2010年中国狂犬病疫情分析

目的 了解我国狂犬病持续流行相关影响因素,以其对防控工作提供基础数据.方法 采用统计分析和描述流行病学的方法对我国2010年狂犬病的流行情况进行分析.结果 2010年全国23个省817个县（区）报告狂犬病病例为2048例,较2009年下降7.46％.病例以儿童和老人发病率较高,职业以农民（69.14％）为主,男女发病比为2.44：1.全国哨点监测共上报640例个案,致伤动物以犬（87.50％）为主,暴露方式以咬伤为主,病例的暴露后自行处理率、疫苗注射率及被动免疫制剂使用率仍然较差.门诊监测病例暴露后预防处置除个别省外大部分监测点疫苗注射率达98％以上,但Ⅲ度暴露后被动免疫制剂的使用率不高.结论 2010年全国狂犬病疫情有所缓解,门诊病例暴露后预防处置情况良好,但个案病例暴露后预防处置情况依然没有得到改善.     

2013年中国狂犬病流行特征分析

目的 分析中国2013年狂犬病病例流行病学特征与趋势,探讨相应防治对策建议.方法 利用2013年“传染病报告信息管理系统”和6省监测点监测上报的数据,进行回顾性描述分析.结果 2013年我国28个省共报告狂犬病1172例,较2012年下降17.75％.病例主要分布在南方地区,报告发病数居前5位的省份依次为广西(161例)、广东(140例)、贵州(84例)、湖南(83例)和河南(81例),占全国报告发病总数的46.84％.高发季节为夏秋季,病例以农民、学生和散居儿童为主.病例男女性别比为2.27∶1.40-64岁组报告病例最多,其次为0-14岁组.共收集到319例狂犬病病例个案调查表,致伤动物仍以犬为主(占93.83％),其次为猫(占5.48％).病例潜伏期中位数为67天.暴露程度以Ⅲ级暴露为主,占64.36％.暴露后疫苗接种率为11.86％,但疫苗全程接种率仅1.36％,Ⅲ级暴露者的被动免疫制剂注射率为5.91％.结论 2013年全国狂犬病疫情总体继续呈下降趋势,南方病例仍然多于北方,但北方地区疫情有上升和扩散的趋势.病例主要分布于农村地区,病例职业以农民、学生、散居儿童为主.病例的伤口自行处理与医疗机构处理率、疫苗接种率与被动免疫制剂注射率均很低.应加强狂犬病监测工作,以农村地区为重点,加强狂犬病暴露后预防处置宣传.     

广西2004-2008年狂犬病高发因素分析

目的分析广西2004-2008年狂犬病流行病学特征和2006--2008年健康犬脑带毒检测结果,探讨广西狂犬病高发因素及相关性。方法收集分析2004--2008年广西疾病监测信息系统和全国狂犬病监测系统资料,DFA和RT-PCR法检测2006--2008年健康犬脑标本。结果2004—2008年间广西共报告狂犬病2463例,年发病率0．98／10万。疫情波及95个县,高发县数量减少,低发县数量增多,中西部地区疫情增长迅速。病例四季没有显著高峰。高发人群为农民、儿童和散居儿童,〈20岁和≥40岁发病较多。病例犬伤占83．79％;病例多为Ⅲ级暴露,占78．5％;受伤部位上下肢占83．17％,头面颈部占10．56％。67．88％的病例未处理暴露伤口,18．31％注射狂犬疫苗,3．63％Ⅲ级暴露病例注射被动免疫制剂;潜伏期的中位数为60d。2006--2008年健康犬脑狂犬病毒RT—PCR检测阳性率分别为1．92％、0．93％和0．89％。结论暴露后处置未能规范实行、地域内存在大量的狂犬病毒感染的健康犬是广西狂犬病高发的两个重要因素。     

番禺区2006—2007年狂犬病流行病学分析

目的了解番禺区狂犬病门诊暴露人群的流行病学特征，为制定狂犬病预防策略提供科学依据。方法对2006—2007年在狂犬病预防门诊接受诊治的狂犬病门诊暴露人群进行描述性流行病学分析。结果2006—2007年番禺区共报告狂犬病暴露者19532人。两年均无因本地动物伤害而引起的狂犬病病例报告。动物伤人一年四季均可发生，其中以7～10月相对较多，第三季度共发生5574例。暴露者中男性占56．43％．女性占43．57％。所有暴露者中15～44岁占51．22％。中心城区的暴露水平较周边地区高。伤人动物以犬为主，占87．82％，受伤部位以下肢为主共10190例，占52．17％，暴露人员中以Ⅱ度暴露最多共18193例，占93．14％。结论当前控制狂犬病流行需加强养犬管理，有效地降低人群狂犬病暴露水平；加强狂犬病防治等相关知识的宣传教育．提高人群的自我保护意识等综合措施。以控制狂犬病的发生。     

平远县2001-2010年狂犬病流行病学分析

目的探讨平远县近10年来狂犬病流行病学特征及流行因素,为制订防控措施提供科学依据。方法收集2001-2010年平远县传染病疫情资料、狂犬病个案资料和狂犬病疫点调查处理资料,采用描述性流行病学方法进行分析。结果 2001-2010年平远县共报告狂犬病16例,年平均发病率为0.64/10万;死亡16例,病死率为100%;常年散发,秋季发病较多（占50%）;发病以农村为主,农民和农村学生为主要发病人群;男性多于女性（性别比为5：3）,40～70岁年龄组发病较多（占62.5%）;头面部咬伤的潜伏期短,下肢咬伤的潜伏期较长;87.5%的病例未进行规范伤口处理,87.5%的病例未进行免疫接种。结论预防狂犬病须采取综合措施,加强犬类管理,加大健康教育力度,将农民和学生作为预防狂犬病的重点人群,规范暴露后伤口处理和提高狂犬疫苗接种率,才能有效降低发病率。     

广西阳朔县54年间狂犬病流行情况分析

目的分析狂犬病的流行特征,探讨狂犬病流行相关因素,为防制提供科学依据。结论收集1956-2009年阳朔县狂犬病疫情资料及个案调查表,采用EXCEL进行数据整理,采用SPSS软件进行统计分析。结果阳朔县54年间共报告狂犬病病例200例,病死率为100%,以春冬季多发,年发病率为0～7.47%,全县9个乡镇均有病例分布。男女性别比为4.6∶1,各年龄段均有发病,60岁以上年龄组多发。发病以农民为主,报告病例个案调查表显示,未做伤口处置的病例高达85.71%,处置不及时的病例占14.29%,未接种过疫苗的病例占85.17%。不同病例潜伏期差异显著,以40～90d居多,病程较短且临床表现各异。结论阳朔县54年间狂犬病的流行情况呈波动性,1993年疫情控制后,2003年又出现反弹。犬只管理不到位、人群缺乏狂犬病的防治知识、防范意识差或者暴露后无免疫接种是其流行的主要因素。     

在诊治和护理狂犬病患者中的职业防护

目的 探讨狂犬病患者在急诊救治和护理过程中采取有效的防护措施,减少或避免职业暴露的发生.方法 对本科救治5例狂犬病患者过程中发生职业暴露的情况进行回顾性分析.结果 最先接诊的1例狂犬病患者在急诊救治和护理过程中有5人发生职业暴露,后4例未发生职业暴露.结论 首先,医护人员在工作中应普遍采取标准防护,同时应熟悉狂犬病的临床表现,尽早对狂犬病患者和疑似患者做出诊断,采取针对性的防护措施,可减少或避免职业暴露的发生.     

狂犬病暴露人群监测

目的了解狂犬病暴露人群的情况，为预防和控制狂犬病的发生和流行提供科学的依据。方法对2007年1～12月因动物致伤后来我院急诊科注射狂犬病疫苗的就诊者，采用《深圳市狂犬病暴露人群监测表》登记资料进行分析。结果5481例狂犬病暴露者中，男性2629例（占47．96％），女性2852例占（52．03％），男女比例为1：1．08。高发年龄是15。44岁3493例（占63．72％），其次是0—15岁1111例（占20．27％）。伤人动物主要为犬类，宠物犬和家犬共3845例（占70．15％）。伤口部位主要为上肢3029例（占55．26％），其次是下肢2079例（占37．93％）。I级暴露人群最多5420例（占98．88％）。受伤程度以浅表为主5276例（占96．25％）。所有暴露者经正确处理伤口，全程规范接种狂犬疫苗，迄今无1人发病。结论目前对狂犬病尚无有效的治疗方法，做好暴露后免疫预防是关键，最有效的措施是加强犬类管理．减少暴露机会，及时规范处理伤口并全程接种狂犬疫苗。     

2010-2012河南省狂犬病流行情况监测

目的分析2010-2012年河南省人狂犬病流行特征。方法采用EpiData3.0和SPSS13.0软件对河南省2010-2012年狂犬病流行情况进行汇总分析。结果河南省出现了大范围的狂犬病疫情,波及13个地市中的53个县乡级行政区;总共发病94例,男女性别比1.94∶1,40~65岁年龄组报告病例数最多,9月为全年发病最高峰,农民占全部狂犬病病例的72.3%,绝大多数病例由狗咬伤而感染,但有1例为猫抓伤,病例有失踪现象。结论河南省是我国重要的狂犬病流行区,需要多部门联合采取综合防治措施防止疫情的扩散。     

清新县2003—2008年狂犬病流行情况分析

目的通过分析清新县2003—2008年狂犬病的发病情况,了解其流行趋势,为制定防控措施提供科学依据。方法采用描述性流行病方法,运用EpiInfo软件进行分析、评价。结果2003—2008年清新县共报告30例狂犬病临床诊断病例,年平均发病率为0．70／10万,其中2008年发病率高达2．31／10万,病死率为100％;全县9个镇均有发病,以龙颈镇最多（共7例）,占总发病数的23．33％;发病年龄最大76岁,最小12岁;职业以农民为主,占63．33％;传染源以犬为主,占86．67％;全部病例均无接种疫苗。结论防病意识薄弱,伤口处理不规范,狂犬疫苗接种率不高,是清新县人狂犬病流行的主要因素。因此,加强宣传教育,提高犬伤者免疫率是今后工作的重点。     

2009-2010年绵阳市4531例狂犬病暴露人群流行病学调查

目的了解2009-2010年绵阳市狂犬病暴露人群流行病学特征及暴露后所采用的预防控制措施,为加强狂犬病防治工作提供依据。方法采用描述性研究方法,对狂犬病暴露人群的性别、年龄、就诊时间、暴露级别、伤口处理、狂犬病疫苗及人狂犬病免疫球蛋白接种的及时性以及伤人动物的类别等因素进行统计分析。结果 2009-2010年绵阳市9个县市区疾病预防控制中心犬伤门诊共接诊狂犬病暴露人群4531例,男女性别比为1.14：1;0～岁组和40～岁组被咬伤人数最多,分别占犬伤总人数的23.31%和15.12%;伤后24h内就诊者达92.45%;Ⅱ级暴露者和伤及四肢者最多,分别占53.59%和87.46%;犬伤人占大部分,为93%;使用狂犬病免疫球蛋白人数占应使用者的45.35%。结论预防狂犬病要及时规范处理伤口并全程接种狂犬疫苗;加强犬类管理,减少暴露机会;同时,应加强狂犬病防治知识的宣传教育和医务人员的培训,普及狂犬病的防治知识。     

Rabies and post-exposure prophylaxis in Thai children

Thailand is an endemic area for rabies, with approximately 300 human deaths reported annually. More than half of the rabies patients are children under 14 years of age. This paper reports clinical data of paediatric rabies cases occurring from 1980 to 1986, and the protective efficacies of human diploid cell rabies vaccine (HDCV) and purified Vero cell rabies vaccine (PVRV) in children exposed to rabid animals. The analysis of 120 medical records revealed that rabies in children had incubation periods which ranged from less than fifteen days to more than three months, but generally between one to three months. The most frequent symptoms observed in the patients were hydrophobia, restlessness, fever, vomiting and aerophobia. Most of the rabid children admitted to hospital died within 24 hours. HDCV was administered to 50 children exposed to rabies with the cumulative dosages of 327 ml. All patients survived without serious adverse effects during a-two year follow-up. Mild reactions were seen in 1.5 percent (5/327 doses). Unfortunately, levels of rabies antibody in these vaccinees were not determined. Among another series of children exposed to rabid animals, comprising 27 individuals who received a total of 168 doses of PVRV, only mild local reactions were seen in 6 subjects. No rabies deaths were reported in 2 years of follow-up. The children who received PVRV either with or without human rabies immune globulin developed similar levels of rabies neutralizing (NT) antibody, which reached the high titers on day 30. At one year after the first dose of vaccination, all vaccinees still had NT antibody at titers higher than 0.5 IU/ml.(ABSTRACT TRUNCATED AT 250 WORDS)     

Effect of the interferon inducer double-stranded RNA on the development of vaccinal antirabies immunity

Experimental mice treated with an interferon inducer (double-stranded RNA) and vaccine, vaccine alone, and gamma-globulin plus vaccine were used to study the time course of development of immunity to rabies by intramuscular and intracerebral challenge with street rabies virus. Combined use of the interferon inducer and specific vaccine was shown to produce an earlier and more intensive immunity than vaccine alone or gamma-globulin and vaccine, and also a more marked humoral immune response. It is concluded that the new method for prevention of hydrophobia is effective and promising, particularly in cases of severe bites with a short incubation period.     

Epidemiological aspects of human and animal rabies in the urban area of Bamako, Mali

The district of Bamako is the political and economical capital city of Mali with 1,800,000 inhabitants. The goal of the present retrospective study was to determine the frequency of animal bites, human and animal rabies on the one hand and to determine the frequency and the nature of mad animals on the other hand from January 2000 to December 2003 (4 years). To achieve this goal, we have analysed registers and documents related to rabies in the department of prevention and fight against diseases, the central veterinary laboratory, and also at the lazaret clinic involved in caring for human rabies cases. Human rabies diagnosis has been brought up based upon the following clinical arguments: agitation and lethal hydrophobia within few days following bites by known or unknown animal. Agitation and aggressiveness followed by the animals' death within an observation period of 15 days maximum, allowed to evoke the diagnosis in animals. In Bamako an average of 1470 persons have been bitten each year. In 97.1% of the cases, the mad animal was a dog; cats (1.6%), donkeys, horses, cattle and rats (1.4%) have also been identified on a total of 5870 cases of notified human bites by animals; 10 cases of notified human rabies have been recorded. The dog has been incriminated in 6 cases of human rabies out of 10, in the 4 other cases, it has not been possible to identify the mad animal. Among the 3924 mad animals in observation at the veterinary clinic, 187 have been clinically mad that is 4.8%. The rabies virus has also been researched by direct immunofluorescence in 121 specimens of dead mad animals brain. This research has been positive in 119 cases among which 116 dogs, 2 sheep and 1 cow. Anyway the vaccinal status of people bitten by mad animals has not been clearly established. According to these results, we recommend the implementation of a national specific program to eradicate rabies in Bamako.     

Abortive rabies in rabbits and white rats infected intracerebrally

Summary Non-fatal rabies was successfully reproduced in rabbtis infected intracerebrally with a highly pathogenic strain of street virus isolated from a man who had died of hydrophobia after a dog bite and in white rats infected intracerebrally with the CVS strain of fixed virus. All the animals were pretreated with a sublethal intraperitoneal dose of live rabies virus. The surviving animals showed residual neurological symptoms (except one rat) in the form of paresis (both mild and marked) and high titres fo virus-neutralizing antibody in the brain comparable to the level of serum antibody.Successful reproduction of abortive rabies in rabbits infected intracerebrally with the classical strain of street virus suggests that different forms of rabies infection may probably exist in nature.     

早期慢性阻塞性肺疾病诊断与防治研究

慢性阻塞性肺疾病（COPD）是以持续气流受阻进行性发展为特征的一种可预防和治疗的疾病。COPD发病率、致残率较高,严重威胁人类健康安全。目前,早发现、早诊断、早治疗是我国COPD防治的重要手段。我国早期COPD病例数量大,不同患者症状存在明显差异性。研究早期COPD诊治情况,有望探索对患者进行个体化治疗的方法,进一步促进临床治疗策略的制定,提高慢性阻塞性肺疾的临床诊治研究水平。本文现就COPD早期的诊治研究进行综述,以期为临床诊治慢性阻塞性肺疾提供理论参考依据。     

Anthrax in America 2001-2003

Anthrax caused by Bacillus anthracis in humans is rare. Two recent outbreaks that were intentionally caused occurred among postal employees, politicians, and journalists in the United States. This has caused tremendous fear, and our experience with these "anthrax incidents" has changed our views on the natural history of this disease in people. In this paper, we review the lifecycle and biology of this micro-organism. Anthrax that occurs from a weaponized form of this micro-organism has a specific clinical presentation that requires a suspicion of anthrax exposure to be diagnosed. New methods of testing for anthrax have been developed and may simplify diagnosis in the future. The range of illness caused by B. anthracis from the molecular level to the clinical symptoms is discussed. We also review the diagnostic criteria and differential diagnosis as well as treatment of this condition.