Abstract: Objective Analysis of the characteristics of grade Ⅲ exposure cases in rabies clinic in Jiaxing city, to understand the decision of immunoglobulin injection and knowledge of prevention and control of rabies, and to provide baseline data for the prevention and control of rabies. Methods Individual of grade Ⅲ rabies exposure cases were collected at the clinics affiliated to Jiaxing Center for Disease Control and Prevention(CDC) to establish the rabies surveillance database. Besides, from 2015 June to December, 437 grade Ⅲ rabies exposure cases from the clinics were investigated about their immunoglobulin injection and knowledge of prevention and treatment. Logistic regression is used to deal with the data, and R language is used to achieve statistical analysis. Results A total of 22 327 grade Ⅲ rabies exposure cases were treated at clinic during 2011-2016.The grade Ⅲ rabies exposure mainly occurred in people aged >20 years old,accounting for 21.26%. Local farmers accounted for 31.52%. The peak of rabies exposure was during July to August, and 77.35% of the grade Ⅲ exposure cases were caused by dog biting. 3.55% of the cases were exposed by the head and face, and the 0-old group accounted for 46.85%. Up to 74.72% of grade Ⅲ exposures were treated within 24 h. The combined injection of rabies immunoglobulin accounted for 32.24% of the total number of injections at grade Ⅲ exposure cases. In the survey of 437 cases with grade Ⅲ exposure, 53.88% chose to inject combined rabies immunoglobulin. The injection rate was related to body weight, rabies vaccine experience within 3 years and the exposure site (P=0.020, 0.016, 0.020, respectively). Only 11.44% had a clear picture as for "Why should I need rabies immunoglobulin injection?". Conclusion Grade Ⅲ rabies exposures increase every year in Jiaxing city.It is necessary to strengthen the management and immunization of dogs, especially in rural areas. And it is needed to improve the knowledge of public rabies prevention and controlfocusing on the young age children, the elderly and other high-risk groups. After exposure to rabies, it is necessary to treat the wound in time and inoculate the rabies vaccine. Rabies immunoglobulin should be used correctly for grade Ⅲ exposure.

Key words: Rabies, Grade Ⅲ exposure, Management, Influence factor

摘要： 目的 分析浙江省嘉兴市犬伤门诊Ⅲ级暴露者特征，了解狂犬病免疫球蛋白注射的选择和防治知识的知晓情况，为预防和控制狂犬病提供依据。方法 收集嘉兴市CDC门诊部2011-2016年犬伤狂犬病Ⅲ级暴露者个案资料，建立狂犬病暴露处置门诊数据库；调查2015年6-12月437例门诊Ⅲ级暴露者的狂犬病免疫球蛋白注射及防治知晓情况。采用Logistic回归处理数据，利用R语言实现统计分析。结果 嘉兴市2011-2016年犬伤门诊共接诊狂犬病Ⅲ级暴露者22 327例，20~岁年龄组暴露者比例最高，占总暴露数的21.26%，本地农民占31.52%；7-8月为Ⅲ级暴露者高峰，77.35%的Ⅲ级暴露者为犬致伤；3.55%的患者暴露于头面部，其中0~岁年龄组占46.85%；74.72%的Ⅲ级暴露者在24 h内就诊；Ⅲ级暴露者中联合注射狂犬病免疫球蛋白者占应注射人数的32.24%；53.88%暴露者选择联合注射狂犬病免疫球蛋白，注射率与体质量、本人3年内是否注射过狂犬病疫苗及暴露部位3个变量差异有统计学意义（P=0.020、0.016、0.020）。"为什么需要注射狂犬病免疫球蛋白"的知晓率最低，仅为11.44%。结论 狂犬病Ⅲ级暴露人数呈逐年递增趋势，需加强犬类管理和免疫，尤其是农村地区。需提高居民狂犬病防治知识，特别是狂犬病免疫球蛋白相关防治知识。重点关注低龄儿童和老年人等高危人群。狂犬病暴露后需及时处理伤口和按程序接种狂犬病疫苗，对Ⅲ级暴露者应正确使用狂犬病免疫球蛋白。

关键词: 狂犬病, Ⅲ级暴露, 处置, 影响因素