广西狂犬病流行特征及部分地区动物致伤人群的暴露处置和效果研究

发布时间：2018-03-28 19:31

本文选题：狂犬病　切入点：流行特征　出处：《广西医科大学》2017年硕士论文

【摘要】：目的:1.描述分析2006-2016年广西狂犬病流行特征2.分析广西钦州市、防城港市动物致伤人群流行特征和暴露后预防处置的情况3.评价广西狂犬病防控措施的防控效果并提出狂犬病的防控策略和建议方法:1.流行特征分析:整理中国疾病预防控制信息系统中狂犬病报告信息,统计分析2006-2016年广西狂犬病发病率、构成比等描述性指标和广西狂犬病三间分布特征。2.动物致伤人群的调查:广西钦州市、防城港市分别选择一所市级疾控中心的预防门诊,采用描述统计学方法分析动物致伤人群的三间分布的特征、致伤部位和致伤动物特征,以及门诊就诊者暴露后预防处置情况。3流行病生态学研究:广西狂犬病高、中、低发区分别抽取3个市(贵港市、玉林市和崇左市),并对其所有新农合机构、各级疾病预防控制中心和犬伤处理门诊、农业畜牧兽医部门进行问卷调查。研究指标包括狂犬病疫苗、被动免疫制剂报销的金额以及报销人次数、狂犬病疫苗和狂犬病被动免疫制剂的使用量、犬伤处理门诊就诊人次数、犬只的免疫密度、兽用疫苗使用量。分析三市狂犬病发病率与相关因素的相关性,采用双变量的相关分析狂犬病发病率与各个变量间的关系。对双变量均属于正态分布,采用pearson相关分析,对于变量不符合正态分布,采选用spearman秩相关分析。结果:1.总发病情况及构成。2006-2016年广西壮族自治区狂犬病各年报告的总发病人数分别为518例、493例、372例、324例、303例、286例、227例、163例、125例、111例、56例。年发病率分别为1.112/10万、1.045/10万、0.780/10万、0.673/10万、0.624/10万、0.621/10万、0.488/10万、0.348/10万、0.265/10万、0.234/10万、0.117/10万。11年间共报告狂犬病2978例,占所有法定传染病的比重为0.07%,占乙类传染病的比重为0.17%。死亡2975例,病死率为99.96%。2.三间分布情况。从时间分布看,2006-2016年,广西狂犬病全年均有发病报告,呈现逐年下降的趋势。尤其是2013年广西将狂犬病暴露后处置费用纳入新农合后,2013-2016年狂犬病发病数比2009-2012年下降60.94%。7-10月为发病高峰期。从地区分布看,狂犬病的流行地区明显缩小,有狂犬病报告的县(区)数逐年明显下降,广西狂犬病高发区流行强度不断下降。以玉林市、柳州市、崇左市降幅较大。从人群分布看,男女发病性别比例为2.61:1,农民、学生和散居儿童是狂犬病高发人群。3.2016年钦州、防城港市动物致伤人群流行特征及犬伤门诊暴露后处置情况。时间分布均呈现夏秋季高发。人群分布以青壮年和婴幼儿发生的例数较高,且男性远高于女性。致伤的部位主要下肢为主,其次为手部,与狂犬病的发病特征一致。防城港市就诊者暴露分级主要以Ⅱ度为主,钦州市以Ⅲ度为主,防城港市疫苗全程接种的水平高于钦州(χ2=33.06,p0.05),2016年两市Ⅲ度暴露被动免疫制剂注射率在70%-80%。4.广西狂犬病防控效果分析。对贵港市、玉林市和崇左市的流行病生态学研究显示:自2013年狂犬病暴露暴后处置费用纳入新农合,狂犬病报销金额、犬伤门诊就诊人次和狂犬病疫苗的使用量都有大幅提升。其中崇左市疫苗使用率和被动制剂使用率明显高于贵港市和玉林市(χ2=12.45,p0.05;χ2=8.67,p0.05),并与狂犬病发病负相关(r=-0.624,p0.05)。11年间崇左市犬免疫密度为92.56%,钦州市和贵港市犬免疫密度分别为66.56%、65.39%。5.狂犬病相关因素。本研究对2009-2016年贵港市、玉林市和崇左市狂犬病发病率与相关因素的多重线性回归分析,狂犬病疫苗的使用率和犬只免疫密度与狂犬病发病率成负相关。结论:1.2006-2016年,广西狂犬病发病率从1.114/10万下降到0.117/10万。尤其是狂犬病疫苗纳入新农合后,狂犬病的发病率下降明显,狂犬病流行区域也明显缩小。狂犬病发病有明显的季节性,每年7-10月份发病高峰期。狂犬病高危职业人群为散居儿童和青壮年,且男性发病高于女性。2.广西犬只免疫率已逐渐达到或接近70%免疫屏障水平,提高犬只免疫水平是预防狂犬病根本措施,可以有效遏制广西人间狂犬病的流行。3.狂犬病疫苗的使用率和犬只的免疫密度与狂犬病发病率成负相关。4.结合本研究结果及广西实际情况提出以下防控策略:(1)加强犬类管理,提高犬只免疫密度;(2)提高暴露后及时正确处置率和免疫接种水平;(3)完善联防联控机制,建议广西建立多部门参与的狂犬病防控联席会议制度,强化信息沟通机制,提高各部门防控水平,不断使联防联控机制高效化和长效化。
[Abstract]:Objective: to describe the epidemiological characteristics of rabies in Guangxi 1. 2006-2016 2. year analysis of Guangxi Qinzhou City, Fangchenggang City, the epidemic characteristics of injury caused by animal population and prevention treatment after exposure of 3. Guangxi rabies prevention and control measures of the evaluation of control effect and proposed control strategies and suggestions: 1. analysis methods of rabies epidemic characteristics: Chinese disease prevention and control of rabies consolidation report information in information system, statistical analysis of 2006-2016 years the incidence of rabies in Guangxi, which hurt the crowd caused Descriptive Index and distribution characteristics of rabies in Guangxi three.2. animal investigation ratio: Guangxi Qinzhou City, prevention clinic in Fangchenggang city were selected in a municipal CDC, used to describe the distribution of three statistical methods to analyze the injury characteristics of the animal population, injury and injury characteristics of animal, and outpatient post exposure preventive treatment of.3 epidemic ecology Study on rabies in Guangxi: high, low incidence areas were selected in 3 cities (Guigang City, Yulin city and Chongzuo city), and all of its medical institutions at all levels of the Centers for Disease Control and prevention and treatment of dog injury clinic, animal husbandry and Veterinary Department of agriculture conducted a questionnaire survey. The indicators included rabies vaccine, passive immunization reimbursement the amount of reimbursement and the number of people, use of rabies vaccine and rabies passive immunization, treatment clinic number of injured dogs, dogs immune density, veterinary vaccine usage. Correlation analysis of three rabies incidence rate and related factors, correlation analysis using bivariate relationship between the variables and the incidence of rabies. For two variables belong to normal distribution, using Pearson correlation analysis, the variables do not accord with normal distribution, mining using Spearman rank correlation analysis. Results: the total incidence of 1. and.2006-2016 The total incidence of rabies in the Guangxi Zhuang Autonomous Region each year report were 518 cases, 493 cases, 372 cases, 324 cases, 303 cases, 286 cases, 227 cases, 163 cases, 125 cases, 111 cases, 56 cases. The annual incidence rate was 1.112/10 million, 1.045/10 million, 0.780/10 million, 0.673/10 million, 0.624/10 million, 0.621/10 million, 0.488/10 million, 0.348/10 million, 0.265/10 million, 0.234/10 million, 0.117/10 million.11 total of 2978 cases of rabies, accounting for the proportion of all infectious diseases was 0.07%, 2975 cases of class B infectious diseases accounted for 0.17%. of death, the mortality rate was three. The distribution of 99.96%.2., distribution from time 2006-2016 in Guangxi, the incidence of rabies throughout the year, showing a declining trend. Especially in 2013 Guangxi will post exposure treatment costs included in the new rural cooperative after 2013-2016 years the incidence of rabies ratio declined for 2009-2012 years in 60.94%.7-10 months is the peak incidence. From the perspective of regional distribution. The dog disease epidemic area was significantly reduced, there are reports of rabies county (District) number decreased year, a high incidence of rabies epidemic in Guangxi. Strength decreases in Yulin City, Liuzhou City, Chongzuo City, a larger decline. From the view of the distribution of population, the proportion of men and women of sex is 2.61:1, farmers, students and children is the high incidence of rabies Qinzhou.3.2016, Fangchenggang city animal injury population and epidemic characteristics of rabies clinics after exposure to disposal. Time distribution showed a higher incidence in summer and autumn. The population distribution in young infants and the number of cases is higher, and the male is much higher than that of women. The main parts of lower limb injury, followed by hand, consistent with the onset of the characteristics of rabies. Fangchenggang city were exposed to graded mainly in the second degree, Qinzhou city in Fangchenggang city of the main vaccine vaccination levels higher than Qinzhou (2=33.06, P0.05), in 2016 two, III The degree of exposure to passive immunization injection rate analysis of 70%-80%.4. in Guangxi. The effect of rabies prevention and control in Guigang City, epidemic ecological research on Yulin city and Chongzuo city shows that since the storm after the disposal expenses included in the new rural cooperative medical exposure to rabies in 2013, rabies outpatient reimbursement amount, amount of dog injury attendances and rabies vaccines have increased dramatically. The use of Chongzuo City, the vaccine rate and passive preparation was significantly higher than that of Guigang City and Yulin city (x 2=12.45, P0.05; X 2=8.67, P0.05), and the incidence of rabies negative correlation (r=-0.624, P0.05).11 Chongzuo from canine immune density was 92.56%, the city of Qinzhou and Guigang City dogs immune density were 66.56%, 65.39%.5. related factors rabies. This study of Guigang City, 2009-2016 years, multiple linear and related factors in Yulin city and Chongzuo City, the incidence of rabies regression analysis, rabies vaccine usage and dogs The immune density and the incidence of rabies was negatively correlated. Conclusion: 1.2006-2016 years, Guangxi rabies incidence decreased from 1.114/10 to 0.117/10 million million. Especially the rabies vaccine included in the new rural cooperative, rabies incidence rate decreased significantly, the rabies epidemic region is also significantly reduced. Rabies incidence has obvious seasonal, annual 7-10 month peak incidence. Rabies occupation high risk population for children and young adults, and the incidence was higher in male than female.2. Guangxi dog immunization rate has gradually reached 70% immune barrier, improve immunity level is the fundamental measures for the prevention of canine rabies, can effectively curb the epidemic of human rabies in Guangxi.3. rabies vaccine usage and dog immune density and the incidence of rabies.4. was negatively correlated with the results of this study and the actual situation of Guangxi and put forward the following strategy: (1) to strengthen the dog management. High density dog immunization; (2) increase after exposure to timely and correct disposal rate and immunization level; (3) improve the joint prevention and control mechanism, establish multi sectoral joint meeting system of rabies prevention and control in Guangxi, strengthen the information communication mechanism, improve the level of prevention and control departments, joint prevention and control mechanism, and long-term..

【学位授予单位】：广西医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R512.99;R181.3

【相似文献】