Vaccination against rabies in Poland

The data on anti-rabies vaccination in Poland in the last fifteen years are presented. In general, 89,019 people were vaccinated against rabies in Poland in the years 1986-2000, among them 580 after deep bite by rabid animal and 4814 after deep bite by an animal suspected of having rabies (III category of risk according to WHO). Among the patients with the III category exposition only a fraction were administered anti-rabies serum (12% of patients with deep bite by rabid animal), but this practice was becoming more frequent in recent years. 73% of patients were given vaccine after contact with domestic animals (dogs or cats), 9% after contact with wild foxes, which are the main reservoir of rabies in Poland. No cases of uneffective vaccination were observed. The preventive vaccination was sporadic and limited to persons with high professional risk of infection.     

云南省富源县2003—2009年狂犬病流行特征分析

目的分析富源县2003—2009年狂犬病流行特征,为今后预防控制狂犬病提供科学依据。方法对所收集到的全部疫情资料及狂犬病个案调资料进行描述流行病学分析。结果富源县在2003—2009年共发生狂犬病23例,发病高峰在2006年（20例）,发病率为2.87/10万;2003、2007、2009年分别发生狂犬病1例,2004、2005、2008年无狂犬病发生;发病率范围波动在0～2.87/10万之间,年均发病率为0.46/10万;男性明显多于女性,少年儿童和青壮年病例较多,农民发病最多;夏秋季节病例较多。病例中95.65%为犬伤,4.35%为猫咬伤。86.96%的病例伤后未进行处理或规范处理,78.26%未进行预防接种。结论养犬数量大而免疫率低、暴露后未进行伤口的规范处理、狂犬病免疫制剂使用率低是富源县狂犬病疫情上升的主要原因。     

Surveillance épidémiologique de la rage humaine dans un contexte d’endémie de rage canine en Cote d’Ivoire

Aim

The objective of this study was to analyze the epidemiologic monitoring of human rabies in the rabies medical center of Abidjan.

Patient

A cross-sectional study was undertaken based on files of patients having consulted in the rabies center after exposure and suspicion of human rabies between January 2001 and June 2009.

Results

Twenty-six cases of human rabies were reported in 10,706,136 inhabitants (annual incidence of 0.028 cases per 100,000). The number of detected cases increased considerably after reinforcing the monitoring of the disease. Most cases occurred in an urban environment and concerned both sexes. The most concerned age range was under 31 years. The patients’ were mostly school children and housewives. In all cases, the rabid animal was a dog and the type of exposure was a bite. Fifty-six percent of the victims had not received any local treatment and almost all no post-exposure prophylaxis. The mean delay before the first symptoms was 49.5 days after exposure and for death, 4 days after the onset of symptoms. Virological diagnosis was made in four cases.

Conclusion

In spite of the increase of cases observed since 2006, certainly due to reinforcement of the monitoring network, improvement is needed to assess the real incidence of rabies in the Ivory Coast.     

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.     

Human rabies post exposure prophylaxis in Bhutan, 2005-2008: trends and risk factors

The aim of this study was to understand the use and distribution of human rabies post exposure prophylaxis (PEP) vaccine in Bhutan and to identify risk factors for receiving an incomplete course of the vaccine. We analyzed post exposure treatment records from 28 medical hospitals from 2005 to 2008. Males (59%) accounted for significantly more PEP events than females (41%) across all age groups (P < 0.001). Children - particularly 5-9 years of age - received more rabies PEP than other age groups. Animal bite and non-bite accounted for 27% (n = 2239) and 16% (n = 1303) of rabies PEP, respectively, whilst 57% (n = 4773) of the PEP events had no recorded information about the reasons for post exposure treatment. Post exposure treatment was provided throughout the year with a higher number during the winter and spring months. The number of PEP events significantly (P < 0.001) increased between 2005 and 2008, from <1000 to >2800 events, respectively. Significantly (P < 0.001) more PEP events were reported from the southern parts of Bhutan that are endemic for rabies or those areas in eastern Bhutan that have reported rabies outbreaks than other parts of Bhutan. Forty percent (n = 3360) of the patients received an incomplete course of vaccine (<5-doses of vaccine intramuscular). Results suggest that patients with animal bite injury were less likely to receive an incomplete vaccine course than non-bite recipients, and patients presented to hospitals in rabies endemic or outbreak areas were less likely to receive an incomplete course than in non-rabies areas or rabies free areas. Similarly, patients presenting to hospitals for PEP during spring and summers months were less likely to receive an incomplete vaccine course than those during other seasons. Public education campaigns need to be conducted in Bhutan to reduce dog bite incidents and also to prevent mass exposures to rabies. A thorough assessment of each individual case based on the WHO guidelines would reduce unnecessary PEP (and therefore costs) in Bhutan.     

广东省云安县2004—2009年狂犬病流行病学分析

目的分析云安县狂犬病流行病学特征及其流行因素,为制定预防控制措施提供科学依据。方法采用描述性流行病学分析方法对云安县2004-2009年全县报告的狂犬病病例个案资料进行统计分析。结果云安县2004—2009年共发生报告狂犬病34例,全县8个镇中7个镇有病例报告,均在农村发病。发病时间以5、7、9、10、12月为主,占79.4%;男性多于女性,男女性别比为1.83:1;年龄分布以50岁以上居多,占58.8%,15岁以下儿童次之,占29.4%;职业分布以农民为主,占70.6%,学生次之,占26.5%;伤人动物中,以犬为主,占85.3%,猫次之,占11.8%;伤及部位以上肢为主,占58.8%,下肢次之,占23.5%;全部病例均没有规范处理伤口和狂犬病疫苗、抗毒血清(或免疫球蛋白)接种;潜伏期最短9d,最长3年,平均为98d;具有典型狂犬病临床症状,病程1～12d,34例全部死亡。结论云安县2004—2009年所发生34例狂犬病主要是由于疫情扩散、犬密度过高、犬类"管、免、灭"综合防治措施不到位、群众防控制意识不强和麻痹尧幸心理所引起的,今后防治对策主要是着力提高群众防控意识和建立政府主导的狂犬病防控长效机制。     

洛阳市狂犬病流行特征及防制措施探讨

目的：分析洛阳市2007-2013年狂犬病流行特征及流行影响因素,为制定狂犬病防控策略和防控措施提供科学依据。方法：对洛阳市2007-2013年狂犬病网络报告和个案调查资料进行统计分析。结果：洛阳市7年共报告狂犬病35例,年平均发病率0.0772/10万。患者年龄3-75岁,夏季发病率较高。狂犬病患者Ⅲ级暴露者30例,占85.71%;在35例患者中,有28例没有进行任何医疗预防处置,占74%;只有4例（11.42%）进行伤口清洗;只有3例（8.82%）患者在暴露后接种了狂犬疫苗。所有患者均未注射抗狂犬病免疫球蛋白。结论：应进一步加强狂犬病防治知识宣传,提高市民狂犬病防治知识知晓率,提高犬及宠物狂犬病免疫率,提高狂犬病暴露人群伤口规范化处理及狂犬疫苗、狂免蛋白注射比例。     

2002-2011年周口市狂犬病流行因素分析

目的分析2002-2011年周口市狂犬病流行特征及流行影响因素,为制定狂犬病防控策略和防控措施提供科学依据。方法对2002-2011年周口市狂犬病网络报告和个案调查资料进行统计分析。结果周口市10年共报告狂犬病183例,年平均发病率0.17/10万。患者年龄最小6个月,最大75岁,夏季发病率较高。狂犬病病人3级暴露者169例,占92.3%,患者被咬伤后只有5例(2.7%)病人伤口进行规范化处理,。只有4例(2.2%)患者在暴露后接种了狂犬疫苗。结论应进一步加强狂犬病防治知识宣传,提高市民狂犬病防治知识知晓率,提高犬及宠物狂犬病免疫率,提高狂犬病暴露人群伤口规范化处理及狂犬疫苗、狂免蛋白注射比例。     

2003-2010年江苏省沭阳县狂犬病疫情分析

目的 探讨狂犬病流行因素和制定有效防治措施.方法 对2003-2010年沭阳县狂犬病疫情进行统计学分析.结果 2003-2010年该县狂犬病累计发病60人,死亡60人,年均发病率为0.42/10万,病死率为100％.男女性患者分别为38、22人,性别比为1.73:1.年龄最小5岁,最大70岁,平均年龄38.36岁,以40 ～59岁年龄组为发病高峰,共24例,占发病总数的40.00％.职业以农民为主,共47人,占78.33％.夏秋季发病较多,合计37人,占61.66％.伤口及时和规范化处理0人,暴露前狂犬疫苗和抗狂犬病毒免疫球蛋白接种都为0人,暴露后接种狂犬疫苗的有12人,其中首针24 h内接种0人,3人完成全程接种,5人在接种完第4针后发病,4人在在接种完第3针后发病,其余48人未接种狂犬疫苗.结论 伤口处理不规范和疫苗接种率低下是导致发生狂犬病的主要原因.     

62例烧伤患者治疗费用构成分析

目的分析特定人群烧伤住院治疗及费用资料,为卫生决策、资源配置提供参考。方法排除工伤交通事故引起的烧伤,2012年,共收治烧伤患者62例,男性45、女性17例,年龄平均29.5岁（0.7-75岁、中位数29岁）。对62例患者伤情、住院时间、治疗费用分别进行整理。结果 62例患者,平均烧伤面积14.2%TBSA（1%TBSA~42%TBSA,中位数10.5%TBSA）。平均住院时间14.8天（3~48天,中位数13.5天）,治疗费用平均15 721元（1 145~61 111元,中位数9 374.5元）。每1%TBSA烧伤面积治疗费用为1 108元。住院时间是影响治疗费用的最主要因素,药物是住院费用中最主要部分,占31.9%。结论本组资料反映特定烧伤人群在区域性烧伤治疗中心的治疗及费用现状,减少住院天数、降低药品费用是控制治疗费用的关键。     

Five-year (January 2004-December 2008) surveillance on animal bite and rabies vaccine utilization in the Infectious Disease Hospital, Dhaka, Bangladesh

The magnitude of animal bite and utilization of rabies vaccine was determined at the Infectious Disease Hospital, Dhaka, Bangladesh. From January 2004 to December 2008, 150,068 patients with animal bite visited the hospital, 86.2% and 13.8% of them received nerve tissue and tissue culture vaccine (TCV), respectively. Dog bite was most frequent, found in 90.7% cases. In 794 rabies cases only 24.4% had a history of post-exposure vaccination. Only a negligible number of patients received rabies immunoglobulin (RIG). To prevent further human deaths and economic losses intra-dermal TCV regime and equine RIG should be immediately introduced in Bangladesh.     

Animal-associated injuries and related diseases among returned travellers: a review of the GeoSentinel Surveillance Network

BACKGROUND: Increased travel to exotic destinations around the world is escalating the risk of exposure to animal-associated injuries with a risk of acquiring rabies. METHODS: We have examined data reported to GeoSentinel Surveillance Network to highlight characteristics of animal-associated injuries in travellers. RESULTS: A total of 320 cases were reported from 1998 to 2005. Travellers were predominantly tourists from developed countries with median travel duration of 23 days. A pre-travel encounter was recorded in 45.0% of the cases. A significantly greater proportion of patients with animal-related injuries were female compared to other travel associated diagnosis (54.7% versus 47.4%) and were most likely patients aged <15 years (6.2% versus 2.6%). The proportionate morbidity for sustaining an animal bite was higher among travellers visiting Southeast Asia (3.9%) and the rest of Asia (2.2%) compared to Australia-New Zealand (1.9%), Africa (1.0%), Latin America (0.8%), North America (0.9%) and Europe (1.2%). Seventy-five percent of cases occurred in countries endemic for rabies. Dogs were involved in 51.3% of cases, monkeys in 21.2%, cats in 8.2%, bats in 0.7% and humans in 0.7%. The higher likelihood for animal-related injuries among female travellers was dependant on the animal species involved, with monkeys accounting for the majority of injuries. In contrast, males were more likely to be injured by dogs. Only 66.1% of all patients reported with animal-related injury received rabies post-exposure prophylaxis. CONCLUSIONS: This data shows that animal-associated injuries are not uncommon among returned travellers presenting to GeoSentinel sites. The highest proportion of injuries was recorded in travellers to Asia, mostly in regions, which are endemic for rabies, and this had led to a requirement for PEP.     

Epidemiology and molecular virus characterization of reemerging rabies, South Africa

The incidence of dog rabies in Limpopo Province, South Africa, increased from 5 cases in 2004 to 100 in 2006. Human rabies had last been confirmed in 1981, but investigations instituted after an index case was recognized in February 2006 identified 21 confirmed, 4 probable, and 5 possible human cases between August 5, 2005, and December 31, 2006. Twelve of these case-patients were identified retrospectively because the diagnosis of rabies was not considered: 6 of these patients consulted a traditional healer, 6 had atypical manifestations with prominent abdominal symptoms, and 6 of 7 patients tested had elevated liver enzyme activity. Molecular genetic analysis indicated that outbreak virus strains were most closely related to recent canine strains from southern Zimbabwe. Delayed recognition of the human cases may have resulted from decreased clinical suspicion after many years of effective control of the disease and the occurrence of atypical clinical presentations.     

Epidemiological study of a cohort of adult patients with Erythema migrans registered in Slovenia in 1993

Epidemiological characteristics of 892 adult patients with typical Erythema migrans (Em), registered at Lyme borreliosis Outpatients' Clinic, Department of Infectious Diseases, University Medical Centre Ljubljana, Slovenia, in 1993, are presented. Data were gathered prospectively by means of a questionnaire. All the patients were seen by at least one of the four authors of this report. There were 57% females and 43% males aged from 15 to 91 years (median value 44 years, mean 44.4 ± 14.3 years). The highest number of patients was found in age groups from 30 to 59 years. 73% of the patients quoted a tick bite at the site of later Em and 6% an insect bite; 21% didn't remember any bite. 212 out of 638 patients with a tick bite were able to assess the maximal possible duration of tick attachment: two-thirds quoted 24 hours or less. Interval from a tick bite to the appearance of skin changes was one day to six months (median value 15 days, mean 20.3 ± 20.6 days) and from the beginning of Em to registration one day to 10 months (median value eight days, mean 17.1 ± 24.2 days). More than half of the patients were registered in June, July and August. The majority of patients with Em resided in the region of Ljubljana. They were bitten by ticks predominantly near their homes but some of them also quite far away. Slovenia is an endemic region for Lyme borreliosis. The number of cases presented in our report is most likely only a fraction of the real number of patients with Em in the region of Ljubljana and is even further underestimated for other parts of Slovenia.     

2007-2015年云南省罗平县狂犬病监测分析

目的 分析云南省罗平县2007-2015年狂犬病监测结果.方法 采用资料分析法,整理罗平县9年的狂犬病疫情监测数据和病例流行病学调查资料,使用Excel 2007建立数据库,并使用SPSS 19.0进行数据处理和统计分析.结果 2007-2015年共报告狂犬病38例,累计发病率为6.55/10万,病死率为100%,发病率呈逐年下降趋势;狂犬病呈散发流行,地区差异较大,季节性强,有夏秋季高峰;发病年龄为36.16±24.68岁,男女性别比为2.45:1;94.70%的病例为被狗咬伤,57.90%是自家养的狗,暴露部位主要是手部(44.74%)和下肢(36.84%),65.80%的病例暴露程度为Ⅲ级,34.20%为Ⅱ级.52.60%的病例暴露后未进行任何处理,97.40%的病例未进行疫苗接种,100%没有接种免疫球蛋白.狂犬病潜伏期短,平均潜伏期为68.00±19.53天,不同年龄(χ2=23.055,P=0.042)和暴露部位(χ2=17.033,P=0.038)的潜伏期差异有统计学意义;发病急,发病到死亡时间平均为3.26±2.59天.结论 罗平县狂犬病呈散发流行,发病率有逐年下降的趋势.在暴露后及时、正确处理和疫苗接种率较低,需要加大健康教育力度,提高预防狂犬病的意识.     

2016-2018年兰州市狂犬病暴露人群流行病学分析

目的 了解 2016-2018 年7月兰州市狂犬病暴露人群流行病学特征,为狂犬病预防控制及暴露处置提供依据。方法 整理兰州市狂犬病暴露处置门诊暴露人群的就诊数据进行分析。结果 2016-2018年7月共报告37293例狂犬病暴露病例,男女性别比1.20∶1,平均年龄（32.19±19.01）岁,15~29岁组暴露人数最多;2016年和2017年暴露率分别为330.71/10万和405.57/10万,狂犬病暴露人数近年来呈上升趋势,季节分布主要以夏秋季(6-10月)为主(55.61%),峰值为7月;暴露地区以城区为主(81.91%);暴露分级中以Ⅱ级暴露21199例(56.84%)为主,接种程序以Essen程序为主,接种完成率逐年降低,全程规范接种率逐年升高,超期接种率逐年降低,Ⅲ级暴露者被动免疫试剂使用率为3.65%,且逐年增高;PEP起始时间符合规范的为94.16%,延迟天数分组中1~3天组最高。结论 兰州市狂犬病暴露人群年暴露率较高,处于暴露率较高地区,建议采取综合防控措施,降低狂犬病暴露率、提高疫苗接种率和被动免疫制剂的使用率,降低狂犬病发生风险。     

2004-2008年宁波市狂犬病流行因素分析

目的分析宁波市2004--2008年狂犬病流行因素,探讨有效防制措施。方法通过对宁波市发生的所有狂犬病病例的流行病学个案调查和全市犬密度及犬免疫状况调查;收集全市110家狂犬病门诊（暴露人群监测点）的数据进行分析。结果2004--2008年全市共报告狂犬病病例52例,年平均发病率0．16／10万,病死率为100％;全市8个县（市、区）均有病例报告,以慈溪市发病最多（28例）,占全市病例总数的53．85％;发病年龄最大80岁,最小3岁,儿童及青壮年发病较多;病例职业分布以农民（46．15％）为主,伤人动物全部为犬;伤口暴露部位以上肢（67．31％）为主,伤口暴露以Ⅲ度（76．92％）暴露为主,未进行伤口处理35例（67-31％）,未接种疫苗42例（80．77％）,10例接种疫苗者均未完成全程免疫。门诊暴露监测点显示暴露人群以农民为主;各月均有暴露者,以7—8月最多;最大年龄84岁,最小158d;暴露部位以上下肢为主（68．22％）,暴露咬伤程度以Ⅲ度为主（83．05％）;犬密度为42.39只／100户,犬的免疫率为9．62％。结论犬密度高,免疫率低,群众防病意识差,暴露后未进行规范的预防治疗,是宁波市人间狂犬病流行的主要因素。     

上海市嘉定区2005年被动物伤害人群的流行病学分析

[目的]分析嘉定区2005年被动物伤害人群流行病学特点和狂犬病防制存在的问题,提出狂犬病防制策略。[方法]收集嘉定区2005年犬伤门诊就诊登记和个案调查资料,对被动物伤害个案的流行病学资料进行统计分析。[结果]嘉定区2005年动物伤害发生率为41.05/万。咬伤部位以下肢最多(占49.58%),其次为上肢(占42.27%);10岁以下年龄组被动物伤害发生率最高,被咬伤头面部比例也最高(8.47%)。伤人动物以犬为主,伤人犬免疫率低(29.34%),人被动物伤害后及时就诊率和伤口处理率低。[结论]儿童、少年是被动物咬伤高危人群。大众缺乏狂犬病防范知识,犬的免疫接种率低,人被咬伤后处理不及时,因此,应加强犬、猫等动物管理,提高免疫接种率,开展狂犬病防治知识宣传。     

Current aspects of pediatric and adult tetanus in Dakar

OBJECTIVE: This retrospective study was undertaken to assess epidemiological and clinical aspects as well as outcome of tetanus cases in patients over 28 days of age, so as to issue recommendations. PATIENTS AND METHODS: This study included patients admitted to the Fann teaching hospital in Dakar from 2001 to 2003. Age, sex, portal of entry, clinical signs, delay from onset to admission, stage and outcome of the tetanus were recorded. RESULTS: 410 cases of tetanus were observed. The sex-ratio was 2.41. The mean age was 20 years [range 2 months-89 years]. Sixty-two percent of the patients were between six and 30 years of age. Most of the patients were workers and craftsmen (58%) or pupils (19%). A wound was the most frequent portal of entry (73%). Tetanus was localized in four out of 406 cases. The global mortality rate was 22%; but it was higher when tetanus was stage III and in case of complications. CONCLUSION: According to these results, it seems necessary to include booster doses in the Expanded Immunization Program, and to implement better prevention strategies targeting people not taken into account in this program. In addition, health care providers should check out the immunization status of their patients and accordingly offer an update or a full course of active immunization.     

2006—2011年广宁县狂犬病流行病学分析

目的分析广宁县2006—2011年狂犬病流行情况,为制定预防控制措施提供科学依据。方法用描述流行病学方法对广宁县2006—2011年报告的狂犬病资料进行统计分析。结果广宁县2006—2011年共报告狂犬病34例,死亡34例,病死亡率为100%。每年均有病例报告,年平均发病率为1.31/10万。34例病例均分布在农村,性别比为2.78∶1;发病年龄以50～59岁为主,占35.29%;其次为40～49岁和60～69岁,各占20.59%。职业分布以农民为主,占91.18%;其次为学生,占5.88%。发病时间以4—6月最多,共18例,占总发病人数的52.94%。83.25%的病例被犬只抓、咬伤或接触犬只感染病毒。58.82%的病例暴露后伤口未作处理或未及时正确处理。91.18%的病例未接种人用狂犬病疫苗。结论犬伤后患者的伤口未及时作规范处理、未接种人用狂犬病疫苗或同时使用抗狂犬病免疫球蛋白是广宁县狂犬病发病的主要原因。加强狂犬病预防知识特别是暴露处理知识的宣传,提高群众预防意识,是防制狂犬病的有效措施。