Qi Li, Su Kun, Shen Tao, Tang Wenge, Xiao Bangzhong, Long Jiang, Zhao Han, Chen Xi, Xia Yu, Xiong Yu, Xiao Dayong, Feng Liangui, Li Qin
Chongqing Municipal Center for Disease Control and Prevention, No.8, Changjiang 2nd Road, Yuzhong District, Chongqing, China.
Chinese Field Epidemiology Training Program, Chinese Center for Disease Control and Prevention, Beijing, China.
BMC Infect Dis. 2018 Jan 3;18(1):6. doi: 10.1186/s12879-017-2830-x.
According to the global framework of eliminating human rabies, China is responding to achieve the target of zero human death from dog-mediated rabies by 2030. Chongqing is the largest municipality directly under central government in China. We described the epidemiological characteristics and post-exposure prophylaxis (PEP) of human rabies in this area, in order to provide a reliable epidemiology basis for further control and prevention of human rabies.
The most updated epidemiological data for human rabies cases from 2007 to 2016 in Chongqing were collected from the National Disease Reporting Information System. A standardized questionnaire was applied to the human rabies cases or family members of cases as proxy to investigate the PEP situation.
A total of 809 fatal human rabies cases were reported in Chongqing from 2007 to 2016. There was a trend of gradual annual decline about number of cases from 2007 to 2013, followed by stable levels until 2016. Rabies was mostly reported in summer and autumn; a majority of cases were noted in farmers (71.8%), especially in males (65.3%). The cases aged 35-74 and 5-14 years old accounted for 83.8% of all the cases. We collected information of 548 human rabies cases' rabies exposure and PEP situation. Of those, 95.8% of human rabies cases were victims of dog bites or scratch, and 53.3% of these dogs were identified as stray dogs. Only 4.0% of the domestic dogs were reported to have been vaccinated previously. After exposure, 87.8% of the 548 human rabies cases did not seek any medical services. Further investigation showed that none of the 548 cases received timely and properly standardized PEP.
Human rabies remains a major public health problem in Chongqing, China. Dogs are the main reservoir and source of human rabies infection. Unsuccessful control of canine rabies and inadequate PEP of cases might be the main factors leading to the serious human rabies epidemic in this area. An integrated "One Health" approach should be encouraged and strengthened in this area; with combined effort it would be possible to achieve the elimination of human rabies in the expected date.
根据全球消除人类狂犬病框架，中国正在努力实现到2030年犬传狂犬病导致的人类死亡为零的目标。重庆是中国最大的直辖市。我们描述了该地区人类狂犬病的流行病学特征和暴露后预防（PEP）情况，以便为进一步防控人类狂犬病提供可靠的流行病学依据。
从国家疾病报告信息系统收集重庆2007年至2016年人类狂犬病病例的最新流行病学数据。对人类狂犬病病例或病例家属采用标准化问卷进行调查，以了解PEP情况。
2007年至2016年重庆共报告809例人类狂犬病死亡病例。2007年至2013年病例数呈逐年下降趋势，之后至2016年保持稳定。狂犬病多在夏秋季节报告；大多数病例为农民（71.8%），尤其是男性（65.3%）。35至74岁和5至14岁的病例占所有病例的83.8%。我们收集了548例人类狂犬病病例的狂犬病暴露和PEP情况信息。其中，95.8%的人类狂犬病病例是被狗咬伤或抓伤的受害者，这些狗中有53.3%被确认为流浪狗。据报告，只有4.0%的家犬之前接种过疫苗。暴露后，548例人类狂犬病病例中有87.8%未寻求任何医疗服务。进一步调查显示，548例病例中无一例接受及时、适当的标准化PEP。
人类狂犬病在中国重庆仍然是一个主要的公共卫生问题。狗是人类狂犬病感染的主要储存宿主和来源。犬狂犬病防控不力和病例PEP不足可能是导致该地区严重人类狂犬病流行的主要因素。应鼓励并加强该地区综合的“同一健康”方法；通过共同努力，有可能在预期日期实现消除人类狂犬病的目标。
