2015-2021年湖北省106例狂犬病病例流行特征及潜伏期影响因素分析

Analysis of epidemic characteristics and influencing factors of incubation period of 106 rabies cases

目的 分析2015-2021年湖北省有明确暴露时间的狂犬病病例流行特征及潜伏期影响因素,为狂犬病防控提供依据。方法 利用2015-2021年湖北省狂犬病病例监测中各县(市、区)开展的个案调查中有明确暴露时间的个案资料,采用描述性流行病学方法进行分析。结果 2015-2021年湖北省有明确暴露时间的狂犬病病例共106例,男女性别比为1.65∶1,50~79岁组占74.53%,农民占83.02%,鄂西北的襄阳市、宜昌市、十堰市和荆门市报告病例数占80.19%。发病较多的月份为10、6和1月,分别占16.98%、13.21%和10.38%。伤口Ⅱ级暴露和Ⅲ级暴露分别占24.53%和75.47%,手部、下肢膝以下、头面、手臂、下肢膝以上分别占暴露部位的48.11%、27.36%、10.38%、8.49%和5.66%;狗、猫和野生动物分别占暴露动物来源的96.23%、2.82%和0.94%,流浪动物、自家养、邻居养、野生动物分别占暴露动物来源的42.45%、39.62%、16.98%和0.94%,邻居养和自家养动物均未接种兽用狂犬病毒疫苗。暴露后到医疗机构处置伤口和接种人用狂犬病毒疫苗的均仅占9.43%,Ⅲ级暴露注射狂犬病病毒免疫球蛋白的占5.00%。潜伏期呈右偏态分布,中位数为77.5天,95%CI为60.71~100.00。单因素分析结果显示,暴露程度、暴露部位、伤口处理和接种疫苗对潜伏期影响有统计学意义(P<0.05)。多重线性回归分析结果显示,暴露程度和暴露部位对潜伏期影响有统计学意义(P<0.05),Ⅲ级暴露较Ⅱ级暴露的潜伏期短,暴露部位离头部越近潜伏期越短。结论 潜伏期受多种因素影响,规范犬只管理,暴露后规范处置伤口、及时接种人用狂犬病毒疫苗、必要时注射狂犬病毒免疫球蛋白是预防控制狂犬病的关键。

Objective To analyze the epidemiological characteristics and influencing factors of incubation period of rabies cases with specific exposure time in Hubei province in recent years, and to provide evidence for the prevention and control of rabies.Methods Data of rabies cases with specific exposure time in Hubei province from 2015 to 2021 were collected, and analyzed by descriptive epidemiological method. Results A total of 106 rabies cases with definite exposure time were reported in Hubei province from 2015 to 2021.The male to female ratio was 1.65 ∶1. Farmers accounted for 83.02% of the total cases, and 50-79years old group accounted for 74.53%. The incidence was mainly concentrated in Xiangyang, Shiyan, Yichang and Jingmen,accounting for 80.19%. The months with more cases were October, June and January, accounting for 16.98%, 13.21% and10.38%, respectively. Exposure of grade Ⅱ and Ⅲ accounted for 24.53% and 75.47%, respectively. Hands, lower limbs below knee, head, arms and lower limbs above knee accounted for 48.11%, 27.36%, 10.38%, 8.49% and 5.66% of the exposed parts,respectively. Dogs, cats and wild animals accounted for 96.23%, 2.82% and 0.94% of the exposed animals, respectively. Stray animals, domesticated animals, neighbors’ animals and wild animals accounted for 42.45%, 39.62%, 19.98% and 0.94% of animal sources respectively. Neither the neighbors nor domesticated animals were vaccinated against veterinary rabies virus.After exposure, 9.43% of patients went to medical institutions for standard treatment of wounds, 9.43% were vaccinated with human rabies vaccine, and 5.00% were injected with rabies virus immunoglobulin. The median incubation period was 77.5 days,95%CI(60.71-100.00). In univariate analysis, exposure level, exposure site, wound management and vaccination had statistically significant effects on incubation period(P<0.05). Multiple linear regression analysis showed that exposure degree and exposure site had statistical significance on incubation period(P<0.05). The incubation period of exposure of grade Ⅲ was shorter than that of exposure of gradeⅡ, and the closer the exposure site was to the head, the shorter the incubation period. Conclusions The incubation period is affected by many factors. The key to the prevention and control of rabies is to standardize the management of dogs, to standardize the treatment of wounds after exposure, to vaccinate rabies virus vaccine in time, and to inject rabies virus immunoglobulin when necessary.