PDF《狂犬病预防控制技术指南（2016 版）》

2 Abstract Rabies, caused by the infection of rabies virus, is a zoonotic infectious disease. Its major clinical manifestations are presented as specific hydrophobia, aerophobia, pharyngospasm, and progressive paralysis. Reports on the deaths of rabies have continuously remained the top ones, among all the notifiable infectious diseases in China, which pose serious threats to the health of the Chinese people. In order to promote the prevention and control programs on rabies in our country, to regulate the prevention and disposition of rabies and to reduce the deaths caused by rabies, the Chinese Center for Disease Control and Prevention has organized a panel of experts, in the reference with Guidelines issued by WHO, American Advisory Committee on Immunization Practices, and the latest research progress from home and abroad, and compiled this document-- Technical Guidelines for Human Rabies Prevention and Control (2016) . The Guidelines conducted a systematic review on the etiology, clinical characteristics, laboratory diagnosis, epidemiology of rabies and provided evidence on varieties, mechanisms, effects, side-effects and security of rabies vaccine, as well as on other preparations

3 on passive immunity of its kind, on methods related to prevention and disposition of exposure etc, finally to have come up with the recommendation on the above mentioned various techniques. The guidelines will be used by staff working on prevention and control of rabies from the Center for Disease Control and Prevention at all levels, from the departments of outpatient and divisions of infection and emergency control in all the medical institutions. The guidelines will be updated and revised, following the research progress from home and abroad.

4 前言 狂犬病(Rabies)是由狂犬病病毒(Rabies virus)感染 引起的一种动物源性传染病.狂犬病病毒主要通过破损的皮 肤或粘膜侵入人体,临床大多表现为特异性恐风、恐水、咽 肌痉挛、进行性瘫痪等.近年来,狂犬病报告死亡数一直位 居我国法定报告传染病前列,给人民群众生命健康带来严重 威胁. 暴露后处置是暴露后预防狂犬病的唯一有效手段.世界 卫生组织认为,及时、科学和彻底的暴露后预防处置能够避 免狂犬病的发生.为指导基层疾控机构做好狂犬病预防控制 工作,尤其是暴露后的预防处置,降低狂犬病所致死亡,中 国疾病预防控制中心组织专家,参考世界卫生组织和美国疾 控中心的技术指南,以及国内外最新研究进展,制定了《狂 犬病预防控制技术指南(2016 版) 》 . 本指南适用于从事狂犬病防控工作的各级各类疾病预 防控制机构、狂犬病暴露预防处置门诊、医疗机构感染科和 急诊科等专业人员.根据使用中反馈的问题和狂犬病的国内 外研究最新进展,本指南今后将不断更新、完善.

5

一、病原学和实验室诊断

(一)病原学 狂犬病病毒(Rabies virus,RABV)属于单负病毒目 (Mononegavirales)弹状病毒科(Rhabdoviridae)狂犬病毒 属(Lyssavirus) [1]. 狂犬病病毒颗粒呈子弹状, 长100-300nm, 直径约 75nm.病毒基因组长约 12kb,为不分节段的单股负 链RNA,从3'

到5'

端依次编码

5 种结构蛋白,分别为核蛋 白(Nucleoprotein, N) 、磷蛋白(Phosphoprotein, P) 、基质蛋 白(Matrixprotein, M) 、 糖蛋白 (Glycoprotein, G) 和依赖 RNA 的RNA 多聚酶(RNA dependent RNA polymerase or Large protein , L ) . 病毒颗粒由囊膜(Envelope ) 和核衣壳(Nucleocapsid)两部分组成,基因组 RNA 及外层紧密盘绕 的N、P、L 蛋白共同构成具有转录、翻译功能的核衣壳;