2005-2017年南宁市狂犬病流行病学特征及潜伏期影响因素分析

Epidemiological characteristics of human rabies and factors affecting its incubation period in Nanning City, 2005-2017

目的分析2005-2017年南宁市狂犬病流行病学特征,探讨潜伏期影响因素,为狂犬病防控提供科学依据。方法收集2005-2017年南宁市狂犬病个案调查资料,运用描述性流行病学方法分析人狂犬病三间分布特征,运用软件SPSS 20.0对数据做单因素分析、多因素多元线性逐步回归分析和有序回归分析。结果 2005-2017年南宁市狂犬病发病率呈下降趋势(χ~2_(趋势)=203.95,P<0.001)。各县区均有病例报告,但县城(0.36/10万)发病高于城区(0.14/10万)(χ~2=37.37,P<0.001),男性(0.36/10万)发病高于女性(0.18/10万)(χ~2=26.20,P<0.001)。>40岁病例占69.57%,职业以农民为主占81.03%。病例暴露后狂犬疫苗接种率为11.46%。潜伏期中位数71 d(最短3 d,最长2 459 d)。病例潜伏期与暴露程度、暴露部位、伤口处理、暴露后抗血清/免疫球蛋白注射、暴露后人用狂犬疫苗注射、动物种类和动物来源有关(P<0.05),其中头面部暴露对潜伏期的影响最大,潜伏期的中位数为18 d(OR=0.12,OR95%CI:0.042～0.345)。结论加强狂犬病防制知识宣传,重点是对农民、男性、年龄>40岁的人群开展健康宣教。狂犬病潜伏期受多种因素影响,但提高暴露人群的规范伤口处置率及狂犬病疫苗的接种率是防制狂犬病的主要措施。

Objective To analyze the epidemiological characteristics of human rabies in Nanning City during 2005-2017, to explore the factors influencing its incubation period, and to provide a scientific basis for prevention and control of human rabies. Methods The data regarding human rabies cases in Nanning City during 2005-2017 were collected, and descriptive epidemiological method was used to analyze time, region and population distribution characteristics of human rabies. SPSS20.0 software was employed to perform univariate analysis, multivariate linear stepwise regression analysis and ordinal regression analysis. Results The incidence rate of human rabies in Nanning City during 2005-2017 showed a downward tendency (χ2trend=203.95, P<0.001). The cases were reported in all counties and districts. The incidence was higher in counties than in urban areas (0.36/100,000 vs. 0.14/100,000,χ2=37.37,P<0.001) as well as higher in males than in females (0.36/100,000 vs. 0.18/100,000,χ2=26.20, P<0.001). Cases aged > 40 years accounted for 69.57%, and most of the patients were farmers(81.03%). The rate of vaccination with human rabies vaccine was 11.46% after the patients had been bitten or scratched by animals. The median of human rabies incubation period was 71 days (ranging from 3 to 2,459 days). The incubation period was related to exposure degree, exposure region, wound disposal, antiserum/immunoglobulin injection for post-exposure, human rabies vaccine injection for post-exposure, animal species and animal origin (P<0.05), and the head and face exposure had the greatest impact on the incubation period, with the median incubation period being 18 days (OR=0.12, OR95%CI:0.042-0.345). Conclusions As for strengthening the propaganda regarding rabies prevention and control knowledge, special attention should be paid to farmers, men and people over the age of 40. The incubation period of human rabies is influenced by many factors, but increasing the wound disposal rate and improving the rate of vaccination against rabies are the main measures to prevent and control human rabies.