江苏省脊灰病毒阳性AFP病例残留麻痹影响因素

Influencing factors of residual paralysis in acute flaccid paralysis cases with isolation of poliovirus in Jiangsu province

目的分析脊髓灰质炎(脊灰)病毒阳性、急性弛缓性麻痹(AFP)病例流行病学特征及其残留麻痹影响因素。方法收集2004-2009年江苏省(AFP)病例1 548例,采集粪便标本1 540例,检测脊髓灰质炎病毒(PV),进行描述流行病学分析。结果 1 540例中,检出PV60例,检出率3.90%,均为脊灰疫苗相关株病毒;病例散在发生,男性多于女性;<1岁组阳性病例均高于1～2岁和≥3岁组;<1岁组、未服苗或服苗<3次、服苗与麻痹时间间隔≤60 d的PV阳性AFP病例残留麻痹率均较高;首次服苗并分离出混合型脊灰病毒的5例病例均残留麻痹;疫苗相关麻痹型脊灰(VAPP)总发生率为0.29/100万,首次服苗后为1.56/100万。结论江苏省仍有一定数量的脊灰疫苗株阳性病例和疫苗相关麻痹型脊灰(VAPP)病例发生;年龄、服苗史、服苗与麻痹时间间隔是残留麻痹的主要影响因素。

Objective To analyze the epidemiological characteristics of acute flaccid paralysis（AFP） cases with isolation of poliovirus and to find out factors associated with residual paralysis.Methods During 2004-2009,1 548 AFP cases were reported.The stool specimens were collected and poliovirus was detected among 1 540 cases.The description epidemiological methods were used to analyze the characteristics of AFP cases with positive poliovirus detection.Results Sixty of 1 540 AFP cases had poliovirus positive stool specimen with a isolated rate of 3.90% of vaccine associated poliovirus.All cases were sporadic and the male was more than the female.The rate of poliovirus isolated and residual paralysis in the AFP cases aged 0-1 years was higher than those of aged 1-2 years and ≥3 years.The rates of residual paralysis were higher in the AFP cases aged 0-1 years,unvaccinated or not full course vaccinated（3 times）,and the time between oral poliovirus vaccine（OPV） immunization and disease onset less than 60 days.All five AFP cases with 1 dose of OPV and with the isolation of mixed type poliovirus were residue paralysis.The general incidence of vaccine-associated paralytic poliomyelitis（VAPP）was 0.29/1 000 000,and the incidence of VAPP among the new borns after their first OPV immunization was 1.56/1 000 000.Conclusion There were some AFP cases with isolation of poliovirus and VAPP cases in Jiangsu province.Main influencing factors of residue paralysis are age,history of vaccination,and the time between OPV immunization and disease onset.