Epidemiological characteristics and change trend of human rabies onset and exposure in Guangdong, 2006-2019
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摘要:
目的 分析广东省人群狂犬病发病与暴露流行特征及其变化趋势，为广东省防控狂犬病提供决策依据。 方法 应用描述性流行病学方法分析2006―2019年广东省狂犬病病例及暴露人群特征；采用Joinpoint回归模型分析狂犬病发病和暴露特征变化趋势。 结果 广东省2006―2019年狂犬病年均发病率为0.17/10万，年发病率呈下降趋势，平均年度变化百分比(average annual percentage change, AAPC)为-26.15%(95% CI: -31.81%~-20.02%)。狂犬病年均暴露率为687.72/10万；年暴露率呈上升趋势(AAPC=5.21%, 95% CI: 3.55%~6.90%)，与年发病率存在负相关性(r=-0.947, P < 0.001)。不同地区、性别和年龄组发病率呈不同程度的下降趋势，AAPC介于-22.95%和-49.19%，而暴露率呈不同程度的上升趋势，AAPC介于2.92%和7.93%。致伤动物以家犬居多(57.58%)。从伤口分级来看，以Ⅱ级暴露居多(61.26%)，构成比呈上升趋势(P=0.006)。Ⅱ级和Ⅲ级暴露者年均暴露后伤口处理率为99.20%，呈下降趋势(AAPC=-0.58%, 95% CI: -0.78%~-0.38%)；Ⅲ级暴露者年均被动免疫制剂接种率为23.78%，呈稳定趋势(AAPC=-0.36%, 95% CI: -2.78%~2.13%)。 结论 广东省狂犬病发病率2006―2019年呈下降趋势，目前处于低发态势。狂犬病暴露后犬伤门诊就诊率呈上升趋势，但Ⅲ级暴露者狂犬病被动免疫制剂接种率维持在低水平，需有针对性加大狂犬病宣传力度。 -
关键词:
- 狂犬病 /
- 流行特征 /
- 变化趋势 /
- Joinpoint regression
Abstract:Objective To analyze the epidemiological characteristics and change trends of human rabies onset and exposure in Guangdong for prevention and control of rabies. Methods The descriptive epidemiological analysis was used to analyze the characteristics of human rabies cases and rabies expose population in Guangdong from 2006 to 2019. Joinpoint regression model was performed to analyze change trends of rabies onset and exposure characteristics. Results From 2006 to 2019, the annual average incidence rate of human rabies in Guangdong was 0.17/100 000. And the annual rates showed a downward trend, with an average annual percentage change (AAPC) of -26.15% (95% CI: -31.81%- -20.02%). The annual average exposure rate of human rabies was 687.72/100 000, showed a upward trend, with an AAPC of 5.21% (95% CI: 3.55%- 6.90%). There was a negative correlation between annual incidence rates and annual exposure rates (r=-0.947, P < 0.001). The annual average incidence rates in different regions, gender and age groups showed downward trends to varying degrees, and the AAPCs were between -22.95% and -49.19%. The annual exposure rates in different regions, gender and age groups showed upward trends to varying degrees, and the AAPCs were between 2.92% and 7.93%. Domestic dogs-mediated injuries accounted for 57.58% of all the injuries. According to the wound grading, the proportion of degree Ⅱ exposures was 61.26%, and annual proportions showed a upward trend (P=0.006). The post-exposure prophylaxis services receiving rate of degree Ⅱ and Ⅲ exposures was 99.20%, and showed a upward trend (AAPC: -0.58%, 95% CI: -0.78%--0.38%). The passive immunization rate of degree Ⅲ exposures was 23.78%, and showed a stable trend (AAPC: -0.36%, 95% CI: -2.78%- 2.13%). Conclusions From 2006 to 2019, the incidence rate of human rabies in Guangdong showed a downward trend, and is now in a low incidence state. The exposure rate of human rabies is on the rise, but the passive immunization rate maintain low in degree Ⅲ exposures cases. It is suggested that targeted health education about rabies should be strengthened. -
Key words:
- Rabies /
- Epidemiological characteristics /
- Change trend /
- Joinpoint regression
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图 1 2006―2019广东省狂犬病发病率与暴露率时间分布图
Figure 1. Annual distribution of human rabies incidence and exposure rates in Guangdong, 2006-2019
表 1 广东省狂犬病月发病人数与月暴露人数及其季节因子
Table 1. Seasonal factors of human rabis cases and rabis exposed population in Guangdong
月份
(月)狂犬病病例数 狂犬病暴露人数 病例数(n) 季节因子 人数(n) 季节因子 1 196 -0.79 673 543 -9 170 2 175 -1.90 691 421 -8 361 3 183 -1.88 757 242 -3 779 4 180 -1.78 809 357 -410 5 194 -1.14 861 190 3 060 6 179 -1.79 867 138 2 914 7 215 1.10 963 568 9 530 8 205 0.60 1 003 085 11 725 9 219 1.69 886 117 3 333 10 247 4.09 910 295 4 563 11 209 1.33 796 770 -3 626 12 195 0.48 710 231 -9 779 合计 2 397 9 929 957 
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表 2 广东省人群狂犬病发病流行特征及趋势分析a
Table 2. Epidemiological characteristics and change trends of human rabies cases in Guangdong a
变量 发病人数(n) 年均发病率
(/10万)全区段 区段1 区段2 区段3 AAPC(95% CI)值 起止年度(年) APC(95% CI)值 起止年度(年) APC(95% CI)值 起止年度(年) APC(95% CI)值 全省 2 397 0.17 -26.15 (-31.81~-20.02) 2006―2010 -6.66 (-21.42~10.87) 2010―2016 -29.22 (-37.33~-20.06) 2016―2019 -41.17 (-55.18~-22.76) 地区b 珠三角 626 0.08 -23.44 (-28.09~-18.49) 2006―2010 -7.77 (-24.27~12.33) 2010―2019 -29.53 (-33.42~-25.40) 粤东 100 0.04 -49.19 (-59.92~-35.58) 2006―2019 -49.19 (-59.92~-35.58) 粤西 647 0.30 -28.08 (-35.19~-20.19) 2006―2010 -7.32 (-33.20~28.58) 2010―2019 -35.75 (-41.54~-29.38) 山区 1 023 0.45 -25.10 (-30.22~-19.61) 2006―2013 -9.22 (-18.09~0.62) 2013―2019 -40.15 (-47.46~-31.84) 性别 男 1 681 0.22 -25.15 (-28.91~-21.20) 2006―2010 -7.90 (-16.66~1.78) 2010―2017 -27.94 (-31.69~-23.99) 2017―2019 -43.53 (-58.83~-22.55) 女 716 0.10 -33.70 (-43.09~-22.77) 2006―2013 -16.58 (-33.18~4.15) 2013―2019 -49.29 (-61.70~-32.86) 年龄组(岁) 0~ < 15 504 0.18 -45.59 (-53.80~-35.91) 2006―2017 -20.12 (-26.09~-13.67) 2017―2019 -93.42 (-97.92~-79.17) 15~ < 45 571 0.08 -32.53 (-38.17~-26.37) 2006―2011 -15.08 (-30.92~4.39) 2011―2019 -41.56 (-47.16~-35.37) ≥45 1 322 0.30 -22.95 (-27.42~-18.19) 2006―2013 -11.79 (-19.14~-3.77) 2013―2019 -34.20 (-41.05~-26.54) 注：a表示本表格数据采用对数线性JPR模型; b表示2010年有1例病例为地市未详，未纳入病例地区分布特征分析。
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表 3 广东省狂犬病暴露人群流行特征及趋势分析a
Table 3. Epidemiological characteristics and change trends of human rabies exposure population in Guangdong a
变量 暴露人数(n) 年均暴露率
(/10万)全区段 区段1 区段2 AAPC(95% CI)值 起止年度(年) APC(95% CI)值 起止年度(年) APC(95% CI)值 全省 9 929 957 687.72 5.21(3.55~6.90) 2006―2016 3.35(2.22~4.49) 2016―2019 11.67(4.06~19.83) 地区 珠三角 6 489 148 850.45 4.17(2.29~6.09) 2006―2014 -0.52(-2.59~1.59) 2014―2019 12.14(7.41~17.08) 粤东 449 543 188.16 2.46(-1.46~6.54) 2006―2019 2.46(-1.46~6.54) 粤西 1 084 428 502.82 5.61(2.81~8.48) 2006―2019 5.61(2.81~8.48) 山区 1 906 838 842.68 6.23(4.10~8.41) 2006―2019 6.23(4.10~8.41) 性别 男 5 483 899 729.57 4.02(2.25~5.84) 2006―2015 1.93(0.34~3.54) 2015―2019 8.90(3.15~14.98) 女 4 446 058 642.28 5.81(4.68~6.95) 2006―2019 5.81(4.68~6.95) 年龄组(岁) 0~ < 15 2 502 255 903.11 7.07(5.44~8.73) 2006―2019 7.07(5.44~8.73) 15~ < 45 4 456 469 611.97 2.92(0.29~5.61) 2006―2015 -2.55(-4.81~-0.23) 2015―2019 16.36(7.26~26.23) ≥45 2 971 233 677.44 7.93(6.17~9.72) 2006―2019 7.93(6.17~9.72) 注：a表示本表格数据采用对数线性JPR模型。
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表 4 广东省狂犬病暴露后处置情况及趋势分析a
Table 4. The status and change trends of rabies post-exposure prophylaxis in Guangdonga
变量 暴露人数(n) 构成比(%) 区段1 区段2 区段3 起止年度(年) β1值 t值 P值 起止年度(年) β2值 t值 P值 起止年度(年) β3值 t值 P值 暴露分级 Ⅰ 966 923 9.74 2006―2011 -6.99 -7.31 ＜0.001 2011―2019 0.03 0.07 0.944 Ⅱ 6 082 832 61.26 2006―2008 9.82 3.57 0.006 2008―2019 0.51 2.74 0.023 Ⅲ 2 880 202 29.00 2006―2012 2.55 26.92 ＜0.001 2012―2019 -0.08 -1.04 0.323 伤口部位b 头面 382 698 3.82 2006―2019 -0.02 -0.66 0.522 躯干 464 249 4.64 2006―2019 -0.10 -7.03 ＜0.001 上肢 4 409 301 44.06 2006―2015 0.76 10.37 ＜0.001 2015―2019 1.75 6.93 ＜0.001 下肢 4 751 014 47.48 2006―2009 -1.40 -4.99 0.002 2009―2013 -0.06 -0.22 0.834 2013―2019 -1.42 -15.03 ＜0.001 伤人动物 宠物犬 1 099 546 11.07 2006―2009 1.41 2.27 0.064 2009―2012 -1.41 -1.13 0.300 2012―2019 1.02 6.12 0.001 家犬 5 717 513 57.58 2006―2009 -3.24 -4.15 0.006 2009―2012 0.70 0.45 0.670 2012―2019 -3.14 -15.06 ＜0.001 流浪犬 98 798 0.99 2006―2019 -0.05 -4.60 0.001 猫 2 012 029 20.26 2006―2015 0.93 10.18 ＜0.001 2015―2019 3.14 9.96 ＜0.001 鼠 870 756 8.77 2006―2008 1.12 3.24 0.018 2008―2015 0.41 6.92 ＜0.001 2015―2019 -0.49 -4.51 0.004 其他 131 315 1.33 2006―2019 0.01 0.45 0.663 伤口处理人数 8 891 186 2006―2016 30 227.97 7.23 ＜0.001 2016―2019 97 103.19 2.80 0.021 狂犬病疫苗接种人数 8 399 772 2006―2019 39 409.63 8.68 ＜0.001 被动免疫制剂接种人数 684 781 2006―2016 3 498.13 6.15 ＜0.001 2016―2019 12 728.59 2.27 0.049 注：a表示本表格数据采用线性JPR模型; b犬伤暴露可波及多个伤口部位，构成比计算是以各个伤口部位暴露人数总和作为分母。
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[1] 殷文武, 王传林, 陈秋兰, 等. 狂犬病暴露预防处置专家共识[J]. 中华预防医学杂志, 2019, 53(7): 668-679. DOI: 10.3760/cma.j.issn.0253-9624.2019.07.004.Yin WW, Wang CL, Chen QL, et al. Expert consensus on rabies exposure prophylaxis[J]. Chinese Journal of Preventive Medicine, 2019, 53(7): 668-679. DOI: 10.3760/cma.j.issn.0253-9624.2019.07.004. [2] 周航, 李昱, 陈瑞丰, 等. 狂犬病预防控制技术指南(2016版)[J]. 中华流行病学杂志, 2016, 37(2): 139-163. DOI: 10.3760/cma.j.issn.0254-6450.2016.02.001.Zhou H, Li Y, Chen RF, et al. Technical guideline for human rabies prevention and control (2016)[J]. Chin J Epidemiol, 2016, 37(2): 139-163. DOI: 10.3760/cma.j.issn.0254-6450.2016.02.001. [3] World Health Organization. WHO expert consultation on rabies: third report[EB/OL]. (2018-04-18)[2022-06-25]. https://apps.who.int/iris/handle/10665/272364 .[4] 李艳荣, 祝丽玲, 朱武洋, 等. 中国狂犬病流行特征及防控经验[J]. 中华实验和临床病毒学杂志, 2017, 31(6): 576-579, 封3页. DOI: 10.3760/cma.j.issn.10039279.2017.06.021.Li YR, Zhu LL, Zhu WY, et al. Epidemiological characteristics of rabies and its prevention and control in China[J]. Chin J Exp Clin Virol, 2017, 31(6): 576-579, cover 3 pages. DOI: 10.3760/cma.j.issn.10039279.2017.06.021. [5] 刘佳佳, 朵林, 陶晓燕, 等. 2016-2018年我国狂犬病流行特征分析[J]. 中华流行病学杂志, 2021, 42(1): 131-136. DOI: 10.3760/cma.j.cn112338-20200116-00037.Liu JJ, Duo L, Tao XY, et al. Epidemiological characteristics of human rabies in China, 2016-2018[J]. Chin J Epidemiol, 2021, 42(1): 131-136. DOI: 10.3760/cma.j.cn112338-20200116-00037. [6] Ruan S. Modeling the transmission dynamics and control of rabies in China[J]. Math Biosci, 2017, 286: 65-93. DOI: 10.1016/j.mbs.2017.02.005. [7] 何剑峰, 康敏, 李灵辉, 等. 广东省人群狂犬病暴露及其与狂犬病流行相关因素分析[J]. 中华流行病学杂志, 2009, 30(5): 532-533. DOI: 10.3760/cma.j.issn.0254-6450.2009.05.032.He JF, Kang M, Li LH, et al. Exposure to human rabies and the related risk factors in Guangdong[J]. Chin J Epidemiol, 2009, 30(5): 532-533. DOI: 10.3760/cma.j.issn.0254-6450.2009.05.032. [8] Division of Cancer Control and Population Sciences, National Cancer Institute, Surveillance Research Program. Joinpoint[EB/OL]. (2021-05-25)[2021-06-25]. https://surveillance.cancer.gov/help/joinpoint .[9] 牟笛, 陶忠发, 李中杰, 等. 2007-2018年中国狂犬病流行病学特征分析[J]. 中华实验和临床病毒学杂志, 2021, 35(2): 168-171. DOI: 10.3760/cma.j.cn112866-20201013-00261.Mu D, Tao ZF, Li ZJ, et al. Analysis of epidemic characteristics of human rabies in China in 2007-2018[J]. Chin J Exp Clin Virol, 2021, 35(2): 168-171. DOI: 10.3760/cma.j.cn112866-20201013-00261. [10] Song M, Tang Q, Wang DM, et al. Epidemiological investigations of human rabies in China[J]. BMC Infect Dis, 2009, 9: 210. DOI: 10.1186/1471-2334-9-210. [11] 陈飒, 赵斌, 张义, 等. 1953-2017年陕西省狂犬病的流行特征[J]. 中华疾病控制杂志, 2019, 23(10): 1289-1292. DOI: 10.16462/j.cnki.zhjbkz.2019.10.025.Chen S, Zhao B, Zhang Y, et al. Epidemiological characteristics of rabies in Shaanxi Province from 1953 to 2017[J]. Chin J Dis Control Prev, 2019, 23(10): 1289-1292. DOI: 10.16462/j.cnki.zhjbkz.2019.10.025. [12] 杨卫红, 杨鹤飞, 冯云, 等. 云南省2008-2018年人间狂犬病流行特征及狂犬病病毒基因分析[J]. 中国人兽共患病学报, 2021, 37(4): 339-345. DOI: 10.3969/j.issn.1002-2694.2021.00.035.Yang WH, Yang HF, Feng Y, et al. Epidemiology of rabies in human and genome analysis of rabies virus of Yunnan Province from 2008 to 2018[J]. Chinese Journal of Zoonoses, 2021, 37(4): 339-345. DOI: 10.3969/j.issn.1002-2694.2021.00.035. [13] 刘佳佳, 朵林, 陶晓燕, 等. 中国2017年狂犬病流行特征分析[J]. 中华流行病学杂志, 2019, 40(5): 526-530. DOI: 10.3760/cma.j.issn.0254-6450.2019.05.007.Liu JJ, Duo L, Tao XY, et al. Epidemiological characteristics of human rabies in China, 2017[J]. Chin J Epidemiol, 2019, 40(5): 526-530. DOI: 10.3760/cma.j.issn.0254-6450.2019.05.007. [14] World Health Organization. Rabies[EB/OL]. (2021-05-17)[2022-06-25]. https://www.who.int/news-room/fact-sheets/detail/rabies .[15] 孔令辰, 孙彦伟, 张翰, 等. 2009-2012年广东省狂犬病监测结果分析[J]. 中国兽医杂志, 2016, 52(3): 99-101. https://www.cnki.com.cn/Article/CJFDTOTAL-ZSYZ201603040.htmKong LC, Sun YW, Zhang H, et al. Analysis of rabies surveillance in Guangdong Province from 2009 to 2012[J]. Chinese Journal of Veterinary Medicine, 2016, 52(3): 99-101. https://www.cnki.com.cn/Article/CJFDTOTAL-ZSYZ201603040.htm [16] 李艳荣, 祝丽玲, 朱武洋, 等. 中国2016年狂犬病流行病学特征分析[J]. 中华流行病学杂志, 2018, 39(1): 40-43. DOI: 10.3760/cma.j.issn.0254-6450.2018.01.008.Li YR, Zhu LL, Zhu WY, et al. Epidemiology of human rabies in China, 2016[J]. Chin J Epidemiol, 2018, 39(1): 40-43. DOI: 10.3760/cma.j.issn.0254-6450.2018.01.008. [17] Liu YF, Li L, Lyu J, et al. Epidemiological study of outpatients in rabies post-exposure prophylaxis clinics-Tianjin Municipality, China, 2020[J]. China CDC Wkly, 2021, 3(39): 822-824. DOI: 10.46234/ccdcw2021.201. -
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