狂犬病疫苗接种不良反应发生率及其影响因素分析

Analysis on adverse reaction rate of rabies vaccine and its influencing factors

目的分析狂犬病疫苗接种不良反应发生率及其影响因素。方法收集2011年广西桂林市疾病预防控制中心接种门诊狂犬病疫苗接种记录和随访登记资料,采用描述性研究方法统计分析5剂免疫程序[分别于就诊时(0 d)、3、7、14、28 d,经上臂三角肌肌内各注射1剂疫苗,幼儿可经大腿前外侧区肌内注射]和2-1-1免疫程序[分别于就诊时(0 d)经左右上臂三角肌肌内各注射1剂疫苗,再于第7和21天各注射1剂疫苗,幼儿可经大腿前外侧区肌内注射]接种狂犬病疫苗的不良反应发生率,采用卡方检验和Logistic回归分析影响接种不良反应发生的因素。结果接种狂犬病疫苗后不良反应发生率为2.10%(201/9 572),不良反应中以单纯发热(>38℃)为主,占81.10%(163/201);2-1-1免疫程序接种后不良反应发生率2.37%(128/5 398)明显高于5剂免疫程序[1.75%(73/4 174)](P<0.05),5剂免疫程序接种后不良反应主要发生于前3针次,2-1-1免疫程序接种后不良反应均发生在第1针次;低年龄、受伤程度为Ⅱ级、被狗以外的动物致伤和按2-1-1免疫程序接种狂犬病疫苗后发生不良反应的风险高。结论狂犬病疫苗接种后的不良反应较少且轻微。10岁以下儿童最好采用5剂免疫程序,以减少接种不良反应的发生。

Objective To analyze the adverse reaction rate of rabies vaccine its influencing factors.Methods The vaccination records and data on follow-up of rabies vaccine in clinic of Guilin Center for Disease Prevention and Control,Guangxi Zhuang Autonomous Region,China in 2011 were collected,in which the vaccines were injected by two schedules.Schedule 1（five dose schedule）consisted of five doses on days 0,3,7,14 and 28 d respectively,which were injected i.m.in deltoid in upper arm or in anterior-lateral thigh（for infants）,while schedule 2（2-1-1 schedule）consisted of four doses,i.e.two doses on day 0 in deltoid in left and right upper arms（or in anterior-lateral thigh for infants）respectively,one dose on day 7 and one dose on day 21.The adverse reaction rate was analyzed by descriptive method,while the influencing factors by χ2 test and Logistic regression.Results The adverse reaction rate of rabies vaccine was 2.10%（201 / 9 572）,of which 81.10%（163 / 201）were simplex fever（more than 38 ℃）.The adverse reaction rate of vaccine injected by schedule 2（2.37%）（128 / 5 398） was significantly higher than that by schedule 1（1.75%）（73 / 4 174）（P 0.05）.The adverse reactions of vaccine by schedule 1 mainly appeared after the first to the third doses.However,all the reactions of vaccine by schedule 2 appeared after the first dose.The risks of adverse reactions were high in the victims at low ages,with exposure of degree Ⅱ,bitten by the animals other than dogs,and vaccinated by schedule 2.Conclusion The adverse reaction rate of rabies vaccine was low,and the reactions were mild.Five dose schedule was recommended to the children at ages of less than 10 years so as to minimize the occurrence of adverse reactions.