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目的分析疫苗高变异株病例的发病原因,为制定防控策略提供依据。方法对1例疫苗高变异病例进行流行病学个案调查,采集病例、病例接触者和外环境的标本并进行病毒分离;开展急性弛缓性麻痹(AFP)病例主动搜索和接种率调查。结果该病例为脊髓灰质炎(脊灰)疫苗相关麻痹病例(VAPP)接触者型病例,病例双份大便标本经国家脊灰实验室检测与Sabin株相比对均为Ⅲ型脊灰病毒,有7个核苷酸变异,属脊灰疫苗高变异株病毒,病例第3份标本病毒分离阴性;病例接触者中有1人检出疫苗株病毒,病例居住外环境污水中亦检出疫苗株病毒;病例所在县接种率调查(除甲肝外)均维持在90%以上,入户AFP病例主动搜索未发现漏报病例,市级医院存在AFP病例漏报,漏报率为26.83%。结论该病例为服苗接触者高变异株病例,提高疫苗接种率可有效阻断毒株的循环,防止疫苗衍生病例的发生和流行。
Objective To analyze the etiopathogenisis of cases of high-variant vaccine strains and provide basis for making prevention and control strategies. Methods An epidemiological investigation was carried out on a case of high variation of vaccine. Samples of cases, case contacts and external environment were collected and virus isolated. The cases of acute flaccid paralysis (AFP) were actively searched and inoculated. Results The case was poliovirus (polio) vaccine-associated paralysis (VAPP) contact-type cases, the case of double stool samples by the national polio laboratory testing compared with the Sabin strains are type III poliovirus, there are 7 nucleotide variation, is a high-variant poliovirus strain of poliovirus, the case of the third specimen negative for virus isolation; one case of contact persons were detected in the vaccine strain of virus, the case of living outside the sewage samples were also detected vaccine strains (Except for hepatitis A) were maintained at over 90%. No cases of omission were found in the active search of AFP cases in domestic hospitals. The omission of AFP cases in municipal hospitals was found, accounting for 26.83%. Conclusions This case is a case of high variant strains of contact sufferers. Increasing the vaccination rate can effectively block the circulation of the strains and prevent the occurrence and prevalence of vaccine-derived cases.