1997　1998年5个省急性弛缓性麻痹病例的追踪调查分析

Follow-up Investigations of Acute Flaccid Paralysis (AFP) Cases in 5 Provinces in 1997, 1998 year.

1997、1998年对云南省、山西省、贵州省、广西壮族自治区、新疆维吾尔自治区报告的187例急性弛缓性麻痹（AFP）病例进行了神经学诊断方面的追踪调查，同时对监测工作的质量予以评价．诊察结果为；临床脊髓灰质炎（脊灰）的24例，其余为其它麻痹性疾病。麻痹性疾病的发病率存在着地理性差异，在中国南方地区非脊灰脊髓炎（脊髓炎）病例很多，而西北地区脊髓炎较少，则以格林-巴利综合征（GBS）为多．在追踪临床诊断为脊灰的24例中，仅有3例接脊灰病例报告；在当地诊断为脊灰23例中，追踪诊断为脊灰的仅3例。本次追踪调查在AFP病例监测方面发现以下问题：①对有无后遗症的判定不正确；②由于在家中采集粪便标本，使得粪便标本不能妥善保存；③发病日期的记录不正确等。另外，通过从这些AFP病例中分离出的脊灰病毒均为疫苗株可以判定，存在着在采集粪便标本前给患者服用脊灰疫苗（OPV）的情况。建议省专家诊断小组在对病例进行最终诊断时，有必要慎重地研究临床经过。特别是对高危病例应亲自诊察。对病例的调查不能仅由县级人员进行，应争取地区级和省级神经学专家的协助。在判定临床经过时，不能仅依赖个案调查表，也应查阅医院的病案记录．另外，为防止因主观因素影响到采集粪便标本质量。

For the past 2 years, 1997 and 1998, we conducted follow-up inveshgations of AFPcases in 4 province, Yunnan, Shanxi, Guizhou and Guangxi, and in one autonomous region,Xinjiang. The pmpose of the investigation was to fallow up and examine AFP cases neurologicallyand to know precisely whether each case was handied in correct manner in AFP surveillance.As a total, we followed up 187 AFP cases and they included 24 patients with clinicalpoliomyelitis and other miscellaneous paralytic disorders. There seemed to be geographical differences inthe prevalence of these paralytic disorders. Namely, in southern provinces, together with GBS, casesof non-poliomyelitis were found more common than in northern provinces where GBS solely constituted a significant proportinn of AFP cases. We also compared results of our exalinnation withdiagnosis given by lower levels and described in case investigahon forms. Of the 24 cases of clinicalpoliomyelitis, only 3 had this diagnosis. On the other hand, among 23 cases whose diagnosis'poliomyelitis' had ho given by lower levels, only 3 had signS of poliomyelitis.Several issues on AFP surveillance arose in these follow-up investigations. For example,detendnahon of asidual paralySis was quite inaccurate in a few cases. In others, proals of spedmencollation saaed inappropriate sinCe stools were taken in homes. There were also cases in that anerroneous date of onSet had been reported intentionally. All pollovirus siskinS isolated from therecases were vaccine viruses but in some cases OPV was shown to be given just before spedmen colleCtion.As concluSions, we would like to emphases twortanee of the following issues. FAst, a provindel expert group has to know thoroughly the clinical come of AFP case for making fmal diagnosisand bofution. In particular, the expert group should examine the so -called high-risk patientsdirectly. Prefectural EPS staff and doCtors should cooperate with county staff to perform caseinvestigation including follow-up. For fmal diagnosis of AFP cases at provinCe, the expert groupshould refer to individUal admission records in hospitals besides conventional case investigationforms prepared by county EPS. Provincial EPS needs to superVise strictly and continuouslythe performance of lower levels in term of problems related to specimen, collection ,which may greatlyaffect the quality of laboratory diagnosis, although these issues do not appear in the national AFPsUrVeillance index.