南昌市狂犬病暴露人群的流行病学特征及预防处置对策

Epidemiological characteristics of human rabies and countermeasures for prevention and treatment in Nanchang

目的了解南昌市人群暴露狂犬病暴露人群的流行病学特征及评价暴露处置效果,提出全市狂犬病预防控制对策的建议。方法按照卫生部《狂犬病暴露预防处置工作规范》的要求,集中培训本市辖区内11个狂犬病暴露处置门诊的医护人员,按统一调查表与病历设计内容对2010年在门诊就诊的伤者进行流行病学调查研究,采用SPSS软件对资料进行统计分析。结果我市狂犬病暴露人群在流行病学特征分布上与我国狂犬病病例分布特征相似,尤其是Ⅲ度暴露者:男性多于女性、少年儿童和青壮年多见、夏秋季高于其他季节、暴露动物以犬为绝对优势、动物免疫率低下等。同时还存在以下特点:职业分布中以务工居首位、学龄前儿童和小学生其次,而务农退居第6位;致伤动物中鼠伤高居第2位;Ⅲ度暴露人群以学龄前儿童、小学生和农民为主,居住农村的占68.79%,Ⅲ度暴露者中同意接受联合免疫的仅占50.79%。结论目前我市狂犬病防制的主导措施即保证动物免疫率达70%以上构起免疫屏障等尚不到位,而辅助措施即对暴露者的规范处置等尚难于跟上的情况下,狂犬病防控形势严峻,建议采取政府行为,农业、公安、卫生等多部门齐抓共管,加强动物管理、提高动物免疫率达70%以上;加强技术培训和人员配置,提高各级暴露处置门诊的处置能力,逐步将暴露处置工作放置到医疗机构,提高暴露处置的及时性;在农村,暴露处置费用纳入农村医保,降低农民经济负担,提高暴露处置率。

Objective To understand the epidemiological characteristics of human rabies,evaluation the disposal effect after exposure,and put forward prevention and control suggestions to human rabies in the city.Method According to Ministry of Health＇s Requirement of Human Rabies Prevention and Treatment Criterion,concentrated training the medical workers from 11 human rabies treatment clinics.Using standard questionnaires and designing case history contents to carry out epidemiological investigation to injured persons who visited the doctors at the clinics,and statistic analysis the data by SPSS software.Results The epidemiological characteristics of rabies in our city were similar to our country,especially the person with exposure degree Ⅲ.For example,males were more than females,teenage and children were more than youth and adults,the numbers in summer and autumn were more than in other seasons,the dog was the overwhelmingly dominate exposure animal,and low animal immunity,etc.Meanwhile,they also showed the following features,first,labors had taken the lead in occupation distribution,followed by preschool children and pupils,but the person worked on the land decline to sixth position.Second,the people injured by rats place the second among animal-induced injury.Third,preschool children,pupils and peasants were the dominate human rabies crowd with degree Ⅲ,and the people who lived in the countryside was account for 68.79%.Furthermore,among degree Ⅲ of exposure persons willing to accept the united immunity was only accounted for 50.7%.Conclusions The conclusions were that,in our city the present leading measures for human rabies prevention and control was to build up immunization barrier which required animal immunization rate reached to 70%,and the supporting measures of disposal the exposure person was not standard.Therefore,the situation of rabies prevention and control was still stern.We suggest that,the government departments such as agriculture,public security,and health department worked together to strengthen animal management and increased the animal immunity rate over 70%,enhanced the technical training and personnel allocation,improved the disposal capacity of clinics at all levels and timeliness.In the countryside,the fees of rabies treatment bring into rural health care,lower peasants economic burden,improved the rabies treatment rate.