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目的分析疫苗衍生脊髓灰质炎病毒(VDPV)病例的发病原因并探索控制对策。方法对发生的1例VDPV病例进行个案调查,检测脊髓灰质炎、麻疹及艾滋病抗体,测定免疫功能,并定期采集标本分离病毒;对全县所有医院进行急性驰缓性麻痹(AFP)病例主动搜索;对适龄儿童开展口服脊髓灰质炎减毒活疫苗(OPV)接种率调查;对密切接触者和周围儿童进行粪便标本带毒率调查和脊灰、麻疹抗体检测以及免疫球蛋白测定。结果病例的临床诊断为X-连锁低/无丙种球蛋白血症,最终分类诊断为免疫缺陷脊灰疫苗衍生病毒病例,在中国是首次发现。病例持续排毒直到死亡。丙种球蛋白持续治疗13个月,并未阻断VDPV在病例体内的复制。病例发生后,在全县开展了两轮OPV强化免疫,继续保持高水平的常规免疫接种率,加强了对各级医疗的AFP监测工作。到目前未发现有VDPV引起的脊灰病例。结论该病例由VDPV引起,因免疫缺陷而持续排毒,采取消毒、OPV强化免疫及监测等措施,有效阻断VDPV的循环。
Objective To analyze the pathogenesis of vaccine-derived poliovirus (VDPV) and to explore control strategies. Methods One case of VDPV was investigated by a case-by-case study. Polio, measles and AIDS antibodies were detected, immune function was measured, and samples were collected periodically to separate the virus. The AFP cases of all hospitals in the county were searched actively ; Inoculation rate of live attenuated oral (OPV) oral polio vaccine to school-age children was investigated; Infection rate of polio specimens and polio and measles antibody and immunoglobulin were measured in close contacts and surrounding children. Results The clinical diagnosis of cases was X-linked low / no agammaglobulinemia, and the final classification was diagnosed as immunodeficiency-derived poliovirus-derived virus, which was found for the first time in China. The cases continued detoxification until death. Continuous treatment of gamma globulin for 13 months did not block the in vivo replication of VDPV. After the occurrence of the case, two rounds of OPV intensified immunization were carried out throughout the county, maintaining a high level of routine immunization rates and strengthening AFP monitoring of medical treatment at all levels. To date, no cases of polio caused by VDPV have been found. Conclusions This case was caused by VDPV. Continuous detoxification due to immunodeficiency and disinfection, OPV boosting and monitoring were effective in blocking the circulation of VDPV.