临沂市1974～2005年狂犬病流行特征及防制对策

STUDY ON EPIDEMICAL CHARACTERISTICS AND PREVENTIVE MEASURES ON RABIES FROM 1974 TO 2005 IN LINYI CITY

[目的]总结临沂市狂犬病流行特征和规律,分析疫情影响因素,制定有效的防制策略和措施。[方法]对临沂市32年狂犬病流行状况进行流行病学调查,对疫情报告、疫情监测和流调资料进行分析。[结果]32年中出现两次流行,共发生狂犬病619例,全部死亡,病死率100%。疫情以苍山、平邑、郯城3县为重,发病占全市的53.0%。传染源主要是犬,感染方式以咬伤(97.25%)为主;每年4月份疫情开始上升,7～10月份为发病高峰期。14.05%(87/619)的患者是免疫失败病例,原因:(1)伤口未处理或处理不规范;(2)未联合使用抗狂犬病血清或抗狂犬免疫球蛋白;(3)与现行狂犬疫苗的质量及免疫程序有关。32年中防制策略由单纯灭犬到“管、免、灭”综合性防制,取得了显著成效。但2002年疫情再起。疫情回升的主要原因是犬密度大幅升高、且免疫率低,防制各部门之间缺乏协作。[结论]长期坚持实行“管、免、灭”综合性防制措施是唯一正确的策略,只有降低犬密度,提高犬免疫率,暴露后正确处理伤口,并根据受伤情况采取相应预防措施,才能有效控制狂犬病的发生和流行。

[Objective] To summarize epidemical characteristics and rules on rabies in Linyi city, analyze the influential factors of epidemic situation and make effective measures for prevention and control. [ Methods ] The epidemical conditions of rabies in Linyi city from 1974 to 2005 were surveyed by epidemiology, the data of epidemic situation and epidemiology survey were analysed. [Results] There were two epidemical peaks in the 32 years, with 619 cases of rabies that all died. The fatality rate was 100%. In Cangshan, Pinyi and Tancheng three counties, rabies cases accounted for 53.0% of all. The major infectious source was the dogs, and the main route of transmission was bitting （97.25%） . Every year, the incidence started increasing in April, and reached the peak period from July to October. 14.05 % of cases were immuno-failure, the reasons for which were as follow： （1） The wounds were not handled or handled not normally. （2） RIS or Human Rabies Immunoglobulin was not jointly used. （3） It＇s related to the quality and the vaccination schedule of Rabies vaccine in use. During the 32 years, the tremendous achievements were gained with preventive measures from wiping out the dogs simply to preventing from rabies multiply. But the epidemic situation rose again in 2002, its primary factors were the density of dogs greatly rising, the vaccinated rate was low and the cooperation among the preventive departments was deficient. [Conclusions] The ＂management, vaccination, exterminate＂ multiple preventive measures should be continued for a long term. Only with the integrative method of decreasing the density of dogs and increasing the vaccinated rate of dogs, handling the wounds properly after exposed, and taking out the preventive measures appropriately, rabies can be controlled.