河北省脊髓灰质炎疫苗免疫策略调整后急性弛缓性麻痹病例病原学监测分析  

Analysis of pathogen surveillance on acute flaccid paralysis after the adjustment of polio vaccination immunization strategy in Hebei Province

作　　者：刘岩[1] 张俊棉[1] 赵娜[1] 陈玫[1] 朱怡青[1] 李静[1] 孙丽[1] 郭玉[1] LIU Yan;ZHANG Junmian;ZHAO Na;CHEN Mei;ZHU Yiqing;LI Jing;SUN Li;GUO Yu(Hebei Province Center for Disease Cortrol and Prevention,Shijiazhuang 050021,China)

机构地区：[1]河北省疾病预防控制中心,石家庄050021

出　　处：《医学动物防制》2020年第9期849-851,855,共4页Journal of Medical Pest Control

基　　金：河北省2017年度医学科学研究重点课题计划(20170450)。

摘　　要：目的分析河北省脊髓灰质炎(简称脊灰)疫苗免疫策略调整后对急性弛缓性麻痹(acute flaccid paralysis,AFP)病例报告及病例粪便标本中脊灰病毒分离状况的影响,为制定科学合理的脊灰疫苗免疫策略提供科学依据。方法采用L20B、RD细胞对AFP病例粪便标本进行病毒分离,应用实时荧光定量聚合酶链反应(real-time polymerase chain reaction,RT-PCR)方法对L20B阳性分离物进行型内鉴定(intratypic ifferentiation,ITD)及疫苗衍生脊灰病毒(vaccine-derived poliovirus,VDPV)筛查,脊灰病毒(PV)送国家脊灰实验室进行序列测定。结果2017-2018年共报告488例AFP病例,采集967份粪便标本;14天内双份合格粪便标本采集率96.19%,14天内病毒分离结果及时报告率97.67%;7天内L20B阳性分离物ITD及时率100.00%。967份粪便标本中L20B阳性7份,经ITD检测均为PV,PV分离率为0.72%;967份粪便标本中非脊灰肠道病毒(non-polio enterovirus,NPEV)阳性100份,NPEV分离率10.34%。PV均进行VDPV筛查和VP1区核苷酸序列测定,均为脊灰疫苗类似株,但VP1区核苷酸序列显示均有不同程度变异。结论河北省2017-2018年脊灰疫苗策略调整后AFP病例中PV分离率有下降趋势,分离的PV以Ⅲ为主,VP1区核苷酸变异以低变异为主,均为疫苗类似株,未发现脊灰野病毒(wild poliovirus,WPV)、VDPV和Ⅱ型毒株,河北省继续维持无脊灰状态。Objective To analyze the case reports of acute flaccid paralysis(AFP)and the influences of polioviruses(PV)isolated from stool samples of cases after the adjustment of polio vaccination immunization strategy in Hebei Province,and to provide a scientific basis for the development of a scientific and reasonable polio vaccination immunization strategy.Methods Viruses were isolated from stool samples of AFP cases by L20 B cell and RD cell.Real-time polymerase chain reaction(RT-PCR)was used to conduct intratypic ifferentiation(ITD)on L20 B positive isolates and screen vaccine-derived polioviruses(VDPV).The PV were sent to the national polio laboratory for sequencing.Results In total,488 AFP cases were reported in Hebei Province from 2017 to 2018,with 967 stool samples collected.The collection rate of paired qualified stool specimens within 14 days was 96.19%.The timely reporting rate of virus isolation results within 14 days was 97.67%.The ITD rate of L20 B positive isolates within 7 days was 100.00%.Totally 7 strains of L20 B positive isolates of 967 stool samples were tested as PV by ITD,and the isolation rate of PV was 0.72%.A total of 100 positive strains of non-polio enteroviruses(NPEV)were isolated from 967 stool specimens,and the isolation rate of NPEV was 10.34%.After the VDPV screening and nucleotide sequence determination in VP1 region,all strains were all polio vaccine-like.However,the nucleotide sequences of VP1 region showed different degrees of variation.Conclusion The isolation rate of PV in AFP cases decreased after the adjustment of polio vaccine strategy from 2017 to 2018 in Hebei Province.The isolated PV were mainly typeⅢ.Low variation was mainly seen in nucleotide variation of the VP1 region.And wild poliovirus(WPV),VDPV and type II strains were not detected.Polio-free status continues to be sustained in Hebei Province.

关 键 词：急性弛缓性麻痹 脊髓灰质炎病毒 实时荧光定量聚合酶链反应 病原学 免疫策略 

分 类 号：R18[医药卫生—流行病学] R512.4[医药卫生—公共卫生与预防医学]