2010年四川省狂犬病监测

目的分析四川省狂犬病监测点暴露人群流行病学状况,为狂犬病相关防治提供有效的依据。方法选取2005-2009年四川省狂犬病高发的6个县为监测点,要求每个监测点选择1个县级疾病控制中心和2个乡镇卫生院的犬伤门诊对犬/猫伤处置及相关情况进行登记。对其中3个监测点采集的258份犬标本使用免疫荧光法进行犬只带毒检测。使用Epidata3.02建立数据库,Excel2007统计分析。结果 2010年6个监测点共登记4 835例暴露者,男女比例为1.05∶1;15岁以下儿童暴露占32.60%;6～9月暴露占全年的45.93%;上下肢暴露占66.39%;Ⅲ级暴露占55.56%。暴露者注射疫苗率为98.87%,Ⅲ级暴露注射免疫球蛋白为23.49%。结论 6个监测点犬伤门诊就诊数男女几乎相等,低年龄组暴露为主,夏秋季暴露居多,暴露部位主要为上下肢,犬伤者暴露后使用狂犬免疫球蛋白意识不强。尚需加强农村地区乡镇卫生院犬伤处置培训;加强对农民狂犬病预防知识及伤口处置等预防知识的宣传。     

济宁市2011—2015年狂犬病暴露人群流行病学特征分析

目的了解山东省济宁市狂犬病暴露人群暴露流行病学特征及暴露后处置情况,为狂犬病防控提供科学参考依据。方法收集2011—2015年济宁市狂犬病暴露登记资料进行统计分析。结果 2011—2015年共接诊狂犬病暴露病例221 272例,性别比为1.49:1,0~14岁儿童最多,占32.71%;各月均有暴露者发生,7—8月为高峰,占22.51%;致伤动物以犬类为最多,占83.92%;暴露者到狂犬病处置门诊处理为主,占79.22%,全程接种人用狂犬病疫苗的145 092例,占Ⅱ、Ⅲ级暴露的72.16%,注射过狂犬病被动免疫制剂的12 783例,占Ⅲ级暴露的18.6%。结论济宁市群众对狂犬病防控知识缺乏,狂犬病暴露规范处置率较低,应加强狂犬病监测和健康教育,提高狂犬病防治知识。     

A randomized open-label trial of 2-dose or 3-dose pre-exposure rabies prophylaxis among Thai children

BackgroundWorld Health Organization changed the recommendation for pre-exposure rabies prophylaxis from 3-dose to 2-dose regimen in 2018. Given limited data of 2-dose regimens in pediatric population, this study aimed to compare the immunogenicity between 2-dose and 3-dose pre-exposure rabies immunization.MethodsThis study was conducted among healthy children aged 2–12 years. They were randomized to 2-dose vaccination (2D) on days 0 and 28 or 3-dose vaccination (3D) on days 0, 7, and 28. Purified Vero cell rabies vaccine (PVRV-Verorab™) was administered intramuscularly. Rabies virus neutralizing antibody (RVNA) titers were measured at 3 time points: 14-day after complete vaccination, 1-year pre-booster vaccination, and 7-day post-booster dose to mimic scenario of rabies exposure. RVNA titers ≥0.5 IU/ml were considered adequate antibody. T cell specific response to rabies vaccine antigen was measured using the interferon-gamma enzyme linked immunospot assay.ResultsFrom September to October 2017, 107 participants (51% males), 78 in 2D group and 29 in 3D group were enrolled. Median age was 5.8 years (IQR 4.4–7.3). All participants had RVNA titers ≥0.5 IU/ml after primary vaccination [GMT 2D: 18.6 (95%CI 15.9–21.8) and 3D: 16.3 (95%CI 13.2–20.1 IU/ml), p = 0.35]. At 1-year prior to receiving the booster, only 80% of the children in 2D group maintained RVNA titers ≥0.5 IU/ml compared to 100% of the children in 3D group (p = 0.01). However, all participants in both groups had RVNA ≥0.5 IU/ml at 7-day post booster vaccination [GMT 2D: 20.9 (95%CI 17.4–25.3) and 3D: 22.2 (95%CI 15.8–31.4) IU/ml (P = 0.75)]. The median number of IFN-γ secreting cells at 7-day post-booster dose was 98 and 128 SFCs per 10⁶ PBMCs in the 2D and 3D groups, respectively (P = 0.30).ConclusionsTwo-dose primary rabies immunization provided adequate antibody at post primary vaccination and post booster. The results support 2-dose regimen of pre-exposure rabies immunization in the pediatric population.     

青海省狂犬病暴露处置门诊服务能力与现状分析

目的 掌握青海省狂犬病暴露处置门诊现状,为规范暴露门诊的设置和暴露后处置提供依据。 方法 采用统一设计的狂犬病暴露处置门诊调查表开展现场调查,收集各暴露门诊服务内容、医务人员数量、布局和分区、伤口处置、冷链等硬件设施、管理制度以及年接诊服务量等内容,对门诊服务现状进行综合分析。 结果 全省仅8.76%(12/137)的门诊可同时开展伤口处置、狂犬病疫苗及被动免疫制剂的接种工作,均集中在西宁市、海东市和玉树州;每家门诊获得临床执业(含助理)资质的人员中位数为2人;全省46个县区暴露处置门诊中位数为2.55(QR:2.73);人均门诊数最高为大柴旦(26.41家/10万)和乌兰县(16.81家/10万);人均门诊数最低为民和县(0.54家/10万)和城东区(0.52家/10万)。不同类型暴露处置门诊基本硬件配套设施、服务与管理得分中位数差异较大。2018年各暴露门诊平均就诊人次152人次,不同地区暴露处置门诊就诊人次也存在较大差异(H=16.66,P=0.02)。 结论 青海省狂犬病暴露处置门诊设置及服务能力地区差异较大,基本硬件设施、规范化服务与管理、提供狂犬病被动免疫制剂接种的门诊比例均有待提高。     

Animal-Associated Exposure to Rabies Virus among Travelers, 1997–2012

Among travelers, rabies cases are rare, but animal bites are relatively common. To determine which travelers are at highest risk for rabies, we studied 2,697 travelers receiving care for animal-related exposures and requiring rabies postexposure prophylaxis at GeoSentinel clinics during 1997–2012. No specific demographic characteristics differentiated these travelers from other travelers seeking medical care, making it challenging to identify travelers who might benefit from reinforced pretravel rabies prevention counseling. Median travel duration was short for these travelers: 15 days for those seeking care after completion of travel and 20 days for those seeking care during travel. This finding contradicts the view that preexposure rabies vaccine recommendations should be partly based on longer travel durations. Over half of exposures occurred in Thailand, Indonesia, Nepal, China, and India. International travelers to rabies-endemic regions, particularly Asia, should be informed about potential rabies exposure and benefits of pretravel vaccination, regardless of demographics or length of stay.     

2012-2013年开封市人间狂犬病监测分析

目的了解开封市2012-2013年狂犬病疫情流行特征及狂犬病暴露人群的分布特征,形成防治建议,为政府决策服务。方法收集"疾病监测信息报告管理系统"所报告的2012-2013年开封市狂犬病的数据和各狂犬病门诊登记的狂犬病暴露人员数据并进行汇总分析。结果开封市2012-2013年狂犬病的发病率为0.21/10万和0.15/10万,病例主要为60岁以下的散居儿童和农民,狂犬病2012-2013年平均暴露率为52.14/万,2013年暴露率低于2012年,暴露人群中男性多于女性,16~45岁年龄组暴露数最多,伤口部位主要分布在四肢,下肢暴露最多,平均98.90%的暴露人员受伤后曾进行过伤口处理,致死动物以犬为主。结论开封市狂犬病暴露强度处于较高的水平,成为一个较严重的公共卫生问题,狂犬病的防控重点是农村地区的散居儿童和农民。     

安庆市1953～2006年狂犬病流行特征及流行因素分析

目的了解安庆市狂犬病流行特征,探讨近年来狂犬病发病上升的因素和防制对策。方法收集1953-2006年安庆市狂犬病疫情资料和流行病学调查资料进行分析。结果1953-2006年安庆市共报告狂犬病369例,呈现3次流行。1953-1956年低流行期,年平均发病率0.061/10万;1981-1990年出现流行高峰,年平均发病率为0.56/10万;2003-2006年再次出现流行,年平均发病率0.13/10万,且疫情呈持续上升趋势。除迎江区外,各县（市）、区均有狂犬病报告。季节发病高峰在6~10月份,占60.47%。发病职业以农民为主,占58.06%。暴露后67.74%未进行伤口处理,仅有16.13%进行了疫苗接种。结论安庆市狂犬病态势与全国一致。养犬数量增多,对犬的管理不到位,群众对狂犬病危害认识不足,暴露后未及时有效地进行预防处置是近年来狂犬病发病回升的主要原因。     

济南市2006-2009年狂犬病流行病学分析

目的通过对济南市2006-2009年狂犬病疫情资料分析,为防制狂犬病提供科学依据。方法收集2006-2009年济南市疾控机构报告22例狂犬病疫情,进行统计分析。结果济南市狂犬病暴露人员,农村多于城镇,男性多于女性,2006-2009年各月均有病例发生。结论养犬数增加以及犬伤暴露后预防处置缺乏规范化管理,致使犬咬(抓)伤者得不到及时规范处理;疫苗流通环节较乱,人(兽)用狂犬病疫苗质量得不到保障。     

Epidemiologic Features of Animal Bite Cases Occurring in Rabies-Endemic Areas of Korea, 2005 to 2009

ObjectivesHuman rabies is a reemerging infectious disease in Korea. There was no human rabies case for 14 years until the disease had reoccurred in 1999. To prevent occurrence of human rabies, surveillance for animal bite patients in rabies endemic areas in Korea was conducted since 2005 as a part of a human rabies control program. The animal bite cases were analyzed to determine whether patients were treated according to the post-exposure prophylaxis (PEP) guideline of the Korea Centers for Disease Control and Prevention.MethodsInformation of animal bite cases that occurred from 2005 to 2009 in rabies high-risk regions were collected by cooperation with Regional Public Health Centers in 18 cities/districts of rabies endemic areas.ResultsA total of 2458 animal bite cases were reported. Dogs accounted for 86% of animal bites and 67% of the animals were not vaccinated against rabies virus. For PEP, among rabies-vaccinated animals, 92.7% were observed for clinical signs and 1.4% underwent necropsy. Among unvaccinated animals, 72.7% were observed for clinical signs and 4.1% underwent necropsy. The remaining animals were not available for examination. Of the animal bite patients, 32.5% received PEP and 51.6% were treated by first aid or by washing the wound.ConclusionsGiven that no human rabies cases were reported since 2005 and animal rabies was continuously reported in endemic areas of Korea, the human rabies control program implemented in 2005 appears to have a significant role in the prevention and control of human rabies.     

Pre-exposure rabies prophylaxis: efficacy of a new packaging and delivery system for intradermal administration of human diploid cell vaccine

The efficacy of a newly designed syringe prepacked with human diploid cell vaccine in a sufficient quantity to deliver individual 0.1 ml doses intradermally was tested by injecting 40 veterinary students with a single dose on each of days 0, 7 and 28. A second group of 20 students received the ordinary series of three 1.0 ml intramuscular vaccine doses by needle and syringe. All participants in both groups developed neutralizing antibodies to rabies above the suggested minimum of 0.5 international units per ml by day 49. The geometric mean titres were somewhat lower in the group receiving the 0.1 ml doses compared to the group given 1.0 ml doses; however, this was considered of no clinical significance since everyone achieved a titre above the suggested minimum. There was little difficulty in reconstituting the vaccine prepacked in the lumen of the syringe and the syringe was easy to manipulate.     

心理护理干预在狂犬病暴露人群中的作用研究

目的研究狂犬病暴露人群的心理健康状况,为完善狂犬病暴露人群的综合治疗提供社会心理学依据。方法采用抑郁自评量表（SDS）、焦虑自评量表（SAS）对200例狂犬病暴露患者进行心理评分,将200例患者随机分成试验组与对照组,对照组仅做常规的治疗护理,试验组增加心理护理及系统的健康教育,在干预前后对两组患者分别进行SDS、SAS评分取值。结果狂犬病暴露人群评分与全国常模有显著性差异（P〈0．05）,试验组在干预前后与对照组相比有显著性差异（P〈0．05）,与全国常模相比无显著性差异（P〉0．05）。结论狂犬病暴露人群易出现心理应激障碍,心理护理干预可减轻患者的不良情绪,提高治疗依从性。有利于狂犬病疫苗的免疫。     

云南省5年HIV职业暴露因素分析

[目的]分析艾滋病病毒（HIV）职业暴露现状,探讨职业暴露后应急预防处理方法。[方法]对云南省2005年～2010年报告的由于职业因素引起的HIV暴露案例进行分析。[结果]2005年～2010年共发生职业暴露1138人,包括医护人员和公安司法人员;暴露类型主要包括针刺伤647例（56．9％）、血液接触皮肤粘膜305例（26．8％）和抓伤96例（8．4％）。974（85．6％）人实施暴露后预防（PEP）,采用基本用药程序或强化用药程序进行干预治疗,所有病例随访未发现HIV抗体阳转者。[结论]HIV职业暴露后感染的危险度较低,但是应严格遵守安全防护措施,暴露后及时使用预防用药,可有效阻断发生艾滋病职业暴露后感染。     

浙江省2002～2005年艾滋病职业暴露分析

目的为了解艾滋病（HIV）职业暴露现状，探讨职业暴露后应急预防处理的影响因素。方法对浙江省2002—2005年报告的由于职业因素引起的HIV暴露案例进行调查并统计分析。结果4-4起56人包括医务人员，公安司法职业暴露，暴露类型包括针头刺伤，抓咬伤和血液接触皮肤或粘膜，50人实施暴露后预防（PEP），有43人采用基本用药程序进行干预治疗，占76．8％（43／56）：有7人采用强化用药程序：有6人自愿不实施PEP。目前所有病例随访未发现HIV抗体阳转者，有一例发生丙肝病毒（HCV）抗体阳转。结诊HⅣ职业暴露后感染的危险较低．但是要注意加强对其他各类血液传播疾病的阻断防护。     

暴露后843例狂犬病疫苗接种者流行病学分析

目的分析上高县动物致伤及暴露处置状况,为进一步做好狂犬病暴露后预防处置提供依据。方法收集2007年上高县疾病预防控制中心狂犬病预防接种门诊资料,对狂犬病疫苗接种者及其处置情况作统计分析。结果 843例暴露后免疫接种者中男女之比为1.57:1,致伤的高危年龄段为15岁及30～44岁,以学生和农民居多,7、8月份为致伤高峰。伤人动物以犬最多,其次为猫。致伤部位以下肢和上肢为主,Ⅲ度和Ⅱ度暴露者占96.69%。24h内及时就诊处置占91.10%。70.34%的暴露者进行了规范的清创消毒,完成狂犬病疫苗全程接种的占99.05%,7.59%的暴露者使用了人源狂犬病免疫球蛋白。结论暴露后预防处置对预防狂犬病发挥了重要作用,今后仍需落实暴露人群的规范处置,加强狂犬病防治知识宣传,提高高危人群的自我保护意识。     

Immunogenicity and safety of four different dosing regimens of anthrax vaccine adsorbed for post-exposure prophylaxis for anthrax in adults

Background

Strategies to implement post exposure prophylaxis (PEP) in case of an anthrax bioterror event are needed. To increase the number of doses of vaccine available we evaluated reducing the amount of vaccine administered at each of the vaccinations, and reducing the number of doses administered.

Methods

Healthy male and non-pregnant female subjects between the ages of 18 and 65 were enrolled and randomized 1:1:1:1 to one of four study arms to receive 0.5 mL (standard dose) of vaccine subcutaneously (SQ) at: (A) days 0, 14; (B) days 0 and 28; (C) days 0, 14, and 28; or (D) 0.25 mL at days 0, 14, and 28. A booster was provided on day 180. Safety was assessed after each dose. Blood was obtained on days 0, 7, 14, 21, 28, 35, 42, 49, 56, 63, 70, 84, 100, 180, and 201 and both Toxin Neutralizing antibody and anti-PA IgG antibody measured.

Results

Almost all subjects developed some local reactions with 46–64% reported to be of moderate severity and 3.3% severe during the primary series. Vaccine groups that included a day 14 dose induced a ≥4 fold antibody rise in more subjects on days 21, 28, and 35 than the arm without a day 14 dose. However, schedules with a full day 28 dose induced higher peak levels of antibody that persisted longer. The half dose regimen did not induce antibody as well as the full dose study arms.

Conclusion

Depending on the extent of the outbreak, effectiveness of antibiotics and availability of vaccine, the full dose 0, 28 or 0, 14, 28 schedules may have advantages.     

Rabies Postexposure Prophylaxis for Travelers Injured by Nonhuman Primates,Marseille, France, 2001–2014

Most exposures of residents of Marseille to nonhuman primates occurred among unvaccinated adult travelers to Southeast Asia within the first 10 days of their arrival at 2 major tourist locations in Thailand and 1 in Indonesia. A small proportion of travelers received rabies immunoglobulin in the country of exposure.     

南昌市“狂犬病暴露人群处置情况统计软件”的数据分析与应用效果评价

目的 对2014-2015年“狂犬病暴露人群处置情况统计软件”应用后的数据进行分析,对其在南昌市狂犬病防控中的应用效果进行评价。 方法 采用描述性流行病学方法,对“狂犬病暴露人群处置情况统计软件”中录入的2014-2015年南昌市各级疾病预防控制机构狂犬病暴露门诊主动就诊的狂犬病暴露人群相关数据信息进行流行病学分析。 结果 南昌市狂犬病暴露人群有上升的趋势, 4-10月暴露人群居多,尤其是6-8月份,暴露人群中0~<10岁组、20~<30岁组、40~<50岁组3个年龄段发生暴露比例最大,伤人动物主要是犬,并且伤人动物的免疫率很低,仅占伤人动物的15.7%。 结论 依据软件的实时统计结果,及时发布狂犬病防治预警,促成了《南昌市养犬管理条例》的出台,在对公众进行狂犬病预防与控制的宣传中起到了良好的推动作用。自主研发的“狂犬病暴露人群处置情况统计软件”数据的录入效果整体符合预期,并且其在狂犬病预防与控制上取得了较好的效果,可以对该软件进一步推广。     

Bat incidents at children's camps, New York State, 1998-2002

From 1998 to 2002, a total of 299 bat incidents were reported at 109 children's camps in New York; 1,429 campers and staff were involved, and 461 persons received rabies treatment. In 53.8% of the incidents, the bat was captured and samples tested negative for rabies virus, which resulted in 61.3% of persons not receiving rabies treatment.