动物致伤人群接种狂犬病疫苗后血清学与流行病学效果的初步分析

目的观察就诊的动物致伤者,分别全程足量接种两种剂型狂犬病疫苗后,其血清中抗体阳转率和疫苗保护率。方法2000—2001年就诊者全程接种浓缩苗,2002—2003年的全程接种精制纯化(vero细胞)苗。严重致伤者,于0、3天接种加倍量疫苗,并于0天的同时,对其伤口周围用抗狂犬病血清(40IU/kg)进行浸润注射。联合使用抗血清者,完成全程5次注射后第15、75天各加强1针疫苗。接种结束后15—20天,以间接混合酶标法检测血清中抗狂犬病病毒抗体。期内经疫情报告系统,收集当年观察人群狂犬病病例,计算两接种组人群的发病率,并分别与当年未接种疫苗的动物致伤人群比较,以估算疫苗保护率。结果4年中该人群抗体总阳性率为95.60%。接种精制纯化苗组的阳性率为96.37%,高于浓缩苗组的94.83%。狂犬病疫苗保护率,精制苗1年和2年的均为100.00%;浓缩苗1年的为95.46%,2年、3年和4年的为90.91%。结论动物致伤人群规范处理局部伤口后,及时全程接种狂犬病疫苗,其抗体阳性率较高。国产精制纯化苗接种人群的抗体阳性率和1~2年的疫苗保护率高于浓缩苗。从我国狂犬病防治工作实际出发,提示国产精制纯化苗需尽快降低成本,以巩固和提高其接种率。

The preliminary analysis on the serological and epidemiological effects of in oculation with rabies vaccine in crowd of subjects bitten by animals

To observe the serum antibody conversion rate and the protection rate after vaccine inoculation,the crowd of subjects seeking for medical advice in 2000-2001 received the whole course of inoculations with concentrated vaccine,and those in 2002-2003 received inoculations with refined and purified vaccine(Vero cell vaccine).For severely wounded subjects,double amounts of vaccine were given on day 0 and day 3 in combination with anti-rabies serum(40 IU/kg) injection around the wounded regions on day 0.For those receiving the combined use of anti-rabies serum,another one injection of vaccine was given on day 15 and day 75 after finishing the whole course of 5 injections of vaccines.Fifteen to twenty days after finishing the whole course of vaccine inoculation,the level of anti-rabies antibodies in sera of the inoculated subjects was detected by means of indirect mixed enzyme-linked immunosorbent assay.The protection rate induced by the inoculation of vaccines was evaluated by the differences of incidences developing rabies in comparison with those subjects wounded but not receiving the inoculation of vaccines.In the course of 4 years follow-up study,it was found that the total positive rate of rising antibody tiers in crowd of subjects receiving vaccine inoculation was 95.60%,in which those receiving the refined and purified vaccine and those receiving the concentrated vaccine were 96.37% and 94.83% respectively,the former group was somewhat higher than the latter group.The protection rates of inoculation with the refined and purified vaccines in one and two years were all 100%,but that inoculated with concentrated vaccine in one year was 95.46% and those inoculated in 2,3 and 4 years were all 90.91%.From the results of the above mentioned observations,it is worthy to note that the protection rate of inoculation with the refined and purified vaccine was rather higher than those receiving the inoculation with concentrated vaccine.,indicating the urgent requirement to improve the quality of the locally made-concentrated vaccine and to reduce the cost of the refined and purified vaccine in order to take advantage of increasing its inoculation rate.