37928例狂犬病暴露者流行病学特征分析

Epidemiological analysis of and strategies to deal with 37 928 people exposed to rabies

目的了解2008年济南市狂犬病暴露人群的流行病学特征、狂犬病流行趋势和特点,为狂犬病防治提供依据。方法对2008年《山东省狂犬病门诊预防接种情况汇总表》中各项数据进行统计描述或分析。结果37 928例狂犬病暴露中男性20 660人,女性17 268人;动物致伤人数有明显的季节性,6~8月份致伤人数最多,为12 256人（占32.31%）,1月和12月致伤人数最少;历下区、市中区、历城区和章丘市报告狂犬病暴露人群最多,分别为9 169、4 340、3 791和6 105例;致伤人群以被犬致伤者最多,共32 500例（占85.69%）,被猫致伤者4 377例（占11.54%）,其他1 051例（占2.77%）;致伤部位为四肢者34 016例（占89.69%）;Ⅰ级暴露2 560例（占6.75%）,Ⅱ级暴露21 095例（占55.62%）,Ⅲ级暴露14 273例（占37.63%）;致伤后伤口自行处理者13 783例（36.33%）,在门诊进行伤口处理者19 737例（占52.03%）,伤口未处理者4 408例（占11.62%）;全程接种疫苗36 020例（占95.00%）,使用抗狂犬病免疫球蛋白2 510例（占6.61%）。结论济南市狂犬病暴露人数较多,加大防治知识的宣传力度,提高群众的自我保护意识,提高犬类动物免疫率,加强门诊医务人员脱敏注射抗血清、狂犬病毒免疫球蛋白以及过敏抢救的专项培训等是狂犬病防治的关键。

Objective To ascertain epidemiological features of individuals exposed to rabies in Jinan in 2008 and promptly ascertain the incidence and characteristics of rabies in the city in order to provide information on and a scientific basis for the future prevention and control of rabies.Methods Data from the Summarized Table of Rabies Vaccinations on an Outpatient Basis in Shandong Province were statistically analyzed.Results Of the 37 928 people exposed to rabies,20 660 were male and 17 268 were female.There were 12 256 people injured by dogs from June to August,accounting for 32.31% of those exposed.The number of injuries was lowest in January and December.The Lixia District,Shizhong District,Licheng District,and City of Zhangqiu respectively reported 9 169,4 340,3 791 and 6 105 injuries,which were higher than figures from other districts.Of people injured,32 500 were injured by dogs（85.69%）,4 377 were injured by cats（11.54%）,and 1 051 were injured by other animals（2.77%）.Of those injured,34 016 were injured in the extremities（89.69%）.The level of exposure was level I for 2 560 individuals（6.75%）,level II for 21 095（55.62%）,and level III for 14 273（37.63%）.Of the injured,13 783（36.33%） treated the wound themselves,19 737（52.03%） had the wound treated on an outpatient basis,and 4 408（11.62%） left the wound untreated.Of the injured,36 020（95.00%） had the full course of vaccination and only 2 510（6.61%） received anti-rabies immunoglobin.Conclusion Key to rabies prophylaxis and treatment are the enhanced dissemination of knowledge about rabies prevention,increased awareness of protecting oneself,increased immunity in dogs,enhanced specialized training of medical personnel in injection of antiserum to facilitate desensitization,use of rabies immunoglobin,and remedies in the event of allergies.