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目的分析当地一例Ⅲ型疫苗相关麻痹型脊髓灰质炎病例的发病情况,并评估流行风险。方法对病例开展调查,对当地医院开展急性弛缓性麻痹病例主动搜索,评估县级急性弛缓性麻痹病例监测系统运转情况,采集密切接触者大便标本进行病毒分离,对脊髓灰质炎病毒阳性分离物进行血清型、型内鉴定以及核苷酸序列分析。结果该病例无脊髓灰质炎减毒活疫苗免疫史;早期临床表现有发热、双下肢无力、昏睡、浅昏迷等,恢复期双下肢仍存有麻痹情况,先后在某市级传染病医院和某市级医院住院治疗,主要诊断包括手足口病、病毒性脑炎、急性弛缓性麻痹、脊髓灰质炎,两家医院对此急性弛缓性麻痹病例存在误诊、漏报和迟报现象。病例粪便标本中检出Ⅲ型脊髓灰质炎病毒,为Ⅲ型高变异株,有关该病例感染的途径、时间等难以判定,密切接触者和健康儿童大便标本中未检出脊髓灰质炎疫苗病毒,适龄儿童脊髓灰质炎减毒活疫苗强化免疫接种率达到95%以上。结论Ⅲ型疫苗相关麻痹型脊髓灰质炎病例是单独病例;应急免疫活动中脊髓灰质炎减毒活疫苗强化免疫接种率达到目标;今后为保持无脊髓灰质炎状态,仍要重点落实相关技术措施,加强急性弛缓性麻痹病例监测,加强技术培训和督导检查。
Objective To analyze the incidence of a case of type III vaccine associated with paralytic polio in a local area and assess the prevalence of the disease. Methods To carry out an investigation of cases, carry out active search of acute flaccid paralysis cases in local hospitals, assess the operation of monitoring system of acute flaccid paralysis cases in county level, collect stool specimens of close contacts for virus isolation, carry out poliovirus positive isolates for poliovirus Serotype, in-cell identification, and nucleotide sequence analysis. Results There was no history of live attenuated live attenuated poliomyelitis vaccine. Early clinical manifestations were fever, weakness of both lower extremities, drowsiness and shallow coma. Paralysis still existed in both lower extremities in convalescent days. Hospital-based hospital treatment, the main diagnosis, including hand-foot-mouth disease, viral encephalitis, acute flaccid paralysis, poliomyelitis, the two hospitals on this case of acute flaccid paralysis misdiagnosis, omission and delayed reporting. The poliovirus type III was detected in the stool samples of patients and was a type III highly mutated strain. The pathways and time of infection in this case were difficult to determine. No poliovirus was detected in the stool samples of close contacts and healthy children, Age-matched children live attenuated poliomyelitis vaccine immunization rate reached 95%. CONCLUSIONS: The type III vaccine-associated paralytic poliomyelitis cases are single cases; the live attenuated polio vaccine in emergency immunization activities achieves the goal of intensified immunization; in order to maintain poliomyelitis-free status in the future, it is necessary to focus on the implementation of relevant technical measures, Strengthen acute flaccid paralysis case monitoring, strengthen technical training and supervision and inspection.