山东省临沂市首例疫苗衍生脊髓灰质炎病例流行病学调查与应对  

Epidemiological investigation and control measures on the first case of immunodeficient type Ⅲ vaccine-derived poliovirus in Linyi, Shandong

作　　者：金祥 李存宝 倪振京 栗箫[1] 田春燕 王黎明 高媛 韩文锋[1] 王如德[1] JIN Xiang;LI Cun-bao;NI Zhen-jing;LI Xiao;TIAN Chun-yan;WANG Li-ming;GAO Yuan;HAN Wen-feng;WANG Ru-de(Linyi Center for Diseases Control and Prevention,Linyi,Shandong 276000,China;Lanshan Center for Diseases Control and Prevention,Lanshan,Shandong 276001,China)

机构地区：[1]临沂市疾病预防控制中心,山东临沂276000 [2]临沂市兰山区疾病预防控制中心,山东临沂276001

出　　处：《中国热带医学》2021年第10期970-975,共6页China Tropical Medicine

摘　　要：目的探索疫苗衍生脊髓灰质炎病毒(VDPV)病例管控措施及治疗方法,为应急处置方案的制定提供依据。方法对VDPV病例进行个案调查,采集病例及其父母血液标本进行免疫功能测定和基因检测,并定期采集病例粪便标本分离病毒,对病例所在地和医疗机构开展AFP病例主动搜索,进行儿童脊灰疫苗接种率调查,开展脊灰疫苗查漏补种和应急免疫,对密切接触者和周围健康儿童进行粪便标本带毒率调查和脊灰抗体阳转率检测。结果病例多次进行免疫功能测定,结果显示体内免疫球蛋白含量低于正常值,临床诊断为原发性免疫缺陷综合征,最终分类诊断为免疫缺陷者Ⅲ型疫苗衍生脊髓灰质炎病毒(iVDPV)病例。共计采集患儿粪便标本108份,其中69份标本检测到脊髓灰质炎病毒,病毒核苷酸最大变异数为37个。丙种球蛋白治疗持续24个月,未能阻断VDPV在肠道内的复制。当地的儿童常规免疫接种率较高,脊灰抗体滴度较高。同时AFP监测系统运转良好,监测灵敏度较高。结论在采取排泄物消毒、脊灰疫苗查漏补种、AFP主动搜索等措施后,该病毒未在当地造成循环。职能部门果断实施突发公共卫生事件Ⅵ级应急响应,开展查漏补种和应急免疫等活动,整个应急处置过程严谨规范,快速有效。当前应保持高水平的脊灰疫苗接种率,保持监测系统高度灵敏性,维持无脊灰状态。同时随着全球消灭脊灰的进展,应适时修订免疫策略。Objective To explore the control measures and therapeutic methods of vaccine-derived poliovirus(VDPV)cases, then we provide the basis for the designation of emergency response plan.Methods The VDPV case was investigated,whose antibody as well as immunity function were detected and stool samples were collected regularly for poliovirus isolation.He and his parents were genetically tested. Meanwhile an active search for AFP cases was carried out in case-oriented area and local hospitals. At the same time, the poliovirus vaccine immunization coverage of children from local and neighborhood were investigated. The rate of carried poliovirus in stool samples and polio antibody positive conversion in blood were detected from close contacts and healthy children.Results The immune function of the patient was tested many times, and the results showed that the immunoglobulin in the body was lower than the normal value. Finally, the patients were classified and diagnosed as type Ⅲ vaccine derived poliovirus by primary immunodeficiency syndrome. We have collected and tested 108 stool samples, and poliovirus was detected in 69 samples, the maximum nucleotide variation was 37. Immunoglobulin therapy lasted 24 months, but did not block the replication of VDPV in patients. The local children have high immunization coverage rate, strong immune barrier and high polio antibody titer. The local monitoring system works well with high sensitivity.Conclusions Because of the appropriate prevention and control measures, the virus did not cause circulation in the local area by taking measures such as fecal disinfection, polio vaccine leak detection and reseeding, AFP active search and so on.We launched the emergency plan in time, decisively implemented the level VI emergency response to public health emergencies, and carried out activities such as leak detection, reseeding and emergency immunization. The whole process is rigorous and standardized, fast and effective. At present, we should maintain a high level of polio vaccine coverage an

关 键 词：疫苗衍生病毒 脊髓灰质炎 免疫缺陷者Ⅲ型疫苗衍生脊髓灰质炎病毒 急性弛缓性麻痹 查漏补种 

分 类 号：R512.4[医药卫生—内科学]