2010年山东省狂犬病流行特征及监测研究

Surveillance of human rabies in Shandong province,2010

目的分析2010年山东省狂犬病监测数据,探讨其流行特点,为狂犬病的防控提供依据。方法收集山东省2010年狂犬病疫情资料,利用流行病学和统计学方法对监测数据进行整理汇总和分析。结果 2010年山东省报告狂犬病例74例,农民占77.03%,犬伤所致发病占93.24%,病例暴露后自行伤口处理率为34.38%,疫苗注射率为13.04%,全程注射率为5.8%,被动免疫制剂注射率为1.45%。狂犬病暴露处置门诊就诊者中,免疫接种率95.70%,就诊前自行伤口处理率低;因犬伤暴露就诊者占87.90%,Ⅲ级暴露者中被动免疫制剂注射率为20.88%,各市之间就诊者暴露分级构成比存在很大差异。宿主动物监测犬密度高而免疫率较低。可疑狂犬病犬狂犬病毒检出率高。结论 2010年山东省狂犬病疫情继续下降,病例多发于农村地区,犬仍是主要的狂犬病宿主动物。犬的管理和暴露后预防处置不当、疫苗接种不规范和不及时是狂犬病发病的主要影响因素。疾控部门应继续加强暴露后处置技术培训和健康教育宣传工作,对一犬伤多人的可疑狂犬病犬更应高度警惕,做好暴露后处置尤为重要。

Objective To understand the epidemiological characteristics and incidence trend of human rabies in Shandong in 2010 and provide scientific evidence for the prevention and control of the disease.Methods The descriptive epidemiological analysis and statistical analysis were conducted on the incidence data of human rabies in 2010 in Shandong,which were collected from national disease reporting information system and the rabies clinics conducting surveillance in Shandong.Results A total of 74 rabies cases were reported in 2010.The majority of cases were farmers（77.03%）.Up to 93.24% of cases were caused by dog bites,and 34.38% did self wound treatment.The incidences in children and elder people were high.The vaccination rate after exposure was 13.04%,the full series vaccination rate was 5.8%,the injection rate of rabies immunoglobulin（RIG） was 1.45% and the vaccination rate after exposures in rabies clinics was 95.70%.Up to 87.90% of the people visiting rabies clinics was due to dog bites.The self wound treatment rate before seeking medical care was low in all surveillance areas and RIG injection rate was only 20.88% for grade Ⅲ exposure.The differences on exposure grade classification varied obviously in the rabies clinics.The dog density was high and immunization rate was low in some surveillance areas.The viral antigens were detected in brain tissues of 13 suspected rabid dogs by using immunofluorescence test and RT-PCR.Conclusion The incidence of human rabies continued to decline in Shandong in 2010.Most rabies cases were reported in rural area.Dogs were still the major animal hosts.The main related factors on the incidence of human rabies included poor dog management,inadequate post-exposure prophylaxis and treatment（PEP/PET） and non standard and timely vaccination after exposure.It is necessary for health department to strengthen the training on PEP/PET after exposure and health education about rabies prevention.Close attention should be paid to suspected rabid dogs biting more than one person.