摘要
目的分析原发性免疫缺陷(PrimaryImm unodeficiency,PID)患者排出疫苗衍生脊髓灰质炎(脊灰)病毒(Vaccine-derived Poliovirus,iVDPV)的流行病学调查和处理情况。方法访谈病例发病前后情况,查阅临床病历,对病例及其密切接触者进行医学观察。对病例进行个案调查和标本检测,测定免疫功能,并定期采集粪便标本分离病毒;对病例所在地及医院进行急性弛缓性麻痹(Acute Flaccid Paralysis,AFP)病例主动搜索;对病例所在地及相邻地进行儿童口服脊灰减毒活疫苗(Oral Poliomyelitis Attenuated Live Vaccine,OPV)接种率调查;采集密切接触者和周围健康儿童的粪便标本,以及病例所在村的污水标本进行病毒分离。结果病例最终分类诊断为Ⅱ型(TypeII)免疫缺陷(Immunodeficiency,ID)VDPV(iVDPVII),核苷酸变异1.8%。病例在麻痹后6个月内定期采集17份粪便标本,未检测到脊灰病毒(Poliovirus,PV)。当地儿童OPV常规免疫接种率100%。采集病例接触者粪便标本50份,除分离到6株非脊灰肠道病毒(Non-polio Enterovirus,NPEV)外,未检出PV。采集病例所在村污水2份,未检出PV。发现iVDPVII后,及时采取了包括隔离治疗、环境消毒、接种率调查、AFP病例主动搜索、在病例所在地及相邻地区开展OPV补充免疫活动等多项措施。结论 iVDPVII未在当地造成循环。iVDPVII的发现,提示有必要对ID人群排出VDPV毒力变异的特点及其对易感人群是否具有致病力进行深入研究。
Objective To analyze the epidemiology survey and dealing with the vaccine-derived poliovirus （iVDPV） which discharged by the primary immunodeficient patient （PID）. Methods Information on epidemiology and clinical manifestation of the case was collected from interviewing the keyman and referring to related medical records. Medical observation was conducted among the close contacts of the cases. The iVDPV was investigated, whose immunity function were detected and stool samples were collected regularly for poliovirus isolation. Meanwhile an active search for acute flaccid paralysis （AFP） cases was conducted in case-oriented area and local hospitals. At the same time, the oral poliomyelitis attenuated live vaccine （OPV） immunization coverage rate of children from local and neighborhood were investigated, the stool samples of the close contacts and healthy children of the iVDPV, and the sewages samples in iVDPV-oriented area was collected and tested by poliovirus isolation. Results The category of iVDPV through classified diagnosis was found in Guizhou province firstly , and which was type Ⅱ with 1.8% mutation. The 17 stool samples collected in 6 months regularly after onset were tested and the results showed that the polioviruses had been not found. The vaccination coverage of local children was high. No poliovirus was found from 50 stool samples of close contacts and healthy children, and 2 sewages samples except for 6 and 11 non-polio enteroviruses strains respectively.After the iVDPVu occurred, a set of strategies were conducted, which include the isolation of iVDPVⅡ, the immunization coverage investigation, disinfect of the environment, actively searching for AFP cases, OPV supplementary immunization activities in local and neighboring areas. Conclusion The iVDPVⅡ did not cause circulation in local area. The detection of iVDPVⅡ issues that the VDPV variation characteristics of the ID and the pathogenicity of susceptible population should be in-depth studied.
出处
《中国疫苗和免疫》
CAS
2013年第1期20-23,42,共5页
Chinese Journal of Vaccines and Immunization
