2014 - 2018年南昌市CDC门诊狂犬病暴露处置情况分析

目的 了解近5年南昌市CDC门诊狂犬病暴露人群特征变化，总结暴露处置经验，提出狂犬病防治对策参考意见。方法 选取南昌市CDC门诊部2014 - 2018年的五年间《狂犬病暴露处置门诊日志》，采用Excel 13.0软件进行资料统计分析，人用狂犬病病毒IgG抗体检测（酶联免疫法）用于暴露后全程接种狂犬病疫苗后抗体检测。结果 暴露人群呈逐年上升趋势，病例分布女性多于男性；年龄分布以15～29岁组为高（占26.70%），最低为≥60岁组（占13.05%）；时间分布5 - 9月为高峰期；暴露地点以在家中为主（占78.67%）；暴露部位以肢体伤为多（上肢伤占42.89%、下肢伤占43.31%）；其中Ⅱ级暴露占73.08.%、Ⅲ级暴露占26.92%，Ⅲ级暴露中同意注射狂犬病免疫球蛋白的占38.88%。致伤动物以犬类最多为主（占77.91%），其次是猫（占18.72%），动物有明确免疫率为48.96%。人用狂犬病病毒IgG抗体检测结果显示，五年抗体总阳转率为98.13%，各年度间抗体阳转率比较差异有统计学意义（χ2 = 32.58,P＜0.05）。其中联合注射狂犬病免疫球蛋白组的抗体阳转率为95.31%，仅接种狂犬病疫苗组的抗体阳转率为98.55%， 两组比较差异有统计学意义（χ2 = 81.24,P＜0.01）。结论 Ⅲ级暴露人群的受经费影响规范化处置率低，暴露分级建议针对个体综合伤势、受伤部位、狂犬病疫情、致伤动物状况、伤者健康状况等多因素进行评估后处理。

Analysis on the treatment of rabies exposed to CDC outpatient in Nanchang city between 2014 and 2018

Objective The aim of this study was to understand the characteristics of rabies exposed population in Nanchang CDC outpatient department in recent five years, summarize the experience of exposure and disposal, and put forward the reference opinions on rabies control countermeasures. Methods Data from Nanchang CDC outpatient department from 2014 to 2018 in the five years "rabies exposure disposal outpatient journal” was collected. Excel13.0 software was used for data statistical analysis. Human rabies virus IgG antibody detection(enzyme-linked immune method) was performed for the whole process after exposure to rabies vaccine antibody detection. Results The exposed population showed a trend of increasing year by year, and more women than men were distributed in cases. The age distribution was up to 26.7% in the 15-29 group,and the lowest was 13.05% in the ≧ 60 years old group. The time distribution showed monthly cases every month, and the peak period of May-September was consistent with the onset season of rabies. Exposure sites in the house mainly accounted for 78.67%, that was the location of animal activity. The exposed site had more limb injury. Upper limb injury accounted for42.89%, and lower limb injury accounted for 43.31%. Among them, Ⅱ level exposure accounted for 73.08.%, Ⅲ exposure accounted for 26.92%, and Ⅲ level exposure agreed to inject rabies immunoglobulin accounted for 38.88%. The majority of injured animals were dogs, accounting for 77.91%, followed by cats, accounting for 18.72%. Animals had a clear immunization rate of 48.96%. The results of IgG antibody test for human rabies virus: the total positive conversion rate of antibody for five years was 98.13%, and the difference of antibody positive conversion rate was statistically significant in each year(χ2=32.58, P<0.05). The antibody positive rate of the combined rabies immunoglobulin group was 95.31%, the antibody positive rate of the rabies vaccine group was 98.55%, and the difference between the two groups was statistically significant(χ2=81.24, P<0.01). Conclusion Under financial influence, the standardized disposal rate for the exposed population at the Ⅲlevel was low, and the admission to Medicare is only one way to solve the funding issue. According to the " rabies exposure prevention and disposal work norms(2009 edition)”, disposal will bring a great burden of disease to China, exposure grading recommendations should be performed for individual comprehensive injuries, injury sites, rabies outbreak, injury of animal conditions. Health status of the injured and other factors should be included to assess the subsequent judgment. Attention should be paid to the importance of wound treatment so as to achieve the goal of preventing rabies at the lowest cost. High canine density, low canine immunity rate and weak consciousness of dog breeding are difficult problems in the prevention and treatment of rabies at present.