一例首剂接种二价脊灰减毒活疫苗后引发的高危急性弛缓性麻痹病例的调查  

A case of high-risk acute flaccid paralysis caused by bivalent polio live attenuated vaccine first dose inoculation

作　　者：崔敏[1] 苏文哲[1] 许建雄[1] 沈纪川[1] 马钰[1] 江毅民[1] 贺晴[1] 张桂兴 王鸣[1] CUI Min;SU Wenzhe;XU Jianxiong;SHEN Jichuan;MA Yu;JIANG Yimin;HE Qing;ZHANG Guixing;WANG Ming(Guangzhou Center for Disease Control and Prevention, Guangdong 510440, China)

机构地区：[1]广州市疾病预防控制中心,广东510440 [2]广州市增城区疾病预防控制中心

出　　处：《医学动物防制》2018年第6期574-577,582,共5页Journal of Medical Pest Control

基　　金：国家科技重大专项(2012ZX10004213-005);广东省医学科研基金(A2015384)

摘　　要：目的对广州市2017年3月发生的1例高危急性弛缓性麻痹(Acute Flaccid Paralysis,AFP)病例进行调查,探讨引起该案例的原因,为防控及调查处置类似事件提供经验与借鉴。方法对病例及密切接触者进行流行病学调查,采集血液标本检测脊灰中和抗体,采集粪便标本进行病毒分离与测序;对增城市区级以上医院进行AFP病例主动搜索;对病例所在镇7岁以下儿童开展脊灰疫苗接种率调查及查漏补种。结果患儿在出生5个月时首剂接种二价脊灰减毒活疫苗后发生急性弛缓性麻痹,对患儿连续6次采集粪便标本,前2次均检测出Ⅰ型脊灰疫苗病毒,变异数分别为2,3个碱基;一名密切接触者便标本检出Ⅲ型脊灰疫苗类似株;在患儿、一名密切接触者及患儿母亲血液标本中分别检测到脊灰抗体阳性。未发现医院漏报15岁以下儿童AFP病例。结论该病例属于"高危AFP病例"。省AFP病例分类专家诊断小组将其分类为"脊灰排除病例",但不能排除疫苗相关麻痹型脊髓灰质炎病例(Vaccine-Associated Paralytic Poliomyelitis,VAPP)。提示在实施脊灰疫苗IPV/OPV国际序贯免疫程序转换策略之后,接种单位应优先保障适龄儿童首剂及时接种IPV疫苗,以减少VAPP发生的风险。Objective To investigate a high-risk acute flaccid paralysis(AFP） case occurred in Guangzhou in March 2017 and provide experience for prevention and control of similar event. Methods Epidemiological investigation were conducted on the patient and close contacts and blood samples were collected for polio antibody detections. Stool specimens were collected for virus isolation and sequencing. Active search were conducted on cases of AFP in hospitals above the level of Zengcheng District; supplementary immunization activity(SIA） of oral poliovirus vaccine(OPV） and coverage assessment were applied among children under 7 years old in the local town. Results AFP occurred after first dose of bivalent live attenuated vaccine was inoculated at his 5 months old. Stool specimens were collected for 6 times continuesly. The first 2 specimens were positive for poliovirus(type I）with 2 ～ 3 nucleotide mutations in the isolates respectively and the other 4 specimens were negative. One specimen from close contacts children was positive for polio vaccine type Ⅲ similar strain. Polio antibody was detected in the blood specimens from patient,his mother and a close contacts children. No AFP cases under 15 years old in hospitals failed to be reported. Conclusion The high-risk AFP case was finally diagnosed as discarded poliomyelitis by provincial specialist group,but Vaccine-Associated Paralytic Poliomyelitis(VAPP） cannot be excluded. It suggested that,after the changeover of IPV/OPV international Sequential Immunization Schedule for Poliomyelitis Vaccine,children of the right age should be preferentially vaccinated with IVP in time to reduce the incidence of VAPP.

关 键 词：二价脊灰减毒活疫苗 高危急性弛缓性麻痹病例 个案调查 

分 类 号：R186[医药卫生—流行病学]