西安市6 635例狂犬病暴露者流行病学调查

目的 分析西安市2016-2017年来6 635例狂犬病暴露者流行特征,探讨相关危险因素,为狂犬病的防治提供依据。方法 对狂犬病暴露者按年龄、性别、职业、暴露时间、暴露地点、暴露动物、暴露部位、暴露级别和处置及发病情况等进行统计分析。结果 6-10月为狂犬病暴露高发季节,共暴露4 038例,占60.86%;犬和猫为主要致伤动物,占66.25%和30.49%;暴露男女比为1∶1.19;20~岁及10~岁年龄组暴露最多,占33.56%和16.38%;暴露者以自由职业者、学生及服务业从业者居多,分别占总26.36%、21.75%和15.33%;暴露地点主要在家中,占67.94%;暴露部位以上、下肢为主,分别占43.48%和38.63%;以III级暴露为主,占80.24%;暴露后规范处置率达100%,狂犬病疫苗接种率达100%,疫苗全程接种率为99.83%,III级暴露后被动免疫制剂注射率为52.95%。结论 西安市面临着严峻的狂犬病防控压力,其狂犬病暴露流行病学特征与周边地区及陕西省全省不尽相同,有自己的特点,应重点加强宠物犬猫的免疫与管理,消灭流浪犬猫;针对不同人群特点加强狂犬病预防及处置知识的健康教育,提高其预防意识和认知水平;进一步加强犬伤处置门诊规范化建设。     

河南省人间狂犬病流行特征与防控策略探讨

目的 总结和分析河南省人间狂犬病流行特征,探讨防控策略。方法 收集并整理河南省1951-2015年人间狂犬病疫情相关资料,对2007-2015年病例进行流行病学调查,用SPSS17.0建立数据库并进行统计分析。结果 河南省人间狂犬病上世纪80年代曾严重流行、90年代得到有效控制。本世纪初以来疫情上升明显,近10年又有下降趋势。病例以农村地区居民为主,男多于女,多为35-65岁组及15岁以下组人群。7-9月份是发病高峰期。豫东和豫南是人间狂犬病病例较为集中区域。病例平均潜伏期为60 d,平均病程为3 d。病例暴露后约45.9%未作任何伤口处理,76.5%未曾接种疫苗,伤口肉眼可见出血的占93.6%,抗狂犬病免疫球蛋白注射率仅为0.64%。传染源98.7%是犬只,其中非栓养犬占82.1%以上。犬只狂犬病毒感染率为0.63%~6.00%。农村地区犬只免疫率为0.64%,人犬比值平均为6.50。结论 河南省是狂犬病流行地区,应开展以农村地区为重点的综合防控。     

中山市狂犬病105例回顾性分析

目的收集105例狂犬病完整的流行病学个案资料,分析流行特征,为本市狂犬病的预防控制提供参考。方法病例个案资料录入Epidata数据库,并用spss11.0统计软件包进行分析。结果发病季节以7-12月份为高峰;男性明显多于女性,其发病比例为2.28∶1;职业以农民为主,占55.24%;本市人狂犬病病例传染源以家犬为主,占93.33%;暴露后伤口未作任何处理和接种疫苗的占63.81%,自行处理或不规范处理伤口和无及时接种疫苗的占20.00%,及时处理伤口并注射狂犬疫苗但发病的仅占病例数的7.62%。暴露后潜伏期最短13d,最长1153d,平均潜伏期78.56d。结论建议进一步加强犬类的"管、免、灭";加强宣传和健康教育,使人们在被带狂犬病毒的犬类咬伤后及时获得狂犬病暴露后的免疫预防;尽可能地对高危人群和高发地区开展暴露前免疫,降低狂犬病发病率。     

减毒狂犬病病毒CTN181-3株免疫学特性研究

目的 对本室研发的1株狂犬病减毒株CTN181-3的免疫学特性进行研究。方法 以小鼠和金黄地鼠为模型,口腔或肌肉免疫1次后考查暴露前免疫;以金黄地鼠为模型,肌肉免疫考查暴露后免疫。结果 CTN181-3株经小鼠和金黄地鼠分别口腔或肌肉免疫1次均能产生高滴度的中和抗体和良好的攻击保护效果;经小鼠口腔和肌肉免疫早期即开始产生细胞因子IFN-γ和IL-2,诱发有效的细胞免疫。以金黄地鼠为模型的暴露后免疫结-果显示:肌肉免疫1次的保护率为50%,而免疫2次的保护率可达100%。结论 CTN181-3株具有良好的体液免疫和细胞免疫保护效果,而且暴露后2次免疫不必接种免疫球蛋白即可达到100%有效保护,其免疫性强、保护效果好,是一种很有应用前景的狂犬病动物用候选疫苗株。     

广西1951-2010年狂犬病流行特征分析(英文)

总结和分析广西1951-2010年狂犬病流行情况,探讨疫情流行规律和发病特点,为狂犬病预防控制策略提供科学依据。[HTH]方法采用描述性流行病学方法对1951-2010年广西狂犬病疫情资料和病例个案表进行统计分析。[HTH]结果60年间广西共报告17 210例狂犬病病例,发病流行强度高,每隔10年左右出现1次流行高峰;疫源地流行范围逐年扩大,并呈现由北向南、由东往西扩散的趋势;病例主要分布在农村地区;犬为主要传染源,病例以头面部、上肢和Ⅲ级暴露为主;潜伏期平均为63 d;部分病例虽及时采取正确的暴露后预防处置,但仍然在免疫期间或全程接种后出现发病的现象,狂犬病暴露门诊监测点数据显示,接种后发病率为2.75/10万;2006-2010年外观健康犬脑狂犬病毒核酸阳性率为1.9%、0.93%、0.91%、0.40%和0.00%。[HTH]结论广西狂犬病疫情持续高发并呈周期性流行;犬密度高、免疫率低、外观健康犬只带毒率高、人群暴露率高、自我保护意识淡薄和接种疫苗费用高是狂犬病高发的重要因素;狂犬病自然疫源地的持续扩大蔓延、传染源源头管理不力和综合防制措施落实不到位,是近年我区狂犬病疫情回升的主要原因。加强组织领导和多部门合作,根据广西实际制订出更有针对性的综合措施并认真落实到位,才能有效控制广西狂犬病疫情高发态势。     

狂犬病疫苗接种人群中狂犬病病毒中和抗体水平分析

目的 通过分析狂犬病疫苗接种人群中狂犬病病毒RABV中和抗体特征,为狂犬病防控提供依据。方法 收集2019-2020年杭州市职业病防治院犬伤后暴露预防接种门诊抗体检测者信息,经筛选后确定157例RABV中和抗体检测者作为研究对象,采用快速荧光灶抑制试验检测狂犬病毒中和抗体,利用横断面研究方法对狂犬病毒中和抗体水平进行人群特征分析。结果 研究对象中,初种者98人,复种者59人,复种者中2-1-1程序比5针法产生的抗体水平更高,其余特征均无统计学差异(P>0.05)。除1例初种者中和抗体效价低于0.5 IU/mL,其余检测者中和抗体效价均高于0.5 IU/mL。狂犬病毒中和抗体水平时间趋势分析显示,狂犬病毒中和抗体水平与时间呈负相关,回归方程为(F=4.974,P=0.031),标准化回归系数为-0.322(t=-2.230,P=0.031)。结论 复种者狂犬病毒中和抗体水平与免疫程序有关,2-1-1程序对人体再次免疫应答的效果优于5针法。接种疫苗2年后部分个体出现失保护状态,再次暴露有必要全程接种狂犬病疫苗。     

湖南省68 例狂犬病暴露处置失败病例分析

目的 分析湖南省狂犬病暴露后处置失败的原因，为做好狂犬病的防控提供科学依据。 方法 采用回顾性调查方式收集湖南省 ２００７ ～ ２０１８ 年 ６８ 例狂犬病暴露处置失败病例信息，采用 Ｅｐｉｄａｔａ ３． １ 软件 录入数据，并运用 ＳＰＳＳ ２０． ０、Ｅｘｃｅｌ 进行数据统计分析。 结果 ８６． ７６％ 的病例在暴露后进行了冲洗，其中仅 ７ 例冲洗时间为 １５ ｍｉｎ 及以上；暴露部位主要是头面及颈部（３６ 例），其次是手部（１３ 例），下肢膝以下有 ９ 例，下肢膝以上 ６ 例，其他 ４ 例；在乡镇卫生院及村卫生室、县级医疗机构、市级及以上医疗机构进行就诊的 病例分别占 ５８． ８２％ ，２７． ９４％ 和 １３． ２４％ ，５０％ 的病例注射了狂犬病免疫球蛋白。 １０． ２９％ 的病例接种的疫 苗在别处购买，或将其带回家接种，有 ８８． ２４％ 的病例采用 ５ 针法接种，其中仅有 ２５％ 的病例全程完成了接 种。 有 １１． ７６％ 的病例采用了 ２ － １ － １ 针法接种，其中仅有 １２． ５％ 的病例全程完成了接种。 结论 加大狂犬 病防控知识宣传力度，提高狂犬病暴露后规范处置水平，规范狂犬病疫苗流通渠道，进一步规范养犬，可降 低狂犬病暴露处置失败率。     

狂犬病潜伏期及其影响因素的分析

目的分析并探讨狂犬病潜伏期及影响因素。方法收集并整理2004-2009年河南省468份狂犬病个案调查资料,对病例潜伏期及其可能影响因素通过SPSS15.0统计软件进行统计描述、单因素和多因素分析,并建立影响因素的回归模型方程。结果狂犬病潜伏期呈正偏态分布,其偏度为5.047,峰度为31.099。狂犬病潜伏期最短为4d,最长为2,465d,平均潜伏期（中位数）为60d。单因素秩和检验显示年龄、暴露方式、暴露程度、暴露部位、伤口处理、伤口处理地点、伤口是否冲洗、是否消毒、是否接种疫苗、肇事动物管理、动物伤人原因11个因素有统计学意义。多因素Cox回归分析显示暴露部位、年龄2个因素有统计学意义。结论狂犬病潜伏期呈正偏态分布。狂犬病例暴露部位、年龄是影响潜伏期的重要因素。     

120例狂犬病暴露患者预防失败原因分析

目的探讨狂犬病暴露患者预防失败原因,改进预防措施、降低狂犬病暴露患者的死亡率。方法选取2004～2019年在广西梧州市第三人民医院被确诊为狂犬病死亡的120例患者为研究对象,通过调查病案资料,分析患者的流行病学史、动物致伤史、致伤动物种类、致伤部位、伤口情况、伤口处置和免疫等情况,发现患者在暴露前、被动物致伤后的伤口处置及免疫预防等环节存在的问题。结果 120例狂犬病患者中,男性、居住农村、文化水平较低者居多;明确有动物致伤史患者共89例,伤口达Ⅲ级暴露占94.38%,犬类致伤占92.13%,其中60.67%的患者伤口未做任何处置,77.53%的患者被动物致伤暴露后未接种狂犬疫苗,全部患者暴露后不能按"即刻规范处置伤口+Ⅲ级暴露者注射狂犬病被动免疫制剂+接受全程标准接种狂犬疫苗"的模式进行预防。结论民众预防狂犬病意识薄弱,在暴露前预防、暴露后伤口处置、注射狂犬疫苗和狂犬病被动免疫制剂的各个环节均存在严重缺陷,是导致狂犬病暴露患者预防失败的主要原因。普及狂犬病预防常识,加强相关宣传教育,尤其是提高农民的狂犬病防护意识和自救常识仍应作为相关部门的重点工作来抓。     

狂犬病29例临床分析

目的探讨狂犬病的防治措施,以期降低发病率。方法对绵阳市404医院2007年7月-2010年7月收治的29例狂犬病患者的临床资料进行回顾性分析。结果2007年7月-2010年7月,共收治29例狂犬病患者,男女之比1.9∶1,平均年龄49.34±17.78岁,以农民为主,占86.21%。96.55%的病例有狂犬病典型症状。实验室检查发现患者存在多器官功能损害,表现为心肌酶学升高,肝脏酶学升高,心电图异常。从发病到死亡时间1~6d。潜伏期长短与暴露部位及数量有一定相关性。24.14%的患者到医院处理伤口,10.34%病例暴露后接种狂犬疫苗,仅有6.9%病例接种了抗狂犬免疫球蛋白。结论预防处置率低,未按要求进行暴露后的预防处置,是造成狂犬病发生的重要原因之一。加强犬只管理,狂犬病预防知识的宣教和暴露后规范预防措施是防治狂犬病的重要措施。     

Epidemiology and prevention of animal bite and human rabies in a rural community-One health experiment

ObjectiveTo estimate the incidence of human rabies and animal bite/exposure; to describe the post exposure prophylaxis received by animal bite/exposure cases; to assess the safety and immunogenicity of rabies vaccine (purified chick embryo cell vaccine) administered as pre-exposure vaccination for school children and risk groups by intradermal route in the rural community and to demonstrate a decrease in the incidence of human rabies and animal bite/exposures through implementation of one health experiment.MethodsThis prospective interventional study was conducted over a period of 2 years (December 2009-November 2011) in a rural area near Bangalore, Karnataka, South India and consisted of six villages (project villages), three villages were identified as study villages with active interventions (Implementation of rabies awareness activities, post exposure prophylaxis, pre-exposure intradermal rabies vaccine) and three villages as control villages without any active interventions.ResultsA majority of the animal bite cases were category III exposures and all of them had received rabies immunoglobulin and anti-rabies vaccine as per WHO recommendation. A majority received 3 to 5 doses of vaccine. Three hundred and sixty eight subjects had received pre-exposure intradermal rabies vaccination thrice on days 0, 7 and 28 d.ConclusionsNo human rabies case was reported during the study period and there was 30% decrease in animal bite/exposure cases in study villages after the one health experiment project was implemented. Pre-exposure vaccination was safe and immunogenic.     

狂犬病潜伏期及病例暴露后生存与风险变化的Cox回归分析

目的分析和探讨狂犬病潜伏期及病例暴露后生存与风险随时间变化的特点。方法对2004—2009年河南省狂犬病病例进行流行病学调查,用SPSSl5．0建立数据库,进行Cox回归等统计分析。结果狂犬病潜伏期为正偏态分布,调查显示平均潜伏期为60d。病例暴露后总的生存率变化趋势是,40d时病例累计生存率约为50％,60d时累计生存率约为35％,80d时累计生存率约为10％,120d时的累计生存率几近为零。累计风险量随暴露后时间逐渐增高,120d时达到风险高峰,之后形成一风险平台。暴露后60d以内男性病例累计生存率要高于女性病例,60d以后则低于女性。个案调查资料分析结果显示,在暴露后50d以内,男性累计生存率均高于女性,且30d以内差异有显著性（P〈O．05）。50d之后,男性累积生存率逐渐低于女性,第70d时差异有显著性（P〈O．05）。结论狂犬病潜伏期为正偏态分布,病例暴露后120d时发病累积风险达到最高,且60d内女性发病风险高于男性。     

人用狂犬病疫苗肌肉注射免疫程序研究进展

狂犬病尚无有效治疗方法,其预防措施主要为暴露前或暴露后接种人用狂犬病疫苗。随着狂犬病疫苗生产工艺的发展,疫苗质量不断提高,其免疫程序也在不断改进。目前,国内普遍采用肌肉注射方法进行狂犬病疫苗接种,暴露前免疫程序为在第0、7、21或28天(0、7、21或28 d)各注射1剂疫苗;暴露后免疫程序为5针法和2-1-1法,再暴露免疫程序则根据第1次暴露后免疫后间隔时间的不同,接种不同剂次的疫苗。2018年《狂犬病疫苗:WHO立场文件》根据狂犬病研究的最新进展,对狂犬病暴露预防免疫程序进行了简化。本文将在新立场文件的基础上,对国内外狂犬病暴露预防处置程序研究进展进行总结,并就我国狂犬病疫苗免疫程序与新立场文件倡导的免疫程序间存在的差异及改进方案加以讨论。     

Molecular epidemiology of pneumococci obtained from Gambian children aged 2–29 months with invasive pneumococcal disease during a trial of a 9-valent pneumococcal conjugate vaccine

Background

Rabies is a major public-health problem in developing countries such as China. Although the recent re-emergence of human rabies in China was noted in several epidemiological studies, little attention was paid to the reasons behind this phenomenon paralleling the findings of the previous reports. The purpose of this study is thus first to characterize the current trends of human rabies in China from 1990 to 2007, and then to define better recommendations for improving the post-exposure prophylaxis (PEP) schedules delivered to rabies patients.

Methods

The most updated epidemiological data for 22527 human rabies cases from January 1990 to July 2007, retrieved from the surveillance database of reportable diseases managed by the Ministry of Health of China, were analysed. To investigate the efficiency for the post-exposure treatment of rabies, the details of 244 rabies patients, including their anti-rabies treatment of injuries or related incidents, were ascertained in Guangdong provincial jurisdiction. The risk factors to which the patients were predisposed or the regimens given to 80 patients who received any type of PEP were analysed to identify the reasons for the PEP failures.

Results

The results from analysis of the large number of human rabies cases showed that rabies in China was largely under control during the period 1990–1996. However, there has been a large jump in the number of reported rabies cases since 2001 up to a new peak (with an incidence rate of 0.20 per 100000 people) that was reached in 2004, and where the level has remained until present. Then, we analysed the PEP in 244 rabies cases collected in the Guangdong province in 2003 and 2004, and found that 67.2% of the patients did not seek medical services or did not receive any PEP. Further analysis of PEP for the 80 rabies patients who received any type of PEP indicated that almost all of the patients did not receive proper or timely treatment on the wounds or post-exposure vaccination or rabies immunoglobulins.

Conclusion

While the issue of under-reporting of rabies in previous years may well be a factor in the apparent upwards trend of human rabies in recent years, the analysis of PEP in the Guangdong province provides evidence that suggests that the failure to receive PEP was a major factor in the number of human cases in China. Thus, the data underline the need for greatly improved availability and timely application of high-quality anti-rabies biologicals, both vaccines and immunoglobulins, in the treatment of human bite victims. Controlling dog rabies through pet vaccination schemes may also play a huge role in reducing the rate of human exposure. Education of the public, health care staff and veterinarians will also help to change the current situation.     

Immunoprophylaxis against rabies

Rabies is responsible for a large extent of morbidity and mortality in human beings. However, the long incubation period of the disease allows the effective utilization of post exposure immunization. Till recently neural tissue vaccines were the mainstay of antirabic immunoprophylaxis. These vaccines are, associated with severe neuroparalytic complications. The recent introduction of human diploid cell vaccine and chick embro fibroblast vaccines have heralded a new era in antirabic vaccination because of their high immunogenicity and lack of major side effects.     

Rabies in France: an update

INTRODUCTION: In 1996, rabies was responsible for more than 35,000 deaths worldwide. Three cases of human rabies that had been contracted abroad were diagnosed in France during the same year. Cases notified in 1997 followed exposure outside the country. Fox, bat, and dog rabies are reviewed on the basis of the latest epidemiological data obtained in France. CURRENT KNOWLEDGE AND KEY POINTS: Two cases of fox rabies diagnosed in 1998 occurred at the border between France and Germany, thus preventing five French departments bordering Germany from being officially declared rabies-free in 1999. The campaigns for oral immunization of foxes that are led since 1986 are responsible for the decrease in rabies incidence. Though not well known, bat rabies is a reality in France, involving either European virus strains (five cases all over the country) or African virus strains that are carried along by imported tropical bats. Dogs rabies is also today an imported disease. FUTURE PROSPECTS AND PROJECTS: The decrease in risk for rabies has resulted from the conjunction of multiple efforts: extensive programs aimed at oral vaccination of foxes in France and its neighboring countries, efficient epidemiological survey, sanitary controls at borders, ban on importing tropical bats. Furthermore, recommendations for preventive pre-exposure immunization have recently been changed, leading to modifications of the French licensing form.