湖南省2010-2014年狂犬病流行特征及暴露后免疫失败病例分析

Epidemiological characteristics of human rabies and failure cases of post-exposure treatment in Hunan Province,2010-2014

目的分析2010-2014年湖南省狂犬病流行特征及狂犬病暴露后免疫失败病例原因,探讨流行相关因素及免疫失败影响因素,为湖南省狂犬病防治工作提供参考。方法用EpiData3.1和SPSS18.0统计软件包对收集到的湖南省2010-2014年狂犬病疫情及580份狂犬病个案资料进行整理,分析狂犬病发病流行特征和暴露后免疫失败病例特征。结果湖南省2010-2014年共报告狂犬病病例580例,年均发病率0.176/10万,发病呈下降趋势(χ_(趋势)~2=60.38,P<0.01)。病例分布在全省14个市州108个县(市、区),报告病例的县(市、区)数呈下降趋势(χ_(趋势)~2=16.27,P<0.01)。狂犬病报告累计病例数居前5位的市为邵阳市、永州市、常德市、益阳市和长沙市,共报告332例,占全省报告病例数的57.24%。7-9月份报告病例数最多(共183例,占31.55%),其次是3-6月份(163例,占28.10%)。[55~60)岁年龄组报告病例数最多,为77例(占13.28%);15~<70岁年龄中,随着年龄增长,发病率上升(χ_(趋势)~2=248.63,P<0.01)。男女发病比例2.28:1,男性发病率(1.19/10万)显著高于女性(0.55/10万)(χ~2=74.84,P<0.01)。伤人动物以犬为主,占90.34%。暴露级别以Ⅲ级暴露(84.93%)最多,1处伤口多见(93.20%),最多的为手部伤口(42.29%)。67.93%的狂犬病病例未进行暴露后伤口处理措施。46例(7.93%)死亡病例在暴露后接种了狂犬病疫苗但免疫失败,其中45例免疫失败原因可归纳为头面部暴露致使潜伏期太短、未及时全程接种、Ⅲ级暴露未注射被动制剂共3种原因中至少一种。结论湖南省2010-2014年狂犬病疫情呈下降趋势,小孩和老人是高危人群,多为犬伤人所致。未采取暴露后处置是发病的主要原因,而暴露后处置失败主要是由于头面部暴露致使潜伏期太短、未及时全程接种、Ⅲ级暴露未注射被动制剂。因此,降低暴露后发病风险的重点措施是暴露后应及时到医疗机构进行规范的暴露后处置和防范头面部暴露。

Objective To analyze the epidemiological characteristics of human rabies and the factors influencing failure cases of post-exposure treatment in Hunan Province during 2010-2014 so as to provide references for rabies prevention and treatment. Methods We collected the data about the epidemics of rabies and 580 human rabies cases reported in Hunan Province during 2010-2014. EpiData3.1 and SPSS18.0 software were used to analyze the epidemiological characteristics of rabies and the features of failure cases of post-exposure treatment. Results A total of 580 human rabies cases were reported in Hunan Province from 2010 to 2014. The annual average incidence rate was 0.176/100 , 000 , and the incidence showed a decreasing tendency （x^2trend = 60. 38, P〈0.01 ）. The cases distributed in 108 counties （ cities or districts） , and the distribution of the cases was narrowing 2 （x^2trend = 16.27, P〈0.01）. The top 5 cities with respect to reported cumulative number of rabies cases were Shaoyang City, Yongzhou City, Changde City, Yiyang City and Changsha City, and a total of 332 cases were reported, accounting for 57.24% of the reported cases in Hunan Province. Most of the reported cases occurred from July to September （ n= 183, 31.55% ） and from March to June （n= 163, 28.10%）. The number of the reported cases in the age group of 55-〈60 years was the highest （n= 77, 13.28% ）. The standardized treatment as well as preventing head and face exposure.