山西省2006年4例聚集性高危急性弛缓性麻痹病例分析  

Analysis of 4 Clustered High Risk Acute flaccid Paralysis Cases in Shanxi Province in 2006

作　　者：严冬梅[1] 张勇[1] 王东艳[1] 安洪秋[1] 祝双利[1] 李爱英[2] 杨建芳[2] 温宁[3] 李黎[3] 许文波[1] 

机构地区：[1]中国疾病预防控制中心病毒病预防控制所病毒基因工程国家重点实验室,世界卫生组织西太平洋区脊髓灰质炎参比实验室,北京100050 [2]山西省疾病预防控制中心,太原030012 [3]中国疾病预防控制中心免疫规划中心,北京100050

出　　处：《中国疫苗和免疫》2010年第2期127-131,共5页Chinese Journal of Vaccines and Immunization

摘　　要：目的对山西省2006年报告的4例聚集性高危急性弛缓性麻痹(Acute Flaccid Paralysis,AFP)病例进行流行病学分析,并对采集的粪便标本中分离到的4株Ⅲ型脊髓灰质炎(脊灰)病毒(Poliovirus,PV)进行VP1编码区基因特征分析,以判断这起事件的性质。方法按照世界卫生组织《脊灰实验室手册》进行病毒分离与血清学定型,用逆转录-聚合酶链反应扩增VP1编码区基因片段,并进行核苷酸序列测定和分析,构建基因亲缘关系树。结果4例高危AFP病例中的3例为疑似疫苗相关麻痹型脊灰(Vaccine Associated Paralysis Poliomyelitis,VAPP),在发病时间上接近。4株Ⅲ型PV与疫苗参考株BJOPVⅢ相比,VP1编码区核苷酸同源性分别为99.7%、99.9%、99.4%、99.9%,均鉴定为疫苗相关株。基于VP1编码区核苷酸序列建立的进化树表明,4株PV之间无相关性,从3例VAPP中分离到的3株Ⅲ型PV在VP1编码区共享第2637位胞嘧啶核苷酸(C)→尿嘧啶核苷酸(U)突变位点,该位点变异导致氨基酸由缬氨酸(Val)突变为丙氨酸(Ala)。结论加强聚集性高危AFP病例和VAPP的实验室监测,早期发现PV循环并及时阻断。Objective Analysis of epidemiology of 4 clustered high risk acute flaccid paralysis（AFP） cases reported by Shanxi province in 2006 and VP1 gene characteristic for typeⅢpoliovirus isolated from the four AFP cases.Methods Virus isolation and identification were conducted according to the 4th edition of WHO polio laboratory manual.The sequence of VP1 region were amplified and sequenced.The phylogenetic trees based on VP1 region were constructed.Result Three of four high risk AFP cases were suspected as vaccine associated paralysis poliomyeliti（sVAPP）,the onset date of them were close.VP1 sequencing of the four typeⅢisolates revealed that the identity were 99.7%、99.9%、99.4%and 99.9% respectively compared with vaccine reference strain-BJOPV3.According to WHO criteria,the four isolates were identified as typeⅢvaccine-related poliovirus.Phylogenetic analysis based on VP1 coding sequence showed that the four typeⅢpoliovirus were not related significantly.The typeⅢpoliovirus isolated from 3 suspected VAPP cases shared one nucleotide mutation at 263（7C→U）,which result in the amino acid mutation from Val into Ala.Conclusion The improvement of laboratory surveillance for clustered high risk AFP cases should be strengthened so as to detect and prevent poliovirus circulation timely.

关 键 词：脊髓灰质炎病毒 聚集性高危急性弛缓性麻痹病例 VP1编码区 核苷酸序列测定和分析 

分 类 号：R373.22[医药卫生—病原生物学] R512.4[医药卫生—基础医学]