一起一犬伤13人狂犬病暴露事件的综合处置及效果评价  

The comprehensive disposal and assessment of 13 cases bitten by single dog

作　　者：李幸乐[1] 李凤丽[1] 周瑞清 普海燕 黄学勇[1] 许汴利[1] 

机构地区：[1]河南省疾病预防控制中心,河南郑州450016 [2]兰考县疾病预防控制中心

出　　处：《河南预防医学杂志》2017年第1期4-7,共4页Henan Journal of Preventive Medicine

基　　金：河南省医学科技攻关项目(142102310389;201602310)

摘　　要：目的综合处置一起一犬伤13人的狂犬病暴露事件,评价预防处置措施效果,为规范化处置一犬伤多人事件提供依据。方法根据《狂犬病暴露后预防处置工作规范(2009版)》对一犬伤13人事件中的13人进行伤口清洗、狂犬病疫苗和/或狂犬病免疫球蛋白接种;分别采用RT-PCR方法和RFFIT方法进行伤人犬的实验室诊断和狂犬病暴露后处置人群免疫效果评价。结果伤人犬被打死、焚烧后深埋处理。犬脑组织标本经RT-PCR检测狂犬病病毒N、L基因均有特异性条带出现。13例伤者均为Ⅲ级暴露,均在24 h内主动至当地狂犬病预防处置门诊进行暴露后预防处置,其全程免疫后第15 d的血清抗狂犬病病毒中和抗体水平均>0.5 IU/mL。结论伤人犬为狂犬病病犬,13例狂犬病暴露后免疫人群全程免疫后血清中和抗体均达到保护性水平。及时、有效的多部门合作对一犬伤多人事件的处置具有积极意义。Objective To comprehensive disposal of 13 persons bitten by single dog, evaluate the efficacy of the treat- ment measures, provide the basis for standardization disposal of such accidents. Methods Wound （s） cleaning, rabies vaccines and/or immunoglobulins inoculation was done as soon as possible according to related criteria. The dog brain was tested by reverse transcription polymerase chain reaction （RT-PCR）. Serums of these 13 people sampled 15 days after the full course rabies vaccine were tested by rapid fluorescent focus inhibition test （RFFIT）. Results The predict- ed segments of the nucleoprotein （N）, RNA-dependent RNA polymerase （RdRp）/Large protein （L） genes of rabies virus were amplified from the dog brain samples with the RT-PCR. The dog have been killed, incinerated and deep buried. All 13 people were in grade Ⅲ exposure and have been in rabies vaccination clinics for post exposure prophylaxis （PEP） within 24 hours, the rabies virus neutralizing antibody （RVNP） titre of all 13 people are more than 0.5 IUAnL. Conclusion The dog is a rabies dog, the RVNP titre have reach the protective level after the full course rabies vaccine. Timely and infectively multi-sector cooperation has active significance for the disposal of cases with multi-victims bit- ten by single dog.

关 键 词：一犬伤多人 暴露后免疫 RT—PCR RFFIT 

分 类 号：R512.2[医药卫生—内科学]