上海市狂犬病流行病学及临床特征分析

Epidemiology and clinical features of rabies is Shanghai

目的分析上海近年狂犬病的流行病学及临床特征，为狂犬病的防治提供参考。方法收集我中心2005年1月至2011年12月收治的32例狂犬病病例，对其流行病学和临床资料进行回顾性分析。结果32例狂犬病传染源均为犬，家犬占50％；咬伤部位以手及前臂为主，占58．4％（21例）；24例（75．0％）患者的暴露程度为Ⅲ度；职业分布以农民和工人为主（20例，62．5％）；进行疫苗接种者仅有21．9％（7例）；潜伏期最短20d，最长10年，其中〈3个月者21例（65．6％）。临床表现主要有恐水、狂躁、发热、怕风、流涎、咽肌痉挛、怕光和伤口处感觉异常等；病程平均为（4±3）d，均给予对症支持治疗，患者病死率100％。结论上海市狂犬病的防治工作依然严峻，预防是控制狂犬病的重要措施，防治重点应在周边区县和外来人口聚集区域；预防措施主要包括积极进行犬只管理，加强宣教，指导临床医师和民众做好暴露后伤口的及时正确处理和疫苗接种等。

Objective To analyze epidemiological and clinical features of rabies in Shanghai and to provide reference data for the prevention and treatment of rabies. Methods Thirty-two cases of rabies were collected from January 2005 to December 2011. The epidemiological and clinical data were retrospectively analyzed. Results The source of infection of all patients were dogs and domestic dogs accounted for 50%. The majority site of bite was hand and forearm, accounting for 58.4%. Seventy-five percentage of the patients were grade 11I exposure and 62.5% were farmers and workers. Only 7 patients were vaccinated after exposure. Incubation period of most eases（65.6% ） were less than 3 months. Clinical features were fear of water, manic, fever, fear of the wind, salivation, pharyngeal muscle spasm, photophobia, and wound paresthesia, with the average duration of （4 _＋ 3 ） days. Symptomatic and supportive therapies were mainly used and mortality rate was 100%. Conclusions The prevention and control work of rabies is still serious in Shanghai. Prevention is an important measure to control rabies and the focus should put on suburbs and the area where floating population gathered. Preventive measures include active dog management, strengthening health education, guiding clinicians and the public to make timely and correct treatment of the wound after exposure and vaccination.