江苏省2007-2011年急性弛缓性麻痹病例病原检测分析

Poliovirus surveillance among acute flaccid paralysis patients in Jiangsu province from 2007 to 2011

目的对江苏省2007-2011年急性驰缓性麻痹(AFP)病例粪便标本病原学监测结果进行分析,为制定免疫策略及维持我国无脊髓灰质炎(脊灰)状态提供科学依据。方法按照世界卫生组织(WHO)《脊髓灰质炎病毒检验手册》操作规程进行病毒分离与鉴定,脊灰病毒阳性株送中国疾病预防控制中心国家脊灰实验室进行型内鉴别。用SPSS 18.0软件进行统计分析。结果 2007-2011年共检测1 380例(2 756份)AFP患者的粪便标本;采集双份合格标本1 361例,合格率为98.62%;7d内粪便标本送达江苏省脊灰实验室1 368例,送检率为99.13%;实验室28d内报告1 376例,报告率为99.71%;检测结果与国家实验室符合率为100%。1 380例(2 756份)AFP患者的粪便标本中,分离出脊髓灰质炎病毒(PV)41例,非脊灰肠道病毒(NPEV)90例,分离率分别为2.97%和6.52%。其中脊灰病毒Ⅰ型15例,Ⅱ型19例,Ⅲ型6例,混合型1例,所有PV经国家脊灰实验室型内鉴定均为疫苗株。PV分离率随年龄的增长下降(P<0.05)。不同免疫史病例之间PV检出率差异有统计学意义(P<0.01),接受全程免疫的AFP病例组PV分离率低于其他不足3次口服脊灰疫苗(OPV)免疫组。NPEV分离率7～9月份最高(P<0.05)。结论江苏省2007-2011年急性驰缓性麻痹病例中未发现脊灰野病毒(WPV)和疫苗衍生脊灰病毒(VDPV)株存在,AFP病例监测系统的各项监测指标均符合要求。今后应进一步提高AFP病例监测系统的敏感性,巩固无脊灰成果。

Objective To monitor the status of poliovirus（PV） infection among acute flaccid paralysis（AFP） patients in Jiangsu province during the period of 2007 to 2011 and provide reference for the adjustment of polio immunization strategy in China.Methods Viruses were isolated and identified using the Polio Laboratory Manual issued by the World Health Organization（WHO）;all polio-positive strains were sent to National Polio Laboratory of the Center for Disease Control of China to further determine the viral types.SPSS18.0 software was used for statistical analysis.Results All the surveillance indexes reached the demand of WHO.Double feces specimens from each of the 1 380 AFP patients in Jiangsu province during 2007-2011 were collected and qualified double specimens were obtained from 1 361 cases（98.62%）.All stool samples were sent to the Polio Laboratory of Jiangsu province within 7 days and we received result report for a total of 1 375 cases within 28 days following sample submission.Forty-one PV strains and 90 non-PV enterovirus（NPEV） strains were isolated from 2 766 stool samples of 1 380 AFP patients in Jiangsu province from 2007 to 2011.All PV strains were vaccine-related polioviruses identified by the National Polio Laboratory of China,including 15 type I,19 type Ⅱ,6 type Ⅲ and 2 mixed PV strains.The younger the age,the higher the rate of PV isolation（P〈0.05）.AFP cases accepted full course of polio immunization showed lower detection rate of PV strains than that with partial（fewer than or equal to 2 doses）oral poliovirus vaccination（OPV）（P〈0.001）.NPEV associated AFP cases mostly occurred during the summer season（July to September） in Jiangsu,China（P〈0.05）.Conclusions There were no wild Poliovirus（WPV） or vaccine-derived polio virus（VDPV） detected from AFP cases in Jiangsu province from 2007 to 2011.To safeguard polio-free status,routine polio immunization should be strengthened and expanded and the sensitivity of AFP surveillance should be improved.At the same time,more attention needs to be paid to the monitoring of NPEV.