Lopez A, Miranda P, Tejada E, Fishbein D B
Oficina General de Epidemiologia, Programa de Entrenamiento en Epidemiologia de Campo, Ministerio de Salud, Lima, Peru.
Lancet. 1992 Feb 15;339(8790):408-11. doi: 10.1016/0140-6736(92)90088-k.
Transmission of rabies to man by vampire bats has been known for 60 years but there have been few reports of the features of rabies transmitted in this way. These aspects of the disease were investigated during an outbreak in Peru in early 1990. Between Jan 1 and April 30, 1990, 29 (5%) of 636 residents of the two rural communities in the Amazon Jungle in Peru acquired an illness characterised by hydrophobia, fever, and headache and died shortly thereafter. A census in one of the two towns revealed that the proportion affected was significantly higher for 5-14 year olds (17%) than for other age-groups (p less than 10(-5). Interviews conducted with 23 of the patients or their families revealed that 22 (96%) had a history of bat bite, compared with 66 (22%) of 301 community members who remained healthy (p less than 10(-6). A rabies virus strain identical to those isolated from vampire bats (Desmodus rotundus) was isolated from the brain of the only person on whom necropsy could be done. Because of the extreme isolation of this and other communities affected by bat-transmitted rabies, preventive measures should be directed at decreasing the risk of nocturnal exposure to bats by bat proofing dwellings or use of mosquito nets and at prompt wound care. Rabies pre-exposure or postexposure vaccination is clearly indicated, but may not be feasible in these isolated populations.
吸血蝙蝠将狂犬病传播给人类已有60年之久，但关于以这种方式传播的狂犬病特征的报道却很少。1990年初秘鲁爆发疫情期间，对该疾病的这些方面进行了调查。1990年1月1日至4月30日，秘鲁亚马逊丛林中两个农村社区的636名居民中有29人（5%）患上了以恐水、发热和头痛为特征的疾病，随后不久死亡。对两个城镇之一进行的人口普查显示，5至14岁人群中受影响的比例（17%）明显高于其他年龄组（p<10-5）。对23名患者或其家属进行的访谈显示，22人（96%）有蝙蝠咬伤史，而301名健康社区成员中有66人（22%）有蝙蝠咬伤史（p<10-6）。从唯一进行尸检的人的大脑中分离出一种与从吸血蝙蝠（圆叶吸血蝠）中分离出的病毒株相同的狂犬病病毒株。由于受蝙蝠传播狂犬病影响的这个社区以及其他社区极度偏远，预防措施应旨在通过对房屋进行防蝙蝠处理或使用蚊帐来降低夜间接触蝙蝠的风险，并及时进行伤口处理。显然需要进行狂犬病暴露前或暴露后疫苗接种，但在这些偏远人群中可能不可行。
