广东省云浮市1例免疫缺陷疫苗衍生脊髓灰质炎病毒病例的调查  

Investigation of an Immunodeficiency-related Vaccine-derived Poliovirus Case in Yunfu City of Guangdong Province

作　　者：黄海锋[1] 谭秋[2] 陈绍丽[3] 赖辉兵[1] 陈秋玲[1] 陈伟玲[1] 邓小凤[1] 

机构地区：[1]云浮市疾病预防控制中心,广东云浮527300 [2]广东省疾病预防控制中心,广东广州511430 [3]东莞市疾病预防控制中心,广东东莞441900

出　　处：《中国疫苗和免疫》2016年第3期303-306,349,共5页Chinese Journal of Vaccines and Immunization

摘　　要：目的对云浮市2015年2月发生的1例免疫缺陷疫苗衍生脊髓灰质炎（脊灰）病毒（iVDPV）病例进行调查和采取防控措施,以阻断VDPV循环。方法对病例进行个案调查、免疫功能检测/脊灰中和抗体检测,每月定期采集粪便标本进行病毒分离与鉴定及测序;对云浮市所有县级以上综合性医院2013~2015年3月急性弛缓性麻痹（AFP）病例进行主动搜索;对病例所在县5岁以下儿童开展脊灰疫苗查漏补种（患儿居住镇实施补充免疫）及接种率调查;对密切接触者和周围儿童进行粪便标本检测、常规疫苗的接种率评估及查漏补种。结果病例患有无丙种球蛋白血症,最终分类为Ⅱ型iVDPV病例。未发现医院漏报15岁以下儿童AFP病例;2015年3月9日至2016年1月21日共对患儿连续14次采集粪便标本,前11次均检出Ⅱ型VDPV;后3次均未检出脊灰病毒,2016年2月1日疫情控制措施终止;3月30日采集4名患儿家庭成员和8名5岁以下接触者的粪便标本共12份,其中2名家庭成员的标本检测出脊灰病毒,并有3个核苷酸变异,其余标本未检测出脊灰病毒,接触者均排除VDPV;病例所在县开展查漏补种后脊灰疫苗接种率达96.50%。本次疫情未发生VDPV循环。结论该病例为iVDPV病例,采取排泄物消毒、脊灰疫苗查漏补种、AFP主动监测等措施后,阻断了VDPV循环的发生。Objective To investigate one immunodeficiency-related vaccine-derived poliovirus（ iVDPV）case in Yunfu city and take control measures to interrupt its potential circulation.Methods We conducted case investigation,immune function and polio antibody detections,monthly enterovirus isolation and poliovirus identification,active search for acute flaccid paralysis（ AFP） cases from 2013 to March,2015 in county level or above hospitals,supplementary immunization activity（ SIA） of oral poliovirus vaccine（ OPV） and coverage assessment among children 5 years old in the local county,and enterovirus detection of stool specimens and coverage assessment of routine vaccines in close contacts and local children.Results The case,who had agammaglobulinemia,was finally classified as an iVDPV case.No AFP cases 15 years old in hospitals failed to be reported.Fourteen stool specimens were collected from the case from March 9,2015 to January 21,2016;the first 11 specimens were positive for poliovirus and the last 3 specimens were negative.Control measures continued until February 1,2016.Twelve stool specimens were collected from 4 family members and 8 close contacts 5 years old;two specimens from family members were positive for poliovirus with 3 nucleotide mutations in the isolates,and other specimens were negative.All contacts were discarded as VDPV cases.The OPV coverage in the local county reached 96.50% after SIA.A circulation of VDPV did not occur.Conclusions This case was one iVDPV case.Control measures,such as excrement disinfections,OPV SIA and AFP active search,interrupted the potential circulation of VDPV.

关 键 词：疫苗衍生脊髓灰质炎病毒 无丙种球蛋白血症 防控措施 

分 类 号：R186[医药卫生—流行病学] R512.4[医药卫生—公共卫生与预防医学]