山东省1995年脊髓灰质炎监测报告

POLIOMYELITIS SURVEILLANCE IN SHANDONG PROVINCE IN 1995

自１９９１年４月以来，通过对报告的急性弛缓性麻痹（ＡＦＰ）病例和病人接触者的粪便标本检测，山东省未发现脊髓灰质炎（脊灰）野病毒。自１９９２年开始引用世界卫生组织（ＷＨＯ）的诊断标准，每年均有一定数量的临床确诊脊灰病例。ＷＨＯ提出，分离到野病毒作为唯一的确诊依据，在消灭脊灰后期很有必要。卫生部提出，在ＷＨＯ推荐标准基础上结合专家组诊断意见，能保证临床符合病例具有较高特异性。山东省所有确诊脊灰病例均由专家组诊断，对专家组诊断的临床脊灰病例仍应引起高度重视，以便综合分析是否有野病毒引起的可能。１５岁以下儿童非脊灰ＡＦＰ病例报告发病率已连续３年达到１／１０万的指标，ＡＦＰ病例的粪便标本采集率达到８０．２％，与医院的及时报告率提高有密切关系。受病例麻痹到就诊的时间间隔和其它客观因素的影响，麻痹两周内采集到合格粪便标本的期望比例为９３．５％，市、县两级医院能否及时报告和采便是提高监测系统敏感性和质量的关键。报告ＡＦＰ病例中经省专家组诊查剔除非ＡＦＰ病例１９１例，占报告病例的３１．２％。在强调监测敏感性的同时，也应注意提高监测工作的特异性，以全面提高监测工作的质量。

fter checking the stool samples of AFP and their contacts,Shandong Province is wild-typepolio virus free since April 1991.the laboratory results are believable, there is no evidence to showthat in Shandng Province there has wild polio virus.By using the WHO recommendedcertification in 1992,Shandong has 7-9 VAPP cases per year.In the last stage of polioeradication;isolation of wild polio virus for confirming polio is the unique evidence.WHOrecommended certification of AFP cases when combines with the clinical experts'idea can specificallyconfirm the polio cases.It must be concerned that polio compatible cases is dangerous because ofthe wild polio virus. AFP cases among children under 15 years old is above 1.0 per 100,000 popu-lation for more than 3 years. Collection rate of stool samples from AFP cases increased in 1995.Ifthe city and county level hospitals can report any AFP cases rapidly it can greatly improve thestool sample collection tate.There are 191 non-AFP cases reported by hospitals of two levels inShandong Province in 1995.The specificity of AFP survillance survillance system system must be evaluated on thisproblem.