青海省2012-2017年再发狂犬病流行特征与感染来源

徐莉立; 张华一; 饶华祥; 雷有菊; 李永红; 赵金华; 曹海兰; 冯华祥; 石燕; 刘桂香; 赵生仓

doi:10.16462/j.cnki.zhjbkz.2019.06.014

青海省2012-2017年再发狂犬病流行特征与感染来源

doi: 10.16462/j.cnki.zhjbkz.2019.06.014

1.
810007 西宁, 青海省疾病预防控制中心传染病预防控制所
2.
810007 西宁, 青海省疾病预防控制中心实验室检测中心

基金项目:

青海省高端创新人才千人计划 2016

详细信息

通讯作者:
徐莉立, E-mail: qhcdcxull@126.com

中图分类号: R183.9
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出版历程
- 收稿日期: 2018-12-27
- 修回日期: 2019-04-10
- 刊出日期: 2019-06-10

The epidemiological characteristics and the source of infection of reemerge human rabies from 2012 to 2017 in Qinghai

1.
Institute for Infectious Disease Control and Prevention, Qinghai Provincial Center for Disease Control and Prevention, Xining 810007, China
2.
Center for Laboratory Testing, Qinghai Provincial Center for Disease Control and Prevention, Xining 810007, China

Funds:

Qinghai Provincial Thousand Talents Program for High-level Innovative Talents 2016

More Information

Corresponding author: XU Li-li, E-mail: qhcdcxull@126.com

摘要

摘要: 目的掌握青海省再发狂犬病流行特征，分析感染来源。方法收集2012-2017年人狂犬病基本信息，一犬伤多人(动物)监测结果以及可疑动物脑组织标本狂犬病毒核蛋白(N)基因反转录聚合酶链式扩增实验(reverse transcription-polymerase chain reaction，RT-PCR)及直接免疫荧光((direct immunofluorescence assay，DFA)检测结果，对狂犬病流行特征、宿主动物带毒情况以及感染来源进行描述性分析。结果 2012-2017年，全省报告7例人狂犬病病例，均为牧民，其中1例被狼咬伤，2例为流浪犬所伤，3例家养伤人犬有流浪犬或狼致伤史。2013-2017年共检测犬/动物脑组织标本892份，阳性46份，阳性率5.16%(95%CI：3.70%~6.61%)。阳性标本主要集中在牧业区，与病例分布一致。一犬伤多人(动物)事件中伤人犬/动物脑组织标本阳性率高达73.08%，7例病例中有4例为一犬伤多人事件暴露者。经检测部分动物阳性标本的病毒核苷酸序列为China Ⅳ，属于与野生动物相关的北极群。结论青海再发狂犬病是野生动物特别是狼群内狂犬病流行溢出的结果，应建立健全人、家畜以及野生动物的联合监测系统，加强对野生动物来源狂犬病的监测和防控。
- 狂犬病 /
- 再发 /
- 流行特征 /
- 感染来源
Abstract: Objective To understand the epidemic situation and the source of infection of the reemerge human rabies in Qinghai. Methods We collected the data on human rabies and the data on the cases of multi-victims bitten by the identical dog, and also the laboratory data of the nucleoprotein (N) gene of rabies virus from the samples which were detected by reverse transcription-polymerase chain reaction (RT-PCR) and direct immunofluorescence assay (DFA) from 2012 to 2017, to describe the epidemiological characteristics of human rabies and the prevalence of rabies virus in host animals, and to explore the source of infection of reemerge human rabies. Results A total of 7 human cases were reported in 2012-2017 in Qinghai province, among which 1 was bitted by wolf, 2 were bitted by stray dogs, 3 were bitted by domestic dogs which injured by stray dogs or wolfs. A total of 892 canine brain tissue samples were collected, from which 46 positive samples were detected with the positive rate of 5.16% (95% CI: 3.70%-6.61%). The positive samples were collected from the nomadic region, which were consistent had the location of the human rabies. The samples collected from the cases of multi-victims bitten by the identical dog/animal had the positive rate of 73.08%, and 4 out of 7 human rabies were exposed to the cases of multi-victims bitten by the identical dog/animal. Genetic sequencing of the rabies virus detected from canine brain tissue samples were belong to China Ⅳ lineage, which was closely related to the Arctic clade. Conclusions The reemerging rabies happened in nomadic region of Qinghai province could be a consequence of spillover from wildlife especially from wolfs. The better surveillance system covering the human, livestock and wildlife should be set up to mitigate the rabies virus spread from the wildlife.
- Rabies /
- Reemerge /
- Epidemiological characteristics /
- Source of infection

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图 1 青海省宿主动物狂犬病病毒阳性标本地区分布

Figure 1. The geographic distribution of rabies virus in host animal in Qinghai

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表 1 青海省2012-2017年人狂犬病病例基本信息及暴露发病相关信息一览表

Table 1. List of basic information of human rabies cases and related exposure in 2012-2017 in Qinghai

序号	性别	年龄(岁)	病例类型	伤人动物	咬伤部位	暴露后处置	发病日期	死亡日期	潜伏期(天)	病程(天)	地区	伤人动物标本检测情况	是否一犬伤多人事件
1	男	15	实验室确诊	家犬^a	面部	无	2012/12/17	2012/12/27	19	10	果洛州玛多县	犬脑组织阳性	否
2	男	37	临床诊断病例	狼	左手	无	2013/1/25	2013/2/2	23	8	黄南州泽库县	未采集到标本	否
3	女	20	临床诊断病例	家犬^a	左手腕	伤口自行处理，未接种疫苗	2014/10/31	2014/11/11	76	11	玉树州玉树市	犬脑组织阳性	是
4	女	83	临床诊断病例	家犬^a	右上肢	无	2014/10/16	2014/10/21	61	5	玉树州玉树市	犬脑组织阳性	是
5	男	70	临床诊断病例	流浪犬	面部	伤口自行处理，注射狂犬疫苗2针	2015/9/2	2015/9/3	17	2	玉树州称多县	犬脑组织阳性	是
6	女	19	实验室确诊	流浪犬	左手指	无	2016/10/17	2016/10/21	321	4	玉树州玉树市	未采集到标本	否
7	男	36	实验室确诊	家犬	双手背及手腕	无	2017/4/2	2017/4/6	57	4	玉树州治多县	犬脑组织阴性	是
注：^a表示经证实家犬均为拴养犬，但均有外出被流浪犬或动物致伤史。

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表 2 青海省2013-2017年宿主动物标本实验室检测结果

Table 2. The surveillance data of rabies virus in host animal in 2012-2017, Qinghai

年份(年)	标本数	阳性数	阳性率(%)	95% CI(%)	阳性县(市)
2013	90	5	5.56	0.73~10.38	泽库县、玛沁县
2014	117	21	17.95	10.89~25.01	泽库县、玛多县、玉树市
2015	165	8	4.85	1.54~8.16	循化县、乌兰县、称多县、治多县
2016	247	8	3.24	1.02~5.46	玉树市、曲麻莱县、玛多县
2017	273	4	1.47	0.03~2.90	玉树市
合计	892	46	5.16	3.70~6.61	9个县(市)

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