青海省2012-2017年再发狂犬病流行特征与感染来源
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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。
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.
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.
引文
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[2] 马永成,饶华祥,刘桂香,等.青海省首例实验室确诊狂犬病病例流行病学调查分析 [J].中国人兽共患病学报,2014,30(6):659-662.DOI:10.3969/cjz.j.issn.1002-2694.2014.06.023.Ma YC,Rao HX,Liu GX,et al.Epidemiological analysis on the first laboratory-confirmed rabies case in Qinghai province [J].Chin J Zoono,2014,30(6):659-662.DOI:10.3969/cjz.j.issn.1002-2694.2014.06.023.
[3] 中国疾病预防控制中心.全国狂犬病监测方案 [Z].2005.Chinese Center for Disease Control and Prevention.National rabies surveillance programme [Z].2005.
[4] 中国疾病预防控制中心.狂犬病预防控制技术指南(2016版)[Z].2016.Chinese Center for Disease Control and Prevention.Technical Guidelines for Human Rabies Prevention and Control (2016) [Z].2016.
[5] 刘桂香,姜双应,赵生仓,等.青海省玉树州不同宿主间狂犬病病毒感染的分子流行病学分析 [J].中国病原生物学杂志,2016,11(2):130-134.DOI:10.13350/j.cjpb.160208.Liu GX,Jiang SY,Zhao SC,et al.A molecular epidemiological analysis of rabies viruses infecting different host in Yushu,Qinhai [J].Chin J Pathogen Bio,2016,11(2):130-134.DOI:10.13350/j.cjpb.160208.
[6] Hampson K,Coudeville L,Lembo T,et al.Estimating the global burden of endemic canine rabies [J].Plos Negl Trop Dis,2015,9(4):e0003709.DOI:10.1371/journal.pntd.0003709.
[7] Yao HW,Yang Y,Liu K,et al.The spatiotemporal expansion of human rabies and its probable explanation in mainland China,2004-2013 [J].Plos Negl Trop Dis,2015,9(2):e0003502.DOI:10.1371/journal.pntd.0003502.
[8] Guo D,Zhou H,Zou Y,et al.Geographical analysis of the distribution and spread of human rabies in china from 2005 to 2011 [J].Plos One,2013,8(8):e72352.DOI:10.1371/journal.pone.0072352.
[9] Tao XY,Tang Q,Rayner S,et al.Molecular Phylodynamic Analysis Indicates Lineage Displacement Occurred in Chinese Rabies Epidemics between 1949 to 2010 [J].Plos Negl Trop Dis,2013,7(7):e2294.DOI:10.1371/journal.pntd.0002294.
[10] 蔡亮,高立冬,胡世雄,等.湖南省1979-2010年狂犬病流行特征及其毒株遗传关系分析 [J].中华疾病控制杂志,2012,16(9):774-777.Cai L,Gao LD,Hu SX,et al.Analysis of the epidemiological characteristics and phylogeography of rabies prevalent in Hunan Province,1979-2010 [J].Chin J Dis Control Prev,2012,16(9):774-777.
[11] Tan J,Wang R,Ji S,et al.One Health strategies for rabies control in rural areas of China [J].The Lancet Infectious Diseases.DOI:https://doi.org/10.1016/S1473-3099(17)30116-0.
[12] 李世军,余春,王月,等.伤人犬狂犬病病原学检测与分析 [J].贵州农业科学,2011,39(4):160-162.DOI:10.3969/j.issn.1001-3601.2011.04.050.Li SJ,Yu C,Wang Y,et al.Etiologic Detection and Analysis of Canine Rabies [J].Guizhou Agricultural Sciences,2011,39(4):160-162.DOI:10.3969/j.issn.1001-3601.2011.04.050.
[13] 余峰,张莉萍,金宝芳,等.上海市闵行区1993-2013年狂犬病防治成果 [J].中华疾病控制杂志,2014,18(10):926-930.Yu F,Zhang LP,Jin BF,et al.Achievements of rabies prevention and control in Shanghai City Minhang District from 1993 to 2013 [J].Chin J Dis Control Prev,2014,18(10):926-930.
[14] 原卫生部.中国狂犬病防治现状 [Z].2009.Ministry of health.Current situation of rabies control in China [Z].2009.