2011—2015年上海市浦东新区狂犬病暴露特征分析

Analysis on characteristics of exposure to rabies in Pudong New Area of Shanghai from 2011-2015

目的了解2011—2015年上海市浦东新区犬伤流行病学分布特征及影响因素,为狂犬病预防控制及犬伤门诊暴露人群处置提供依据。方法收集2011—2015年浦东新区犬伤医学门诊狂犬病暴露人群的就诊及发病疫情登记数据进行整理分析。结果 2011—2015年共报告199 603例犬伤暴露人员,年均暴露率745.5/10万,男女性别比1.19∶1;犬伤暴露以夏季为主;城镇片45岁以上的暴露人群较多,而农村片以45岁以下的暴露人群较多;因无主动物引起的狂犬暴露呈逐年上升趋势(χ~2=59.57,P<0.01),且各年间城镇片与农村片之间狂犬暴露差异有统计学意义;经单因素logistic回归分析显示,犬伤暴露分级的影响因素有年龄、性别、地域、动物分类与动物来源;暴露人群到犬伤门诊接种狂犬疫苗总接种率为100%,免疫球蛋白接种率逐年降低(χ~2=757.25,P<0.01)。结论浦东新区狂犬暴露率较高,以犬伤为主,应及时加强无主动物管理,需对城镇片的老年人、农村片的年轻人开展针对性宣传教育,提高犬伤门诊中Ⅲ级暴露者及时给予疫苗与免疫球蛋白接种率。

[Objective]To understand the epidemiological characteristics and influencing factors of dog injury in Pudong New Area of Shanghai from 2011-2015, provide the basis for rabies prevention and control and disposal in outpatient department.[Methods]The epidemic data of visiting and onset of rabies-exposed people in Pudong New Area from 2011-2015 were analyzed,which were collected from registration database of dog injury clinics.[Results]A total of 199 603 rabies-exposed cases were reported from 2011-2015,with the average annual exposure rate of 745.5/lakh,and the male-to-female ratio was 1.19 ∶ 1.Most of rabiesexposed cases occurred in summer. The exposed cases in urban area were mainly people over 45 years old,while the most of cases in rural area were people below 45 years old. Rabies exposure caused by ownerless animals showed an increasing trend（χ~2=59.57,P〈0.01）. There were significant differences in the exposure of rabies between urban and rural areas in every year. Single factor logistic regression analysis showed that the influential factors of dog injury exposure grading were age,gender,region,animal classification and animal origin. All exposed cases received the rabies vaccination in clinics with the inoculation rate of 100%,while the immunoglobulin vaccination rate decreased year by year（χ^2=757.25,P〈0.01）.[Conclusion]The rate of rabies exposure is high in Pudong New Area,and human exposure to rabies is mainly caused by dog injury. It is necessary to strengthen the management of ownerless animals,carry out targeted publicity and education among elderly people in urban area and young people in rural area,and improve the inoculation rate of vaccine and immunoglobulin in case of grade Ⅲ exposure in outpatient department.