2015—2021年湖北省狂犬病流行特征及暴露后免疫失败病例分析

Epidemiological characteristics of rabies and post-exposure immunization failure cases in Hubei Province in 2015-2021

目的分析2015—2021年湖北省狂犬病流行特征及暴露后免疫失败原因,为湖北省狂犬病防控提供依据。方法收集2015—2021年湖北省狂犬病个案调查资料,通过描述性流行病学方法进行分析。结果2015—2021年湖北省共报告狂犬病127例,年均报告发病率为0.31/100万,发病有下降趋势。病例男女性别比为1.70∶1,农民占病例总数的82.67%,50~79岁组占病例的75.59%;发病地区主要集中在鄂西北的襄阳市、十堰市、宜昌市和荆门市,占77.17%;发病时间以夏秋季多发。伤口Ⅱ级暴露和Ⅲ级暴露分别占24.79%和75.21%,手部、下肢膝以下、头面、手臂、下肢膝以上分别占暴露部位的46.15%、25.21%、9.40%、8.55%、7.69%;狗、猫和野生动物分别占暴露动物的95.73%、3.42%和0.85%,流浪动物、自家养、邻居养、野生动物分别占动物来源的41.88%、37.61%、19.66%、0.85%,邻居养和自家养动物均未接种兽用狂犬病毒疫苗。暴露后到医疗机构规范处置伤口的占8.55%,接种人用狂犬病疫苗的占9.40%,Ⅲ级暴露注射狂犬病病毒免疫球蛋白的占4.55%。潜伏期在半年以内、半年至1年、1年以上分别占72.22%、14.74%、12.04%,暴露程度(Z=-1.98,P<0.05)、暴露部位(2=10.91,P<0.05)、伤口处理(2=15.73,P<0.05)3个因素对潜伏期的影响差异有统计学意义。11例暴露后免疫失败病例均为Ⅲ级暴露,暴露部位在头面部的占63.63%,未全程接种人用狂犬病毒疫苗占81.81%,未接种狂犬病毒免疫球蛋白的占63.63%,未规范处置伤口占27.27%。结论规范犬只管理,加强狂犬病宣教,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 epidemic characteristics and causes of post-exposure immunization failure of rabies in Hubei Province from 2015 to 2021,and to provide evidence for the prevention and control of rabies in Hubei Province.Methods The investigation data of rabies cases in Hubei Province from 2015 to 2021 were collected,and descriptive epidemiological methods were used for data analysis.Results A total of 127 cases of rabies were reported in Hubei Province from 2015 to 2021,with an average annual incidence of 0.31/million,showing a downward trend.The male to female ratio was 1.70∶1.Farmers accounted for 82.67%of the total cases,and the 50-79 years old group accounted for 75.59%.The incidence was mainly concentrated in Xiangyang,Shiyan,Yichang and Jingmen,accounting for 77.17%.Most of the cases were concentrated in summer and autumn.Exposure of gradeⅡandⅢaccounted for 24.79%and 75.21%,respectively.Hands,lower limbs below knee,head,arms and lower limbs above knee accounted for 46.15%,25.21%,9.40%,8.55%and 7.69%of the exposed parts,respectively.Dogs,cats and wild animals accounted for 95.73%,3.42%and 0.85%of the exposed animals,respectively.Stray animals,domesticated animals,neighbors′animals and wild animals accounted for 41.88%,37.61%,19.66%and 0.85%of animal sources,respectively.Neither the neighbors′animals nor domesticated animals were vaccinated against veterinary rabies virus.After exposure,8.55%of patients went to medical institutions for standard treatment of wounds,9.40%were vaccinated with human rabies vaccine,and 4.55%of patients with grade III exposure were injected with rabies virus immunoglobulin.The incubation period within 6 months,from 6 months to 1 year,and over 1 year accounted for 72.22%,14.74%,and 12.04%,respectively.The exposure degree(Z=-1.98,P<0.05),exposure site(2=10.91,P<0.05)and wound treatment(2=15.73,P<0.05)had statistically significant effects on the incubation period.Among the 11 cases of post-exposure immunization failure,all were gradeⅢexposure,63.63%were exposed to the head and face,81.81%were not fully vaccinated with human rabies virus vaccine,63.63%were not immunized with immunoglobulin,and 27.27%were inappropriate wound treatment.Conclusion The key to rabies prevention and control is to standardize dog management,strengthen rabies education,standardize post-exposure wound treatment,timely vaccinate against rabies virus,and inject rabies virus immunoglobulin when necessary.