北京市顺义区狂犬病风险评估及防控策略

Risk assessment and epidemic prevention and control strategy of rabies in Shunyi district of Beijing, China

目的了解北京市顺义区狂犬病发病与暴露现状,评估狂犬病发病风险,为制定狂犬病防控策略提供科学依据。方法追溯顺义区有档案记录以来的狂犬病发病历史数据,对2002-2016年狂犬病免疫预防门诊动物致伤患者就诊数据和2010-2016年发生的一犬致伤多人事件进行流行病学分析。结果 1960-2016年顺义区共报告狂犬病26例,其中2010-2016年报告6例;2002-2016年共接诊动物致伤者124 019例,男女性别比为1.26∶1,男性高于女性(χ~2=228.450,P<0.05);夏季有明显的季节高峰,5-8月致伤54 665例(占44.10%);下肢和手是最易被咬伤部位,共100 955例(占81.40%);致伤者以20~49岁中青年为主(占51.13%),工人及农民居多(占32.68%),其次为职员(占30.91%);伤人动物以犬类(>75%)为主,1年内有狂犬病疫苗免疫史动物占35.58%;2008-2016年Ⅲ级暴露人群49 356例(占50.08%),使用狂犬病被动免疫制剂者8 432例(17.08%);2010-2016年共报告一犬致伤多人事件20起,对8起一犬伤多人事件中的44例追踪疫苗全程接种情况,全程接种率为90.91%。结论应加强犬只的管理与免疫,普及狂犬病防治知识,及时进行狂犬病暴露后规范处置;增设伤口处理能力强的二级及以上医院门诊;建立狂犬病疫苗全程接种监测机制,纳入信息化管理;建议政府相关部门将犬伤人员就诊费用进一步纳入新农合及城镇医保减免范围,建立动物狂犬病疫情长期监测机制,完善公安、动物监督、卫生等养犬管理工作成员单位的狂犬病管理联动机制。

Objective To understand the current situation of rabies incidence and exposure in Shunyi district of Beijing,and evaluate the risk of rabies, discuss the prevention and control strategy of rabies, and provide scientific evidences forprevention and control measures against rabies for the residents. Methods Retrospective the history of rabies incidencedata since beginning of the records in Shunyi district, epidemiological analysis was carried out on the surveillance data onpopulations exposed to rabies in rabies immune prevention clinics during 2002-2016 and cases of single dog causing manyinjuries during 2010-2016. Results A total of 26 cases of rabies were reported in Shunyi district during 1960-2016,including 6 cases during 2010-2016; animal-wounded cases were 124 019 from 2002 to 2016, the ratio male cases tofemale ones was 1.26∶1, and the male cases were higher than female ones（χ~2=228.450,P0.05）. There was an obviousseasonal peak in summer, 54 665 cases（44.10%）occurred during May to August. Lower limbs and hands were mostvulnerable to be bitten, which was 100 955 cases（81.40%）. The majority of the injured were middle-aged and young,accounting for 51.13%, workers and peasants（32.68%）accounted for the most, followed by staff（30.91%）. More than75% of cases were caused by dogs, and only 35.58% of which the owner can be found have been vaccinated against rabieswithin one year. A total of 49 356 cases（50.08%）of rabies-exposed people were grade Ⅲ exposure during 2008-2016,while there were 8 432 cases（17.08%）of which received passive immunization. The rate of passive immunity remainedlow, only reaching 32.56% in 2009 but 20% in other years. During 2010-2016, 20 cases of single dog causing manyinjuries were reported, among which 44 people from 8 occurrences were followed for the whole course of vaccination, andaccounted for 90.91%. Conclusion Dogs should be managed strictly and vaccinated in a timely manner. Popularizing theknowledge of rabies prevention and control and promptly disposing of rabies exposure in accordance with standards arecritically important. It is suggested to add clinics of secondary hospital or above to treat the wounds, to establish surveillance mechanism for full vaccination of rabies. It is suggested that the government should further incorporate the costof medical treatment for the injured personnel into the scope of the NCMS and the urban medical insurance. Long-termmonitoring mechanism for animal rabies should be established. Collaborative efforts are needed among health, policedepartment, animals supervising agencies and other members of dog management.