印度人群中动物暴露的多中心社区调查。
A multicentric community survey on animal exposures among humans in India.
机构信息
Professor, Department of Community Medicine, Kempegowda Institute of Medical Sciences, Bengaluru, Karnataka, India.
Additional Professor, Department of Epidemiology, Centre for Public Health, NIMHANS, Bengaluru, Karnataka, India.
出版信息
Indian J Public Health. 2019 Sep;63(Supplement):S9-S14. doi: 10.4103/ijph.IJPH_374_19.
BACKGROUND
Rabies is a 100% fatal disease. There are inadequate data on animal exposures and rabies postexposure prophylaxis (PEP) from community-based field surveys in India.
OBJECTIVES
: The main objective of the study is to estimate the incidence of animal exposures (bite, scratch, or lick) in the study population and to describe the rabies PEP among the cases.
METHODS
A descriptive survey was conducted in seven states of India between July and November, 2017. In each state, multistage sampling methodology was followed for selection of district, taluka/tehsil, block, and clusters within the block. The primary sampling unit was a household (HH). A case was a patient with animal exposure (bite, scratch, or lick) in the last 1 year from the date of survey. The animal exposure was categorized based on the WHO guidelines (Category-I, Category-II, and Category-III). The patients with the history of multiple animal exposures any time during the survey period was considered as a single case.
RESULTS
A total of 1012 HHs were surveyed covering a population of 4294. 3016 (70.2%) participants were from rural settings and 1278 (29.8%) were living in urban settings. 2181 (50.8%) participants were male and 2113 (49.2%) were female. The annual incidence of animal exposure was 1.26% (confidence interval [CI]: 0.93%-1.59%). The annual incidence in urban setting was 1.33% (0.70 - 1.96) and rural settings were 1.23% (CI: 0.84 - 1.62). Majority (68.5%) of the cases were from rural settings, 61.2% of the cases were in the age group of 15-60 years. Among the 43 cases who had received PEP, 21 had Category-II exposures, of whom 66.7% had completed vaccination with either five doses intramuscular or four doses intradermal route. Similarly, 22 had Category-III exposures and only 4 (18.2%) cases had received rabies immunoglobulin and completed rabies vaccination. Six ( 11.1%) cases did not receive PEP. There was no report of human rabies case.
CONCLUSION
The incidence of animal exposure was 1.26%. Rabies PEP in the cases was not satisfactory.
背景
狂犬病是一种 100%致命的疾病。在印度，基于社区的实地调查中，有关动物暴露和狂犬病暴露后预防（PEP）的数据不足。
目的
本研究的主要目的是估计研究人群中动物暴露（咬伤、抓伤或舔伤）的发生率，并描述病例中的狂犬病 PEP。
方法
2017 年 7 月至 11 月在印度七个邦进行了一项描述性调查。在每个邦，采用多阶段抽样方法选择县、乡/镇、乡/镇和乡/镇内的集群。初级抽样单位是家庭（HH）。病例是指在调查之日起过去 1 年内有动物暴露（咬伤、抓伤或舔伤）的患者。动物暴露根据世界卫生组织（WHO）指南进行分类（I 类、II 类和 III 类）。在调查期间任何时候有多次动物暴露史的患者被视为单个病例。
结果
共调查了 1012 个 HH，覆盖了 4294.3016 名居民（70.2%）来自农村地区，1278 名（29.8%）居住在城市地区。2181 名（50.8%）参与者为男性，2113 名（49.2%）为女性。动物暴露的年发生率为 1.26%（置信区间 [CI]：0.93%-1.59%）。城市地区的年发生率为 1.33%（0.70-1.96），农村地区为 1.23%（CI：0.84-1.62）。大多数（68.5%）病例来自农村地区，61.2%的病例年龄在 15-60 岁之间。在接受 PEP 的 43 例病例中，21 例为 II 类暴露，其中 66.7%的人完成了肌内或皮内五剂或四剂疫苗接种。同样，22 例为 III 类暴露，仅有 4 例（18.2%）接受了狂犬病免疫球蛋白并完成了狂犬病疫苗接种。6 例（11.1%）未接受 PEP。无人间狂犬病病例报告。
结论
动物暴露的发生率为 1.26%。病例中的狂犬病 PEP 并不令人满意。
Zotero 插件