【摘要】 目的分析疫苗衍生脊髓灰质炎(脊灰)病毒(VDPV)病例发病原因并探索控制对策。方法对发生的VD-PV病例进行个案调查,检测脊灰、麻疹及艾滋病抗体,测定免疫功能,并定期采集粪便标本分离病毒;对病例所在地及医院进行急性弛缓性麻痹病例主动搜索;对病例所在地及相邻地进行儿童口服脊灰减毒活疫苗(OPV)接种率调查;对密切接触者和周围健康儿童进行粪便标本带毒率调查和脊灰、麻疹抗体检测以及免疫球蛋白测定。结果病例临床诊断为X-连锁低/无丙种球蛋白血症,最终分类诊断为免疫缺陷疫苗衍生脊灰病毒病例,属中国首例。病例自麻痹后在1年时间里定期采集26份粪便标本进行检测,目前仍在持续排毒,已进行型内鉴定的第1~20份粪便标本均分离到Ⅱ型和/或Ⅲ型VDPV,且变异度较高(最高为3.5%)。丙种球蛋白治疗已持续9个月,但并未阻断VDPV在肠道内的复制。当地儿童常规免疫接种率较高,并具有较高的脊灰和麻疹抗体,粪便标本除分离到6株非脊灰肠道病毒外,未检出脊灰病毒。病例发生后,在病例所在地及相邻地区开展OPV强化免疫。结论该病毒未在当地造成循环。当前应维持高水平的OPV免疫接种率,但随着全球消灭脊灰的进展,应适时修订免疫策略。更多还原

【Abstract】 Objective To analyze the cause of onset of vaccine-derived poliovirus(VDPV) case and explore the control approaches.Methods The VDPV case was investigated,whose polio,measles and HIV antibody as well as immunity function were detected and stool samples were collected regularly for poliovirus isolation.Meanwhile an active search for acute flaccid paralysis cases was conducted in case-oriented area and local hospitals.At the same time,the oral poliovirus vaccine(OPV) immunization coverage of children from local and neighborhood and the rate of carried poliovirus of stool samples from close contacts and healthy children were investigated.Their polio,measles antibody and immunoglobulin were detected.Results The clinical diagnosis of the case was X-Linked Agammaglobulinemia and fell into the category of immunodeficient vaccine-derived poliovirus case through classified diagnosis which was the first finding in China.The 26 stool samples collected in 1 year after onset were tested and showed that the polioviruses had been still releasing,among which type Ⅱ and type Ⅲ VDPVs were isolated with high mutation(3.5%).It had been 9 months since the r-globulin treatment began but it could not interrupt the replication of polioviruses in guts.The vaccination coverage of local children’s was high,and so were their polio and measles antibody levels.No poliovirus was found from stool samples of close contacts and healthy children except for 6 non-polio enteroviruses strains.After the case occurred,OPV supplementary immunization ac (tivities) were conducted in local and neighboring areas.Conclusion The VDPVs did not cause circulation in local area.High level of OPV vaccination coverage should be maintained but immunization strategy should be modified in time with the development of global polio eradication.更多还原