【健康山东行动】健康知识普及行动｜这份知识和你所知可能有所不同！来自世卫组织！

今天是第16个世界狂犬病日，世界卫生组织将今年世界狂犬病日主题定为“同一个健康，零死亡”（”One Health,Zero Death”）MangoPro。前不久，世界卫生组织发布《Guide to introducing human rabies vaccine into national immunization programmes》（《将人用狂犬病疫苗引入国家免疫计划指南》），旨在指导各国有关人员将狂犬病暴露后预防措施引入国家免疫计划的政策讨论和规划，争取各国决策者将狂犬病暴露后预防措施纳入现有免疫体系统筹考虑。该指南由世界卫生组织认可的狂犬病和免疫、疫苗和生物制品方面的技术专家合作编写。

指南中对狂犬病和狂犬病预防知识进行了介绍MangoPro。

01

关于狂犬病　

狂犬病是一种病毒性人畜共患疾病，全球每年约有5.9万人因狂犬病死亡，由此造成的伤残调整生命年 （编者注：伤残调整生命年指从发病到死亡所损失的全部健康寿命）损失高达每年370多万MangoPro。狂犬病临床症状出现后，会迅速引发急性进行性脑炎，因而这种病极为致命。大多数狂犬病死亡病例发生在非洲和亚洲服务水平低下的人群，其中约40%是15岁以下的儿童。

Rabies is a viral zoonotic disease responsible for an estimated 59 000 human deaths and more than 3.7 million disability-adjusted life years lost every year. The disease is almost always fatal due to acute progressive encephalitis that occurs soon after clinical signs appear. Most rabies deaths occur in underserved populations in Africa and Asia of which approximately 40% are in children aged < 15 years.

狂犬病毒和其他狂犬病毒属病毒均通过受感染动物咬伤或抓伤传播MangoPro。在狂犬病流行地区，99%的人患狂犬病病例由犬传播，一小部分病例由野生动物传播（通常是蝙蝠和食肉动物，包括雪貂獾、狐狸、豺、猫鼬、浣熊、臭鼬和狼）。人与人之间传播只有在移植被感染的组织或器官等特殊情况下才会发生。

Rabies virus (RABV) and other lyssaviruses are transmitted through bites and scratches from infected mammals. In regions where rabies is endemic, dogs transmit up to 99% of human cases. A small proportion of cases are transmitted via wildlife (typically bats and carnivores, including ferret badgers, foxes, jackals, mongoose, raccoons, skunks and wolves). Human-to-human transmission has been confirmed only in exceptional circumstances, such as transplantation of infected tissue or organs.

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2018年，世界卫生组织、联合国粮农组织（FAO）、世界动物卫生组织（WOAH）和全球狂犬病控制联盟共同通过到2030年犬传播狂犬病零死亡的全球目标MangoPro。这一目标符合联合国可持续发展目标中的目标3，即到2030年“使被忽视的热带疾病蔓延势头终结，并防治其他传染病”。

In 2018, WHO, the Food and Agriculture Organization of the United Nations (FAO), the World Organisation for Animal Health (WOAH) and the Global Alliance for Rabies Control endorsed a global target of zero deaths from dog-transmitted rabies by 2030 to achieve “Zero by 30”. This target aligns with Goal 3 of the United Nations Sustainable Development Goals to “end the epidemics of … neglected tropical diseases and combat other communicable diseases” by 2030.

02

关于狂犬病的预防　

预防狂犬病有2种主要策略，这2种主要策略都需要强有力的国家监测作为支持MangoPro。

There are two main strategies to prevent rabies, both ideally supported by robust national surveillance.

1.预防犬只患病MangoPro。大规模为犬只接种疫苗可以通过阻断狂犬病毒在犬之间的传播，从而减少传播给人的可能性。在非洲、亚洲、欧洲和美洲，已经证实实现70%的犬接种疫苗覆盖率可以有效阻断犬只传播。对犬只接种狂犬病疫苗可以通过开展犬主狂犬病教育和落实犬主责任来实现。

1. Prevent disease in dogs. Mass dog vaccination aims to interrupt RABV transmission among dogs and therefore reduce transmission to people. Campaigns targeting 70% dog vaccination coverage have proven effective in stopping dog-mediated transmission in Africa, Asia, Europe and the Americas. Dog rabies vaccination can be complemented through owner education on rabies and responsible dog ownership.

2.对预防人患狂犬病MangoPro，可以通过以下方式实现：

• 接触后预防(PEP)，包括：①在接触可能患有狂犬病的犬只后彻底清洗伤口；②接种狂犬病疫苗；③注射狂犬病免疫球蛋白MangoPro。接触后预防（PEP）很大程度上依赖对狂犬病的认知和管理水平。

• 接触前预防(PrEP)，包括预防性接种狂犬病疫苗MangoPro。接触前预防(PrEP)建议用于存在狂犬病职业风险的人群，和难以及时获取接触后预防(PEP)的狂犬病高度流行的偏远地区的人群。

2. Prevent disease in people, through:

• post-exposure prophylaxis (PEP), consisting of: (i) thorough wound washing after a suspected exposure; (ii) a series of intradermal or intramuscular rabies vaccinations; and, if indicated, (iii) rabies immunoglobulin (RIG). PEP relies heavily on awareness of rabies and on how to identify and manage a potential exposure; and

• pre-exposure prophylaxis (PrEP), consisting of rabies vaccination before potential exposure. PrEP is recommended for people at occupational risk of rabies and for subpopulations in remote, highly endemic areas where prompt access to PEP is limited.

狂犬病导致的死亡病例主要是那些无法及时获取有效的接触后预防(PEP)的人群MangoPro。接触后预防(PEP)的延误、伤口护理不良、未能发现伤口、头颈部暴露和患者未按时按程序接种等均可能导致接触后预防(PEP)的失败，从而导致死亡。

Rabies mainly kills those who cannot access timely and effective PEP. Delay in seeking PEP, inadequate wound care, unrecognized wounds, exposures to the head and neck, and noncompliance of patients with vaccination schedules, among other factors, can also contribute to PEP failure and subsequent death.

统筹：山东省卫生健康委宣传处

资料来源：世界卫生组织官方网站

编译：孔令曦