一例急性弛缓性麻痹病例检出疫苗衍生脊髓灰质炎病毒的流行病学调查  

Epidemiological investigation on a case of acute flaccid paralysis with detection of vaccine-derived poliovirus

作　　者：唐学雯[1] 白祎然 苏颖 龚黎明[1] 严睿[1] 朱瑶 何寒青[1,4] TANG Xuewen;BAI Yiran;SU Ying;GONG Liming;YAN Rui;ZHU Yao;HE Hanqing(Zhejiang Provincial Center for Disease Control and Prevention,Hangzhou,Zhejiang 310051,China;Henan Provincial Center for Disease Control and Prevention,Zhengzhou,Henan 450016,China;Zhejiang Chinese Medical University,Hangzhou,Zhejiang 310053,China;Zhejiang Key Lab of Vaccine,Infectious Disease Control and Prevention,Hangzhou,Zhejiang 310051,China)

机构地区：[1]浙江省疾病预防控制中心,浙江杭州310051 [2]河南省疾病预防控制中心,河南郑州450016 [3]浙江中医药大学,浙江杭州310053 [4]浙江省传染病疫苗与预防控制研究重点实验室,浙江杭州310051

出　　处：《预防医学》2025年第2期178-180,188,共4页China Preventive Medicine Journal

基　　金：2024年浙江省医药卫生科技计划项目(2024KY899)。

摘　　要：2021年4月,浙江省1例急性弛缓性麻痹(AFP)男婴在上海市复旦大学附属儿科医院治疗期间采集的2份粪便标本检出Ⅰ型疫苗衍生脊髓灰质炎(脊灰)病毒(VDPV),VP1区核苷酸变异数分别为12和14个。病例有3剂次脊灰疫苗免疫史,入院时右下肢近端肌力Ⅲ级,远端Ⅱ级。经对症治疗后,右下肢活动明显好转,肌力基本恢复,予以出院。病例后续采集的第8~12份粪便标本未再检出VDPV;密切接触者粪便标本也未检出VDPV,病例居住地县区各医疗机构、居住地周围及邻近村和乡镇未发现类似病例。由于病例未出现VDPV所致脊灰的相关临床症状,专家小组结合流行病学调查结果、实验室检测结果及脊灰疫苗免疫史等排除脊灰,诊断为血友病A型。本次事件跨省(市)协作,处置及时,未造成病毒进一步传播。提示应保持AFP病例监测系统的敏感性,增加环境监测手段,提高脊灰疫苗接种率,防止病毒传播扩散。In April 2021,typeⅠvaccine-derived poliovirus(VDPV)was detected from two fecal samples of a male in⁃fant with acute flaccid paralysis(AFP)in Zhejiang Province when he was admitted to the Children's Hospital Affiliated to Fudan University in Shanghai,with 12 and 14 nucleotide mutations in the VP1 region,respectively.The case had a history of immunization with three doses of poliovirus vaccines,and gradeⅢproximal muscle strength and gradeⅡdistal muscle strength of the right lower limb.After symptomatic treatment,the activity of the right lower limb and the muscle strength was significantly restored,thus he was discharged.VDPV was not detected from subsequent(the 8th to 12th)fecal samples of the case and fecal samples of close contacts.No similar cases were found in medical institutions in the county,surrounding areas,neighboring villages or towns.Since the case did not exhibit clinical symptoms of po⁃liomyelitis caused by VDPV,poliomyelitis was excluded,and the case was diagnosed with hemophilia type A based on the epidemiological investigation,laboratory tests,and the history of poliomyelitis vaccination.This event involved crossprovincial(municipal)cooperation and was responsed promptly,preventing further spread of the virus.It suggested that the sensitivity of the AFP case surveillance system should be maintained,environmental monitoring methods should be increased,and the poliomyelitis vaccination should be promoted to prevent the spread of the virus.

关 键 词：急性弛缓性麻痹 疫苗衍生脊髓灰质炎病毒 血友病 流行病学调查 

分 类 号：R512.4[医药卫生—内科学]