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在全球消除脊髓灰质炎(脊灰)的进程稳步推进的大背景下,随着口服脊髓灰质炎减毒活疫苗(Oral Polio Vaccine,OPV)的继续使用,疫苗相关麻痹型脊髓灰质炎(Vaccine-associated Paralytic Poliomyelitis,VAPP)越来越受到人们的关注,VAPP在国内外的发病情况不容忽视。WHO估计全球每年约有250~500例VAPP发生,国内的估算数字是76~161例,其中首剂次疫苗VAPP发生率较高。在疫苗选择上,灭活的脊髓灰质炎疫苗(IPV)最大的优点是能够避免VAPP的发生,但成本效益分析结果并不支持引入IPV。尽管如此,为了消除VAPP的危害,一些发达国家已率先使用IPV疫苗,同时一些发展中国家采用IPV/OPV序贯程序。因此,基于当前我国维持无脊灰的现状,VAPP所带来的公共卫生问题是决定选择IPV疫苗的重要因素,在可承担的价格空间上,IPV疫苗可作为首选疫苗推荐,也可先行引入IPV/OPV序贯程序。
Against the background of steady progress in the global elimination of poliomyelitis (polio), Vaccine-related poliovirus (OPV) continues to increase with the continued use of oral polio vaccine (OPV) associated Paralytic Poliomyelitis (VAPP) has attracted more and more attention. The incidence of VAPP at home and abroad should not be overlooked. The WHO estimates that about 250 to 500 cases of VAPP occur each year in the world, with a domestic estimate of 76 to 161 cases, with a higher incidence of VAPP in the first dose of the vaccine. The greatest advantage of inactivated polio vaccine (IPV) in vaccine selection is that VAPP can be avoided, but the cost-benefit analysis does not support the introduction of IPV. However, in order to eliminate the harmful effects of VAPP, some developed countries have taken the lead in using IPV vaccines, while some developing countries have adopted IPV / OPV sequential procedures. Therefore, based on the current situation of polio-free maintenance in our country, the public health problem brought by VAPP is an important factor that determines the choice of IPV vaccine. IPV vaccine can be recommended as the preferred vaccine at an affordable price, and IPV can also be introduced first / OPV sequential procedures.