2006-2019年广东省人群狂犬病发病与暴露流行特征及变化趋势

Epidemiological characteristics and change trend of human rabies onset and exposure in Guangdong, 2006-2019

目的 分析广东省人群狂犬病发病与暴露流行特征及其变化趋势,为广东省防控狂犬病提供决策依据。方法 应用描述性流行病学方法分析2006―2019年广东省狂犬病病例及暴露人群特征;采用Joinpoint回归模型分析狂犬病发病和暴露特征变化趋势。结果 广东省2006―2019年狂犬病年均发病率为0.17/10万,年发病率呈下降趋势,平均年度变化百分比(average annual percentage change, AAPC)为-26.15%(95%CI:-31.81%~-20.02%)。狂犬病年均暴露率为687.72/10万;年暴露率呈上升趋势(AAPC=5.21%, 95%CI:3.55%~6.90%),与年发病率存在负相关性(r=-0.947,P<0.001)。不同地区、性别和年龄组发病率呈不同程度的下降趋势,AAPC介于-22.95%和-49.19%,而暴露率呈不同程度的上升趋势,AAPC介于2.92%和7.93%。致伤动物以家犬居多(57.58%)。从伤口分级来看,以Ⅱ级暴露居多(61.26%),构成比呈上升趋势(P=0.006)。Ⅱ级和Ⅲ级暴露者年均暴露后伤口处理率为99.20%,呈下降趋势(AAPC=-0.58%, 95%CI:-0.78%~-0.38%);Ⅲ级暴露者年均被动免疫制剂接种率为23.78%,呈稳定趋势(AAPC=-0.36%, 95%CI:-2.78%~2.13%)。结论 广东省狂犬病发病率2006―2019年呈下降趋势,目前处于低发态势。狂犬病暴露后犬伤门诊就诊率呈上升趋势,但Ⅲ级暴露者狂犬病被动免疫制剂接种率维持在低水平,需有针对性加大狂犬病宣传力度。

Objective To analyze the epidemiological characteristics and change trends of human rabies onset and exposure in Guangdong for prevention and control of rabies. Methods The descriptive epidemiological analysis was used to analyze the characteristics of human rabies cases and rabies expose population in Guangdong from 2006 to 2019. Joinpoint regression model was performed to analyze change trends of rabies onset and exposure characteristics. Results From 2006 to 2019, the annual average incidence rate of human rabies in Guangdong was 0.17/100 000. And the annual rates showed a downward trend, with an average annual percentage change(AAPC) of-26.15%(95% CI:-31.81%--20.02%). The annual average exposure rate of human rabies was 687.72/100 000, showed a upward trend, with an AAPC of 5.21%(95% CI: 3.55%-6.90%). There was a negative correlation between annual incidence rates and annual exposure rates(r=-0.947, P<0.001). The annual average incidence rates in different regions, gender and age groups showed downward trends to varying degrees, and the AAPCs were between-22.95% and-49.19%. The annual exposure rates in different regions, gender and age groups showed upward trends to varying degrees, and the AAPCs were between 2.92% and 7.93%. Domestic dogs-mediated injuries accounted for 57.58% of all the injuries. According to the wound grading, the proportion of degree Ⅱ exposures was 61.26%, and annual proportions showed a upward trend(P=0.006). The post-exposure prophylaxis services receiving rate of degree Ⅱ and Ⅲ exposures was 99.20%, and showed a upward trend(AAPC:-0.58%, 95% CI:-0.78%--0.38%). The passive immunization rate of degree Ⅲ exposures was 23.78%, and showed a stable trend(AAPC:-0.36%, 95% CI:-2.78%-2.13%). Conclusions From 2006 to 2019, the incidence rate of human rabies in Guangdong showed a downward trend, and is now in a low incidence state. The exposure rate of human rabies is on the rise, but the passive immunization rate maintain low in degree Ⅲ exposures cases. It is suggested that targeted health education about rabies should be strengthened.