我国人狂犬病的流行特征

我国解放后人狂犬病发病例数曾经历3次高峰,分别是20世纪50年代中期、80年代中期和21世纪初期,夏秋季发病数明显高于其他季节。疫情主要分布在华南、西南、华东地区,病例以农村居民、学生和散居儿童为主。我国人狂犬病的主要感染来源是犬,其次是猫;患者暴露部位依次是四肢、头面颈部和躯干。     

广东省人群狂犬病暴露及其与狂犬病流行相关因素分析

对狂犬病认知水平低被认为是影响我国狂犬病流行的重要因素[1-4],但关于我国人群暴露现状及其流行病学特点缺乏连续、全面的科学数据.为了解广东省狂犬病暴露现状,评估狂犬病流行风险,于2005年在全省范围设置犬伤门诊,并以此作为暴露人群监测哨点,按统一的表格对就诊的被动物所伤人员进行登记、调查和报告,进行人群中狂犬病暴露哨点监测工作.     

Human rabies in Delhi

Objective : Analysis of human rabies cases admitted in Infectious Diseases Hospital, Delhi during the course of one year was undertaken to understand the epidemiology of rabies.Methods : The data was collected using standardized proforma and was analyzed on EPI Info 6.02 software version. A total of 49.8% of the human rabies came from Delhi and rest belonged to adjoining states of UP (30.3%), Haryana (18.3%), Bihar (0.8%), Punjab (0.4%) and MP (0.4%). Children in the age group 5–14 years fell victim to the disease in significantly higher numbers (36.7%) as compared to other age groups. Male Female ratio was 4:1. Biting animals involved were dog (96.7%), jackal (1.7%), cat (0.8%), monkey (0.4%) and mongoose (0.4%). Majority (78.8%) had Category III exposure. Hydrophobia, which is the pathogonomic feature of human rabies, was present in 95% of cases. Remaining (5%) gave history of animal bite and presented with features of aerophobia, photophobia along with fever, weakness in limbs, parasthesia, and/or paralysis. Significantly higher number (93.4%) did not receive any local wound treatment. Most (91.7%) cases never received any vaccination and remaining were inadequately vaccinated; only five had received 10–14 injections of Neural Tissue Vaccine (NTV) and one child who had multiple bites on face, received 5 doses of NTV, local wound treatment and intramuscular ARS on 3^rd day.Result : The data strongly reveals that people who died due to rabies either did not receive any treatment or were inappropriately and inadequately treated. Hence, there is need to educate the community and the health care professionals about the importance of immediate and adequate post exposure treatment. The data also indicates that the epidemiology of the disease has not changed much over the decades.Conclusion : The disease can be prevented with the available tools and all we need to do is to implement them effectively.     

Worldwide rabies deaths prevention—A focus on the current inadequacies in postexposure prophylaxis of animal bite victims

The World Health Organization reports that over 60,000 humans die of rabies annually, worldwide. Most occur in remote regions of developing countries. Almost all victims received no postexposure rabies prophylaxis (PEP). There are no facilities or health personnel able to provide it in many areas where the disease is prevalent. A first approach to correct this problem would be by extending provision of modern PEP to areas where human rabies is most prevalent.     

2001—2012 年岳阳市人间狂犬病流行特征分析

目的通过分析岳阳市2001--2012年人间狂犬病疫情的流行现况，为狂犬病的防控提供科学依据。方法采用描述流行病学方法对2001--2012年岳阳市报告的狂犬病疫情进行分析。结果2009--2012年岳阳市报告狂犬病暴露患者76861人。I、Ⅱ和Ⅲ级暴露者分别为4902、50660和21299人。2001--2012年岳阳市共报告人间狂犬病病例192例，男女病例比为2．43：1，中位年龄为40岁。职业分布以农民为最多，占58．85％；其次为学生，占19．27％。夏秋季为高发季节。伤人动物以犬只为主，占92．19％。伤人动物的处理方式比例最大的为捕杀，占43．23％。不处理或是未及时处理伤口者占50．00％，应急接种者占16．67％，病毒血清注射者占3．65％。结论应加强犬只管理，加强对群众的狂犬病防治知识的宣传教育和加强对狂犬病疫苗的监管，强化对动物咬抓伤治疗的医保管理。     

天津市2005-2009年人间狂犬病疫情分析

目的分析天津市人间狂犬病疫情,探讨狂犬病防制的重点策略和措施。方法收集狂犬病病例资料和人口学资料,进行描述性流行病学分析,采用Excel软件进行数据录入和整理。结果天津市2005-2009年累计报告狂犬病病例46例,年均发病率0.09/10万,病死率为100%。发病集中在夏秋季。50～59岁年龄组发病最多,其次为30～39岁年龄组;男性发病多于女性,男女病例比为2.54∶1;病例以农民为主(32.61%),其次为民工(21.74%)。疫情主要集中在农村地区。接受正规伤口处置、接种狂犬病疫苗和注射免疫球蛋白病例分别占4.35%、15.22%和0。结论犬只数量增加、管理不严以及暴露后处理不及时不规范是导致狂犬病病例回升的主要原因。提示今后应加强综合性防治措施,加大宣传力度,以农村地区为重点进行防制。     

Pathology of rabies: A light- and electron-microscopical study with particular reference to the changes in cases with prolonged survival

Summary Light-and electron-microscopical studies were conducted on necropsy material from six cases of rabies encephalitis including three with the unusual feature of surviving for over 14 days as a result of intensive medical care. This included administration of antiviral agents and interferon inducers and prevention of hypoxia by intermittent positive pressure ventilation. In all these cases, typical Negri bodies were demonstrated. Inflammatory reaction was absent or minimal. Unlike the cases with short survival where Negri bodies were infrequently seen and restricted mostly to the hippocampus, in cases with prolonged survival, they were present in large number, widely distributed throughout the grey matter of the brain. The associated inflammatory reaction in these cases, however, did not keep pace with the increase in number of inclusion bodies. Peripheral neuritis was observed in two of these cases, which also showed myelitis involving the cervical region and inflammation of dorsal root ganglia. One of them showed necrosis and severe inflammation of the lower cervical sympathetic ganglion. An electron-microscopical study conducted in four cases showed three forms of the inclusion body in the cytoplasm of neurons.     

河南省狂犬病病例县区层面空间分布特征与动态变化

目的 研究狂犬病病例在河南省县区层面空间分布状态及动态变化.方法 对河南省2004-2010年狂犬病县区层面疫情数据进行收集和整理,进行Poisson分布和负二项分布的拟合与检验,分析聚集特征及变化.结果 按照α=0.05水平,2004、2005、2007和2009年狂犬病病例在县区层面服从负二项分布而不服从P0isson分布(P＜0.001);2008和2010年更倾向于服从负二项分布,但同时不排除服从Poisson分布;2006年两种分布均不服从.从负二项聚集性参数k值来看,狂犬病病例在县区层面的聚集程度从2004-2008年逐年降低,2009年有所增强,2010年又呈现聚集性减弱倾向.聚集程度与疫情县区平均病例数呈正相关(r=0.807,P=0.028).结论 狂犬病病例在河南省县区层面的分布更倾向于负二项分布,具有一定程度的空间聚集性,但聚集程度有逐年下降趋势.

Abstract：

Objective To study the spatial distribution and dynamics of human rabies cases at the county level, in Henan province to provide scientific evidence for the development of control program on rabies. Methods Data of human rabies cases at the county level from 2004 to 2010 in Henan province were analyzed by Poisson distribution and negative binomial distribution. Data calculation was conducted manually. Results According to the level of α =0.05 being set, there were three different results appeared: the first was fitted negative binomial distribution in 2004, 2005,2007 and 2009; the second was prioritized negative binomial distribution, but the poisson distribution could not be excluded in 2008 and 2010; the last one was fitted neither negative binomial distribution nor poisson distribution in 2006. By the clustering parameter k, the clustering degree at county level decreased from 2004 to 2008, then ascending in 2009 but descending again in 2010. The degree of clustering showed a positive correlation with the county mean cases in the prevalent counties (r=0.807,P=0.028). Conclusion As a whole,the distribution of human rabies at county level in Henan from 2004 to 2010 showed negative binomial distribution and presented the spatial clustering.However, the degree of clustering decreased in recent years and showed that the infection resource was possibly scattered more evenly at the county level.