摘要
目的探究疫苗相关麻痹型脊髓灰质炎(vaccine-associated paralytic poliomyelitis,VAPP)的临床特征及危险因素。方法设计VAPP个案调查表,选择2007-2011年北京市西城区处理的11例粪便标本检出脊髓灰质炎疫苗病毒的急性弛缓性麻痹(acute flaccid paralysis,AFP)病例,通过查询医院住院病历,填写VAPP调查表。结果调查的11例AFP病例中,VAPP病例9例,其中服苗者VAPP病例8例,均为首次服苗发病,接触者病例1例。男女性别比为8∶1。9例VAPP病例中有7例在入院前或住院过程中患有其他疾病,4例患有肛周脓肿,均为服苗者VAPP病例。结论 VAPP病例具有典型的AFP症状,因此AFP监测系统可及时发现VAPP病例。服苗者VAPP病例中有部分病例患有肛周脓肿,为减少和避免VAPP的发生,应重视对肛周脓肿的问诊和查体,患有肛周脓肿的儿童可暂缓接种口服脊髓灰质炎减毒活疫苗(oral poliovirus vaccine live,OPV)或接种脊髓灰质炎灭活疫苗(inactivated poliovirus vaccine,IPV)。对于服苗接触者VAPP病例,接种部门应及时为适龄儿童接种疫苗。此外,需继续加强AFP监测管理工作,完善并统一VAPP诊断标准及流程。
Objective To understand the clinical characteristics of vaccine-associated paralytic poliomyelitis （VAPP） and related risk factors. Methods A questionnaire was designed for the survey of VAPP cases. Eleven cases of acute flaccid paralysis （AFP）, from whom polio vaccine strains were isolated, were selected. The questionnaire survey was conducted among them. Results Nine VAPP cases were detected in the 11 AFP cases, in which 8 occurred after the first dose of oral poliovirus vaccine （OPV） immunization and 1 was caused by close contact with VAPP case. The male to female ratio of the cases was 8： 1. Seven VAPP cases had other diseases, 4 had perianal abscess and all the 4 cases were related with OPV. Conclusion VAPP patients has typical acute flaccid paralysis, AFP monitoring system can detect VAPP cases. Some VAPP cases may have perianal abscess. To reduce and prevent VAPP, attention should be paid to perianal abscess. Interrogation and examination are necessary before giving OPV. OPV vaccination may be postponed for children with perianal abscess or inactivated poliovirus vaccine （IPV） can be given for them. Timely vaccination is necessary for the elimination of VAPP in contacts and immunization gap. In addition, it is still necessary to strengthen AFP surveillance management and standardize the diagnostic criteria of VAPP.
出处
《疾病监测》
CAS
2013年第10期818-822,共5页
Disease Surveillance
