped, bullet‑shaped,

nosed neurological disease (1 2).

slngle‑stranded, and minusISenSe RNA virus. The virus belongs
to the genus Lyssavirus of the family Rhabdoviridae ( 1 )･ Soヮe

2. Epidemic of rabies in JaparL

rabies‑related viruses are reported to cause clinical rabies lnhumans (2). Rabies is primarily a disease of animals and is

It is said that rabies was described in the HIshinpo'', theregarded as the one of the most typical zoonoses. Rabies isoldest Japanese medical textbook written in 982 by Yasuyori
Tanba (9 1 11995) based on Chinese medicalbooks of the time

known to have the followlng features.
1) Almost 100 % of patients who develop clinical rabies(1 3). It is uncertain, however, whether rabies occurred among

are destined to die, because the rabies virus causes fatal

dogs in those days in Japan. We tend to think that small

encephalomyelitis and no effective treatment has yet beenoutbreaks, Orlglnatlng from dogs imported from China anddeveloped (clinical features). 2) After initially propagating

Korea, may have occurred sporadica)ly.
A documented large epIZOOtic of rabies occurred in the 1 8tharound the portal of entry, the rabies virus invades theperipheral neⅣOus system and ascends to the central neⅣOus

century in Japan during the 8th Tokugawa Shogunate. Duringsystem by a retrograde axoplasmicflow at a veloclty Of 8‑20

the epIZOOtic, many dogs, horses, foxes, raccoon dogs, etc.,

mワPer day (1)･ The symptoms of rabies, namely itchiness,were sacrificed. In 1756, Genjo Noro (1692‑1761), One of thepalm and paresthesia around the healed bite wound, first
appear after the virus enters the central nervous system. The

medical officials of the Tokugawa Shogunate, published the

incubation period of rabies IS generally very long, 1 ‑3 monthSin

which in Japanese means medical treatment for bite wounds

approximately 60% or all rabies patients (pathogenetic
features). 3) The host animals of the rabies virus differ

by rabid dogs (Fig. 1). In this book he described that thefirst textbook on the therapy of rabies, "Kyoken‑kosho‑chiho"

sickness would become serious after a certain period of time,

according to reglOn, although almost all marrmals cancontract
rabies. The main vectors orrabies are fわxes in Europe andCanada, raccoons, skunks and bats in the United States, dogs
inAsia, mongooses, jackals and dogsinA舟ica, and dogs and鴫整鹿毛軒巌‑精義を感藩轟敷嘘

vampire bats in Latin America (1). There are two types of

T:IJi(漂･l4,八qJ.･‥寺l轟きけ･>.,a:･f＼･〜.･+′･ 1‑､Tf･もて
冬･r‑,…＼･･･ I‑･〜J:柑･r与･車ハ‑･一t･‑
善書洩馨,餐率‑迅速鞄嘗曲磯‑!･畠1:,鷲.義差PJ･L;i+.,…手･=･t与り､･糟 〜,･.∵U＼!｡;蔑,rabies eplZOOtics, namely the urban type in which仇e rabies

virus IS pnnClpally transmitted among dogs, and the sylvatic

type where the vectors are wildhfe, such as foxes, raccoonsand mongooses (epidemiological features).

Humans usually contract rabies through bite wounds fromrabid animals (bite exposure) beca†se the rabies v血s iscontained in the saliva of infected anImals. Rabies can also
be transmitted through non‑bite exposure, although it rarely

occurs. Airbome infections through the aerosol of infectedanimal brain tissue in virus laboratories (3‑5) and throughcontaminated air in bat‑inhabited caves (6) have also been

*Corresponding author: Tel: +81‑3‑3823‑2101 , Fax: +81‑3‑3824‑
Fig. 1. Kyoken‑kosho‑chiho,the丘rst Japanese textbook about the treat‑

1 552, E‑mail : takyarrLnd‑k@komagome‑hospital.bunkyo.tokyo.jp

ment of bite wounds &om rabid dogs.

93.● :.:■ ･:.● 剪･:.● ;::; ･:.■ ;:;: :.■ ■.:● :.■ ●:■... 剪:.I.:. ･:■ン:.

..●...:. I:+:.:. :.I.ン:･:I:I:. 一一●.■.■

闘

｢

辻罎罎

E……………

悶…

乱闘

1907 1909 1911 1913 1915 1917 1919 1921 1923 1925 1927 1929 1931 1933 1935

Fig. 2. Animalrabies cases reported in Japan, 1907‑1935.

一 ●.㍗ ●̀.: I.:. ●..: ●.:. ●..: ●.:. ■:: ■■.: ■:. ●.: 一:.

● 僮 ●.:.:●:. I:. ■..: ■.:. f:.: ■.;. ●:.: I. : 0.:. :. 4‑.: ･:.I.:. :.:●. : ･:.I.:.

:.:一 i:‑■ ･:.:●

I･:.:● :.:.● I:.:r ::::● :.:.■ ･:.二■ ･:.一 :.:I ･:.■ :.:● :::■ ･ン■ ∴一 ･:.● :...4ﾂ:.:一.: :.■.: ･:,I,:, ･:,I,:,:.:JI I:.:I :.:.● ･:.:I :.:.● :.:● :::● ･:.● :.:● 凩 ● I... ●:.:: ●.:.:･:.■ :.:● 二:.● .‑:● 二::● ･二.■ 劔■:.: 4十 一:.: ■∵ll I.:. 一:.::.:0‑.: 1.:■'.: ･こ.■.:. ･:I:. ン一.: :.■:

rT‑rl 箸ﾗ" rlJ‑rl
r1叩r1

194619471948194919501951 1952195319541 955195619571958

Fig. 3. Human rabies cases reported in Japan, 1946‑1958.

監;;a 謄｣｣ｳ｣ｳ｣ｳ｣ｳ｣ｸ+

｣｣｢

白

ﾂ罎

ﾃ｣｣｢

罎

罎

ﾈ

罎

ﾂﾙ?

爾

爾

良

194619471948194919501951 195219531 9541955195619571958

Fig･ 4･ Animal rabies cases reported in Tokyo (a) and in other regions

even if the wounds did not appear to be severe at first, andofJapan (Ej).

finally 8‑9 Out of 1 0 patients would die. Furthermore, he also

wrote that the bestfirstaid treatment was to suck out the bloodquickly and to apply moxa cautery to such bite wounds ( 14).

with血e elimination of stray dogs. As a result, the number ofLittle information is available on epIZOOtics of rabies in the

rabid animals decreased sharplyand no rabies either in amimals

latter part of the Edo Era. We can only assume that outbreaks

or in humans has been reported since 1957, except for oneof rabies occu汀ed sporadically in those days based on theimported hum.an rabies case in 1970 (13)･

statistics of rabid dogs during the Meiji Era (from 1868 to

In Japan eplZOOtics orrabies have historically been of the1912), when 50‑200 rabid dogs were recorded annually.

urban type,with the rabies virus being transmitted from dog

Outbreaks of rabies gradually increased both in number andto dog, and occasionally from dog to humans, cats or otherin scale in the latter part of the Meiji Era. More and moredomestic and wild animals. During such eplZOOtics of rabies,

outbreaks were also reported in the Taisho Era (fTrom 1 91 2 tofoxes and raccoon dogs were also infected with the rabies

1926), mainly in large cities such as Tbkyo and Osaka. In

virus. No transmitting circle of the virus, however, was formed

1924‑1925, due to the confusion a洗er the Kanto Great Earth‑among the wildlife in Japan.

quake (1923), the number of rabid dogs was reported to

The elimination of rabies in Japanyas thought to be possible

exceed 3,000 and the number of human rabies cases was overfor the followiヮg reasons: 1) The epIZOOtics of rabies in Jap甲1 00 per year. Thereafter, the standard rabies control methods

occurred princIPally among dogs; 2) One great advantage lnsuch as compulsory vaccination of all family dogs and thepreventing and to controlling animal rabies due to the fact

elimination of stray dogs were perf♭med all over Japan.

that Japan is an island country; and 3) The Japanese people

Consequently, the number of rabid animals steadily decreased,

were very cooperative in vaccinating dogs agalnSt rabies andreaching 15 0r less during the period from 1934 to 1943 (13;in working to eliminate stray dogs (15).

Fig.2).
Rabies, however, began to increase again due to the social

3. Actual situation of control and prevention ofdisorder after the Second World War. In 1949, 76 cases ofrabies im Japan

human rabies were reported (Fig. 3), and over 800 cases ofanimal rabies occurred in 1950 when仇e Rabies Prevention

The control of rabies mainly depends on measures agalnSt

Act w.as enacted (Fig･ 4)･ The Prevention Act Tequires owners

the infection sources and transmission routes of rabies. There

to reglSter and confine their dogs, and to vacclnate their dogs

are two basic means of preventing people from contracting

against rabies･ This Act was strictly enforced in conjunction

rabies, namely preexposure immunization and postexposure

94Postexposure prophylaxis as early as possible if they happen

prophylaxis.

to be bitten by possibly rabid animals in rabies endemic

3‑1. Measures against the infection sources and traJIS‑

reglOnS. WHO has recommended the followlng POSteXPOSuretreatment: the bite wound should be thoroughly washedwith

mission routes of rabies

Rabies conb･ol measures consist of the registration of familysoap and water･ Human rabies immTnOglobulin (HRIG; 20

dogs, compulsory anti‑rabies vaccination of dogs, restrictionsrM(g of body weight) or equine rabies lmmunOglobulinPRIG;on the movement of dogs, and the elimination of stray dogs,

40 IUD(g) should be injected as much as possible around the

because no sylvatic type outbreak of rabies has occu汀ed inwound and the remainder should be glVen intramuscularly.

Japan since the Edo Era. However, general concem about

Next, a tissue culture‑inactivated rabies vaccine should berabies in Japan is wanlng because neither animal rabies nor

administered on days 0, 3, 7, 14, 30,and 90 (17). Postexposure

human rabies have been reported for more than 40 years inprophylaxis should be given topersons who wantthe treatment

the country except for the one imported case in 1970.Asa

even months a鮎r being bitten because an incubationperiod

result, the number of family dogs not registered or vaccinatedof longer than 12 months has been noted in 6‑7% of rabies

against rabies is increaslng. In J叩an, dogs had been immu‑

cases (17). The vaccination schedule described above isnized with infected animal brain‑derived inactivated rabies

named the Essen schedule, and it is intemationally regarded

vaccine (Semple type vaccine) twice per.year from 1952 toas the standard method of postexposure prophylaxis.

1984. Since 1 985, a tissue‑culture rabies lnaCtivated vaccine

In Japan, regarding the rabies vaccine for human use, a

has been obligatorily administered to dogs once a year. The

tissue culture‑inactivated rabies vaccine is produced by apositive rate of anti‑rabies neutralizing antibody was reported

private manufacturer, the Chemo‑ Sero‑Therapeutic Research

to be 62.4% in 942 canine serum samples taken from familyof serum anti‑rabies antibody among family dogs in Japan

Institute (Kaketsuken, Kumamoto) and they. annually shipfrom 16,000‑24,000 doses of their rabies vacclne (PCEC‑K).
The Japanese Government purchases approximately 540
doses for emergency use every two years. The PCEC‑K is

are not known because no nationwide investlgation has yet

prepared from an attenuated rabies strain HEP‑Flury growndogs in the City ofFukuoka during the period from 1986
to1989 (16). However,仇e vaccination rate and positive rate

been performed. According to the announcement of thein prlmary Cultures or chick embryo cells concentrated andMinistry of Health and Welfare of Japan, the vaccination rate
among 5. 14 million registered dogs was 88.6% in 1997. The

inactivated with betapropiolacton. Its antlgen titer has not been

Pet Food ManufactureAssociation, Japan, estimates based on

K to be less potent than rabies vaccines produced in Franceand Gemany (18).
Neither HRIG nor ERIG are available at present in Japan,
because rabies immunoglobulin (RIG) is not produced orimported. The Japanese Government has no stock of RIG.

ofrlCially armounced. Researchers in Thailand reported PCEC‑

the results or questionllaires by inteⅣiew to 6,340 randomly

selected families that approximately 9.5 million dogs were

kept in Japanese families. The vaccination rate would, thus,

be only approximately 48%, because almost all unreglSteredfamily dogs seem not to be vaccinated against rabies. This

The postexposure prophylaxis according b仇e recommen由一

rate is far lower than the level required to protect agalnSt antiOns ofWHO is, therefore, practicallyinfeasible nowinJapan.

outbreak of rabies, as the World Health Organization (WHO)recommends that a 70 % immunitylevel should be maintained

3‑4. Preexposure immuni2:ation

Preexposure immunization is recorrmended to persons who

throughout the year ( 1 7). Anti‑rabies vaccinations f♭r pet cats

are living ln Or traveling for 3 months or longer to rabies

are not obligatory in Japan.

endemic reg10nS. WHO recommends a dose of tissue‑culture

312. Measures against imported animal rabies

rabies vaccine, with a potency of at least 2.5 IU per dose, toln Japan a quarantine system is also adopted to prevent

be given intramuscularly on days 0, 7 and 28 (17).

animals infectedwith the rabies virus from being brought

In Japan, whereas, preexposure immunization consists of

into this country. Befわre 1998, dogs were the only animal

2 doses ofPCEC‑K at 30‑day intervals and an additional dose

species to be quarantined in Japan. In 1999, however, cats,at 6 months after the 2nd dose. Japanese travelers rarely planfoxes, and raccoons were added to the list of animals to be

their trips 6 months or more befわre their departure, except

put in quarantine to check for rabies besides dogs. Bats havenot been specified as an animal species requlnng quarantine.

rabies endemic areas a氏er the second dose or rabies vaccine

No systems to actively survey outbreaks of rabies amongor w仙out any preexposure immunization.

for some pubhc employees. As a result, most travelers go todomestic andwild animals have yet been established in Ja‑
pan. There is no law requlrlng any Virological investigation

4. Imported human rabies im Japan

concerning rabies when imported animals die from uncertain

cause after having passed quarantine. Moreover, even if an

One case of imported human rabies was reported in Japanowner would want such examinations, it is practically im‑

in 1970. The victim was bitten by a stray dog in Nepal anddeveloped clinical rabies aRer retumlng tO Japan. In the United

possible to perfbm virologlCal or pa仇OloglCal investigationsof dead animals, because of the limited number of facilities

States, imported human rabies cases are steadily increaslng,able to investlgate rabies as well as the limited number ofwith 3 cases reported in the 1960S, 7 cases in the 1970S, andavailable staff members. In Japan, it is, therefore, practically
impossible to fhd rabid animals and to gather virologlCal

rabies cases occurring from 197511984 in the United Statesevidence regarding rabies infection after they have settled

occurred as a result of bites by rabid dogs in rabies endemic

10 cases in the 1980S (1). Eight of the 10 imported humancountries. Six of these 8 rabies patients had not received

into the country a洗er quarantine.

3‑3. Postexposure prophylaxis

postexposure treatment, One had been treated too late after
the exposure, while another one had been glVen the rabies

Animaland humanrabies still occur in manyAsian counties

vaccine but no RIG (19).
Recently, more and more Japanese visit various forelgn

other than Taiwan and Japan. Travelers thus need to receive95Confirmed at the Centers for Disease Control and Prevention(CDC) in the United States. An insectivorous bat‑relatedrabies variant virus was identified by a nucleotide‑sequence

analysis of the products obtained by the reverse transcnptase‑polymerase chain reaction (RT‑PCR) of the RNA extracted
from formalin‑fixed brain tissue.
In addition to the case described above, another report
described a 19‑yeaト01d male in which a diagnosis of rabies

was made based on a microscopic examination performed

more than 2 months after the death of the patient. Rabies was

ruled out in the differential diagnoses because the patient had
not received any animal bite (20)･ Nine of 16 rabies cFses
that have occumd domestically in the United States slnCe
1980 had no history of exposure to rabies (20). Rabies iso氏en inco汀eCtly diagnosed as encephalitis caused by otheragents or as other diseases of仇e central nervous system in:::::::::::::::::::

the United States due to a few human rabies cases occurrlng:::::::;I:;=;;:;::::

annually. In J叩an, Where no rabies cases have recently been冽 ｼhreported, it is possible that rabiesmight be mistakenly diagnosed

19901991 19921993199419951996199719981999

as another disease of the central nervous system such as

Fig. 5. Annual number of subjects (習: male, Eヨ; female) who wereJapanese encephalitis, tetanus or drug intoxication. The ques‑

bitten by possibly rabid animals in the rabies endemic reglOnS andtion as to why no imported human rabies has been reported

thereafter visited our vaccine clinic to receive the rabies postexposurein Japan since 1971 will not be solved as long as Japanese

immunlZation.

medicalinstitutions fail to pay more attention to rabies andwhile sufrlCient number of virologlCal examination facilities

countries, including rabies endemic areas. The number offor rabies are not available.

Japanese overseas travelers exceeded 16 million per year in
1996. 1t is not rare that Japanese travelers are bitten by

5. Measures for the prevention of imported

rabies‑suspected animals in such rabies endemic reglOnS andhumam rabies

they do not always receive proper postexposure treatment at
the place the accident occu汀ed. The number of individuals

Although rabies has essentially been eradicated in Japan,

who have been bitten by dogs, cats or monkeys in rabies

there are many countries where rabies is still endemic. The

endemic areas and thereaftervisited our vaccine climic topossibility that rabies may lnVade Japan, should therefわrereceive postexp?sur.e immunization is sharply increa苧ing (Fig･always be kept in mind. Recently, more than 16 million

5). In this situat10n It Seems rather unnatural that no Imported

Japanese people visit abroad armually, and they lnCreaSlngly

human rabies case has been reported since 1971 in Japan.

prefer to visit small towns and villages alone or with a few
companions instead of going ln groups tO famous sightseelng

ln Japan, the domestic occurrence or human or animal
rabies has not been reported fわr more than 40 years. As aspots that used to be very popular among Japanese travelers.

result, there are currently few physicians who have any

Consequently, the current risk of exposure to rabies fわr

experience in examlnlng rabies patients in Japan. In the United

Japanese travelers may be much larger than that of a few

States, where only 0‑6 human rabies cases have been reported

decades ago. In such a situation, rabies most hkely would

annually slnCe 1 981 , there have been some human rabies cases

occur among travelers who come back to Japan without properthat were not suspected or diagnosed as rabies antemortem

postexposure treatment after having been bitten by stray dogs

and a diagnosis of rabies was made based on pathologlCal

or stray cats in rabies endemic reg10nS. We herein describe

examinations performed postmortem ( 1 9‑26). We herein cite

two cases of Japanese travelers who were bitten in rabies

a case report of human rabies. In this case, the diagnosis ofendemic areas, as fわllows.

rabies was conrlrmed by histologlCal examination of brain

Case 1. A 201year‑Old Japanese female.

While bTaVeling aroundinSriLanka, she tried to drive away atissue taken at autopsy (22).

Case report.

cat that had strayedinto her bedroom at a hotelinthe mountains

On July 5, 1993, an ll‑year‑old girl who lived in New

and was bitten onthe finger of her left hand by the cat. Bleeding

York State, Complained ofpaln in the knuckles on her leftfrom the bitten wound was noted, but she did not request

hand. The pan extended up to the left shoulderwithin 2 days.

medical treatment and kept traveling. Two days later, she was

On Ju)y 9, she developed fever, severe muscle spasms of the

but no focal neurological findings. She was alert, oriented, andadvised to visit a hospital by a doctor at the hotel in Colombo
City. The next day she received RIG and purified Vero cellrabies vaccine (PVRV) at a hospitalinthe city. She was further
Injected with PVRV 3 days and 6 days later. After retumlng
to Japan, she visited a umiversity hospital near her home but

cooperative, but agltated. The patient developed respiratory

they did not have any rabies vaccine available. She was,left arm, dimculty walking, and hallucinations. She would
not drink and had di爪culty swallowing oral secretions. On

July l 1 , she had a temperature of40.7oC, mild menlnglSmuS,

distress, hypertension, tachycardia, and then arrhythmias. She

therefore, sent to our hospital and iqectedwith PCEC‑K

died on the same day. During the autopsy perf♭med on Julybecause PVRV is not available in Japan.
Case 2. A 29‑year‑old Japanese male.

1 2, no brain‑tissue sample was taken for viralexaminations,although brain edema was noticed. About 50 days later,

When he was sightseelng lnrural Mexico near the United

microscoplC examination or histological slides of the brain

States border, he was suddenly bitten in the right lower

tissue revealed possible Negribodies. A rabies diagnosis was

extremity from behind by a stray dog. The teeth of the dog

96bit into the bare skin of his leg and the bite wound bled. He

7. Houff, S. A., Burton, R. C., Wilson, R. W., Henson, T.

treated the wound by himself withantiseptic solution but did

E., London, W. T., Baer, G. M.,Anderson, L. J., Winkler,

not look for any postexposure treatment. Four days later heW. G., Madden, D. L.and Sever, J. L. (1979): Human‑to‑retumed to Japan, and then he began to worry about rabies.

human transmission of rabies virus by comeal transplant.

He visited our clinic and received the first injection of PCEC‑

N. Engl. ∫. Med., 300, 603‑604.

8. Centers for Diseaseand Control (1980): Human‑to‑humanK 7 days after being bitten.

Almostal1victims bitten by rabidanimals can avoid rabies
death if they receive proper postexposure treatment consistingtransmission via a comeal transplant‑France. Morbid.

of RIG and immunization with a tissue culture‑inactivatedrabies Vaccine (17)･ Today in Japan, however, few medical
institut10nS keep rabies vaccine in stock and thus cannot offer

9. Centers for Diseaseand Control (1981): Human‑to‑humantransmission via comeal transplant‑Thailand. Morbid.

postexposure vaccination to travelers bitten by animals in

10. Gode, G. R. and Bhide, N. K. (1988): Two rabies deaths

Mortal. Wkly. Rep., 29, 25‑26.

Mortal. Wkly. Rep., 30, 473‑474.

rabies endemic areas. Moreover, RIG cannot be administeredafter comeal grafts from one donor. Lancet, 2, 791.

because RIG is not produced or imported at present in Japan,

1 1. Javadi, M. A., Fayaz, Mirdehghan, S. A. andAinollahi, B.

as mentioned above.

To receive postexposure vaccination, 45 travelers bitten by(1 996): Transmission of rabies by comeal graR. Comea,
15, 431‑433.

animals in fbrelgn COuntries in 1998 and 67 in 1999 visited

12. Tariq, W. U. Z., Shafi, M. S., Jamal, S. andAhmad, A.

our vaccine clinic. It is reasonable to estimate, therefore, that(1991): Rabies in man handling infected calf. Lancet,

more than 100 travelers have annually returned to Japan

337, 1224.

of medical institutions can promptly provide postexposure

13. Iwabuchi, H. (1970): Transition in epidemic and preven‑tion of rabies. Nichijukaishi, 23, 367‑376 (inJapanese).
14. Noro, G. (1756): Kyoken‑kosho‑chiho. Osakashorin,
Osaka (in Japanese).

vaccination against rabies. In addition, RIG should be imme‑

15. Okamura, Y. (1993): Zoonosis and hygiene for domestic

diately made available in Japan by either local production or

animals. Infect. Immun. Child., 5, 45‑46 (in Japanese).
16. Murakawa, Y., Uchinuno, Y., Tokiyosi, S., Fujikawa, H.,
Taneno, A･, Yamada, S･ and Eto, M･ (1992): Persistepce

after receivlng animal bite wounds in rabies endemic reglOnin recent years. To prevent imported humanrabies, Japanesepublic healthauthorities should ensurethat a sufficient number

importati on.

and prevalence or antibodies produced by vaccinatlOn

6. Conclusions

agalnSt rabies in dogs. J. Jpn. Vet.Assoc., 45, 7961798.
17. World Health Organization (1992): WHO expert

At present in Japan, not only the general public but mostmedical persorLnel seem to have littleinterestinrabies, probably

coワmittee on rabies (8th report)･ WHO teclmical reportsenes, 824. World Health Organization, Geneva, Switzer‑

because no domestic occurrence of human rabies or animal

rabies has been reported since 1957･ Quarantine and theland.

compulsory vacclnation of dogs are both indispensable to18. Benjavongkulchai, M., Kositprapa, C., Limsuwun, K.,

prevent rabid animals from entering Japan and also to prevent
rabies from spreading rapidly and widely if rabies were tooccur domestically. Postexposure prophylaxis is essential to

Khawplod, P., Thipkong, P., Chomche, P., Yountong, C.,
Naraporn, N., Ayuthaya, A. B. N., Raksakate, S.,
Samranwetaya, P., Oka, T., Ohkuma, K., Hamasaki, T･

avoid rabies death. To keep Japan free from rabies deaths,

and Wilde, H. (1997): An immunogenicity and e爪cacy

improvements in vaccination coverage among dogs and instudy of purified chick embryo cell culture rabies vaccine

the supply of postexposure prophylaxis to travelers bitten by

manufactured in Japan. Vaccine, 15, 1816‑1819.
19. Centers for Disease and Control (1984): Human rabies

possibly rabid animals, as well as the establishment or arabies surveillance system all over Japan are strongly called

acquired outsidethe United States. Morbid. Mortal. Wkly.

for. More than anything else, we should never forget thatRep., 34, 235‑236.

rabies is a preventable but incurable disease.

20. Centers f♭r Disease and Control (1985): Human rabies

diagnosed 2 months postmortem‑Texas. Morbid. Mortal.

Wkly. Rep., 34, 700, 705‑707.

REFERENCES

21. Centers fわr Disease and Control (1988): Human rabies‑

Califomia, 1987. Morbid. Mortal. Wkly. Rep., 37, 305‑

1. Fishbein, D. a. andRobinson, L E. (1993): Rabies. N.

308, 1988.

Engl. ∫. Med., 329, 1632‑1638.

2. Rupprecht, C. E., Dietzshold, B., Wunner, W. H. and

22. Centers for Disease Control and Prevention (1993):

Kopr?wski, H･ (1991)‥ Antigenic relationships or

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