暴露后免疫失败狂犬病病例原因分析

目的分析18例暴露后免疫失败狂犬病病例发病因素。方法从暴露后局部伤口处理、抗血清的应用、免疫疫苗、伤口部位、潜伏期等因素进行统计分析,并以未免疫组狂犬病病例做对比。结果18例暴露后免疫失败病例,分布在农村乡(镇),年龄从2～83岁各个年龄组,男女性别比1∶0.8,短潜伏期(28天内)占77.8%(14/18);咬伤部位头颈部61.5%、手及手臂伤30.8%;其中头颈部位短潜伏期占91.7%(10/12);暴露后到乡、镇医院处理伤口的9例(50.0%),仅有1例使用人抗狂犬病病毒血清,疫苗种类国产地鼠肾(5例)和Vero(8例)精制苗,另5例国产苗种类不详。结论强化犬类等动物管理和免疫,在疫区应用暴露前免疫,是减少短潜伏期发病的最有效途径;同时暴露后的正确处理和抗狂犬病毒血清或免疫球蛋白的肌内注射(包括局部浸润注射)、高效价疫苗的应用,是减少暴露后免疫失败的关键。

After Exposure Analysis the Reason to the Immune Unsuccessful Rabies Cases

Objective To analyze the immunization failure factors of 18 exposed rabies.Methods A statistical analysis factors is based on processing the exposed local wounds, the application of anti-serum, vaccines, wound area, incubation period, and compared to immune cases. Results Eighteen people, exposed immunization failure cases, scattered in the rural area(town). Thire age distribution is in all age groups during 2~83 years old and sex ratio of the men and women is 1:0.8.The short incubation period(28 days) accountered for 77.8%(14/18);Among by 61.5% people was bitten in neck accounter for 91.7%(10/12);Nine cases went to the village and town hospital to deal with the wound ,but only one case used rabies virus serums. Vaccines made in China are rat kidney(five cases) and refined Vero(8 cases), at the sane time the other five types made in China were unkown. Conclusions The most effective way to reduce the incidence of short incubation period is to strengthen management and immunization of animals such as dog, and to apply exposed former immunization in the epidemic area. At the same time, the key to reduce exposed immunization failure is exposed dealing in right ways, the muscle injection with anti-virus serums or immune globulin, and application of vaccine.