2015—2024年浙江省湖州市狂犬病暴露处置与流行特征分析

Analysis on exposure disposal and epidemiological characteristics of rabies in Huzhou, Zhejiang Province from 2015 to 2024

  • 摘要: 【目的】 分析2015-2024年浙江省湖州市狂犬病暴露流行特征与预防处置现状,为完善狂犬病防控策略提供参考。【方法】 收集该市各区县犬伤门诊上报的暴露人群汇总数据及病例个案资料,对暴露人群的时间、地区分布及暴露特征进行描述性流行病学分析,暴露率的时间趋势采用Joinpoint回归模型进行分析,构成比的趋势变化采用卡方趋势检验,对狂犬病病例进行个案分析。【结果】 十年间共报告暴露者510 653例,年均暴露率1 619.89/10万,Joinpoint回归显示2015-2018年暴露率快速上升,2018-2021年显著下降,2021-2024年再度回升。暴露呈夏秋季高峰,7-8月为峰值,合计占21.83%,冬季为低谷,12月及1-2月分别占6.1%、5.7%和6.3%。地区以安吉县暴露率最高(1 814.49/10万),南浔区最低(1 443.15/10万)。致伤动物以犬为主(65.67%),猫致伤占比逐年上升(P<0.001)。暴露部位以上肢和下肢为主,分别占51.35%和43.27%,上肢、躯干、头面部暴露构成比均呈上升趋势(P<0.001)。暴露分级以Ⅱ级(66.05%)和Ⅲ级(31.55%)为主,III级暴露构成比呈上升趋势(P<0.001)。Ⅲ级暴露人群狂犬病被动免疫制剂使用率为21.38%,呈上升趋势(P<0.001)。共报告狂犬病病例9例,均为男性,农民占66.67%,所有病例均未接受规范处置与全程免疫。【结论】 湖州市狂犬病暴露率呈上升趋势,夏秋季高发,犬致伤为主,猫致伤构成比持续增长,Ⅲ级暴露人群被动免疫制剂使用率偏低,建议加强犬伤门诊规范化管理,规范犬猫致伤处置流程,提高被动免疫制剂可及性,加强农村地区宣教,并强化多部门协作推进动物源头免疫,以降低狂犬病发生风险。

     

    Abstract: Objective To analyze the epidemiological characteristics and prevention and treatment status of rabies exposure in Huzhou, Zhejiang Province from 2015 to 2024, and to provide references for improving the rabies prevention and control strategies. Methods The aggregated data of exposed individuals reported by the dog bite clinics in each district and county of the city, as well as the case-specific information, were collected. Descriptive epidemiological analysis was conducted on the temporal and regional distribution of the exposed population and their exposure characteristics. The time trend of the exposure rate was analyzed using the Joinpoint regression model, the trend change of the composition ratio was tested using the chi-square trend test, and individual case analysis was performed for rabies cases. Results Over a period of ten years, a total of 510,653 cases of exposure were reported, with an average annual exposure rate of 1,619.89 per 100,000 people. The Joinpoint regression analysis showed that the exposure rate increased rapidly from 2015 to 2018, decreased significantly from 2018 to 2021, and then rose again from 2021 to 2024. The exposure rate showed a peak in the summer and autumn seasons, with the peak occurring in July and August, accounting for 21.83% in total. Winter was the low season, with 6.1%, 5.7%, and 6.3% in December, January, and February respectively. The exposure rate was the highest in Anji County (1,814.49 per 100,000 people), and the lowest in Nanxun District (1,443.15 per 100,000 people). The main cause of injury was dogs (65.67%), and the proportion of cat injuries increased year by year (P<0.001). The exposed areas were mainly the upper and lower limbs, accounting for 51.35% and 43.27% respectively. The proportions of exposure to the upper limbs, trunk, and head and face all showed an upward trend (P<0.001). The exposure grades were mainly grade II (66.05%) and grade III (31.55%), and the proportion of grade III exposure showed an upward trend (P<0.001). The rate of passive immunization with rabies vaccine for the population with grade III exposure was 21.38%, showing an upward trend (P<0.001). A total of 9 cases of rabies were reported, all of which were male. Farmers accounted for 66.67% of the cases. All cases did not receive standardized treatment and full immunization. Conclusion The rabies exposure rate in Huzhou is on the rise, with a peak in the summer and autumn seasons. Dog bites are the main cause, and the proportion of cat bites has continued to increase. The passive immunization rate for the population with grade III exposure is low. It is recommended to strengthen the standardized management of dog bite clinics, standardize the disposal procedures for dog and cat bites, improve the accessibility of passive immunization preparations, strengthen education in rural areas, and enhance multi-department collaboration to promote animal source immunization to reduce the risk of rabies occurrence.

     

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