安徽省70例狂犬病暴露后免疫失败流行病学分析

目的 分析狂犬病暴露后免疫失败个案,探讨免疫失败的原因。方法 收集整理安徽省2005-2016年70例狂犬病暴露后免疫失败个案资料,使用Epi Data3.1软件录入数据,用SPSS 22.0软件对数据进行统计分析。结果 65.71%病例暴露后均能在24 h内赴医疗机构进行伤口的冲洗和消毒。81.43%的病例未全程接种疫苗,其原因主要是存在侥幸心理,不愿继续接种疫苗,抗血清使用率2.86%。48.57%的病例在非暴露后门诊进行处置。潜伏期中位数40 d (最短9 d,最长10.5年),暴露于头颈部的病例潜伏期较短,不同咬伤部位之间的差异有统计学意义(χ²=25.01,P<0.01)。结论 建立狂犬病暴露后补偿机制,规范狂犬病疫苗流通渠道,打击非法及伪劣产品,加强狂犬病暴露后处置门诊医疗人员的技能培训,提高公众知信行,是预防人间狂犬病暴露后免疫失败的关键。

Epidemiological analysis of immune failure in 70 cases of rabies in Anhui Province,China

We analyzed the causes of the failure of immunity after the failure of immunization in the case of rabies exposure and provided evidences for control and prevention of rabies among human beings. Data from 70 questionnaires for human rabies cases reported during 2005-2016 in Anhui Province were entered into Epidata3.1 to build a data-base. SPSS 22.0 was used for statistical analysis. Among these cases, 65.71% received treatment from medical institutions in 24 hours after exposure. 81.43% did not get full-access vaccination, and the main reason was that they had fluke mind and were unwilling to complete the vaccination. The usage rate of antiserum immunoglobulin was only 2.86%. The 48.57% did not get treatment in rabies post-exposure outpatient. The median of rabies incubation period was 40 d (the shortest period was 9 days, the longest was 10.5 years). It was statistically significant of the difference between exposure position and rabies incubation (χ²=25.01, P<0.01). The key to prevent human rabies and post exposure immunization failure were establishing rabies post exposure compensation mechanism, regulating the circulation of rabies vaccine to combat illegal and counterfeit products strengthening exposure to rabies after disposal of outpatient medical staff skills training and increasing public knowledge, attitude and practice.