福建省脊髓灰质炎疫苗转换前后AFP病例病原学监测结果分析  

Etiological Surveillance of AFP Cases Before and After Conversion of the Poliomyelitis Vaccine in Fujian Province,China

作　　者：郑凝旋 陈致飞[1] 张苏晗 李东[1] 张海荣 杨秀惠[1] 潘伟毅[1] 周勇[1] ZHENG Ningxuan;CHEN Zhifei;ZHANG Suhan;LI Dong;ZHANG Hairong;YANG Xiuhui;PAN Weiyi;ZHOU Yong(Fujian Center for Disease Control and Prevention,FuZhou 350001,China)

机构地区：[1]福建省疾病预防控制中心脊髓灰质炎实验室,福州350001

出　　处：《病毒学报》2021年第4期872-878,共7页Chinese Journal of Virology

基　　金：闽科计[2016]9号社会发展引导性(重点)项目(项目号:2017Y011),题目:脊灰疫苗转换后人群及外环境中PVII疫苗株等肠道病毒流行变化及防控策略研究;闽科资[2020]13号福建省科技创新平台项目(项目号:2019Y2001),题目:福建省预防医学研究院建设。

摘　　要：自2016年5月1日起,我国与全球另外154个国家和地区同步实施脊髓灰质炎(以下简称"脊灰")疫苗免疫策略转换,停用三价口服脊灰减毒活疫苗,改用二价口服脊灰减毒活疫苗。为探讨脊灰疫苗转换对福建省急性弛缓性麻痹(Acute flaccid paralysis,AFP)病例监测结果产生的变化,本研究收集2012-2018年福建省AFP病例的流行病学及实验室监测数据,对脊灰疫苗转换前后AFP病例的监测结果进行描述性分析,采集AFP病例及其接触者粪便标本,并使用RD细胞和L20B细胞进行病毒分离;对L20B阳性分离物进行脊灰病毒(Poliovirus,PV)的型内鉴别(Intratypic differentiation,ITD),对PV衣壳蛋白VP1编码区核苷酸序列测定和分析。使用SPSS 21.0软件对数据进行统计检验,比较采用χ^(2)检验。结果显示,2012-2018年福建省累计报告AFP病例1776例,根据AFP病例分类流程确诊的AFP病例1283例,排除的非AFP病例493例,疫苗转换前后报告发病率平均为2.83/10万和2.71/10万。实验室共检测3123份粪便标本(包括AFP病例、非AFP病例及接触者),其中合格标本采集率为92.42%,7日及时送检率为97.85%,14日内病毒分离完成率接近100%,疫苗转换前后PV平均分离率分别为1.91%(38/1986)、1.58%(18/1137),非脊灰肠道病毒平均分离率分别为10.22%(203/1986)、5.45%(62/1137)。2016年5月1日之前分离出Ⅰ型PV 6株,Ⅱ型PV 13株,Ⅲ型PV 19株;2016年5月1日之后分离出Ⅰ型PV 6株,Ⅲ型PV 12株。本研究结果提示,脊灰疫苗转换前后福建省AFP监测系统运转正常,始终保持较高的敏感性和及时性。2012-2018年福建省分离出的PV均为脊灰疫苗株,毒株血清型别以Ⅲ型为主,VP1编码区核苷酸以低变异为主,未发现疫苗衍生脊灰病毒及脊灰野病毒,疫苗转换后再未检出II型PV,提示II型脊灰疫苗株病毒可能已被阻断。On 1 May 2016,China and 154 other countries simultaneously implemented conversion of the immunization strategy for the polio vaccine:discontinuing the trivalent oral live attenuated polio vaccine(tOPV)and switched to the bivalent oral polio attenuated live vaccine(bOPV).We explored whether conversion of the polio vaccine affected the sensitivity and surveillance of acute flaccid paralysis(AFP)cases in Fujian Province,China.The surveillance results of AFP cases before and after conversion of the polio vaccine were analyzed based on the epidemiological data and laboratory data of AFP cases in Fujian Province,China,from 2012 to 2018.A total of 1,776 AFP cases were reported in Fujian Province,China,from 2012 to 2018,of which 1,283 were AFP cases and 493 were excluded as non⁃AFP cases.The average reporting rate of AFP cases before and after vaccine conversion was 2.83/100 thousand and 2.71/100 thousand,respectively.In total,3,123 fecal specimens from 1,283 cases were detected by laboratory monitoring.14 days collection rate of the qualified specimens was 92.42%,and 7 days stool specimens delivering rate was 97.85%.14 days completion rate of virus isolation was 100%.The average isolation rates of poliovirus(PV)before and after vaccine conversion were 1.91%and 1.58%,respectively,and that of non⁃poliovirus enteroviruses(NPEV)were 10.22%and 5.45%,respectively.There were 6 strains of type I,13 strains of type II,and 19 strains of type III before 1 May 2016.There were 6 strains of type I and 12 strains of type III after 1 May 2016.These results suggested that the AFP surveillance system in Fujian Province,China,operated normally before and after conversion of the polio vaccine,and maintained high sensitivity and timely use.The PVs isolated from Fujian Province,China,from 2012 to 2018 were polio vaccine strains.The PVs were mainly type III.The nucleotides of the VP1 region had mainly low variation.A vaccine⁃derived poliovirus(VDPV)or wild⁃type poliovirus(WPV)were not found.A type⁃II PV was not detected after vaccin

关 键 词：急性弛缓性麻痹(AFP) 脊髓灰质炎病毒(PV) 病原学监测 疫苗转换 

分 类 号：R373.2[医药卫生—病原生物学]