我国现阶段维持无脊髓灰质炎状态面临的挑战和对策

Challenges and Strategies on Maintaining Polio-free Status in Current Period in China

中国通过使用口服脊髓灰质炎(脊灰)减毒活疫苗(Oral Poliomyelitis Attenuated Live Vaccine,OPV)、加强OPV常规免疫和开展补充免疫活动,以及加强急性弛缓性麻痹(Acute Flaccid Paralysis,AFP)病例监测,消灭脊灰已取得了重大进展。1994年报告最后1例本土脊灰野病毒(Wild Poliovirus,WPV)病例,2000年包括中国在内的世界卫生组织西太平洋区实现无脊灰目标。随后中国实施了维持无脊灰策略和措施,但2011年新疆维吾尔自治区发生了输入脊灰疫情。在现阶段中国维持无脊灰状态面临的挑战包括:WPV输入风险很大,疫苗衍生脊灰病毒(Vaccine-derived Poliovirus,VDPV)和疫苗相关麻痹型脊灰病例时有发生,常规免疫存在薄弱环节,脊灰疫苗免疫策略需要调整。为继续维持无脊灰状态,直至全球消灭脊灰,中国要大力加强OPV常规免疫,适时引入脊灰病毒灭活疫苗和调整脊灰疫苗免疫策略,保持高水平AFP病例监测质量,及时和有效地处置可能发生的WPV输入和VDPV循环事件,开展WPV、VDPV及其感染或潜在感染性材料的封存和安全处理。

Remarkable progress of poliomyelitis eradication has been made in China after introducing oral poliomyelitis attenuated live vaccine （OPV）, strengthening routine immunization of OPV, conducting supplementary immunization activities of OPV and acute flaccid paralysis （AFP） surveillance. In 1994 China reported last indigenous wild poliovirus （WPV） case. In 2000 Western Pacific Region of World Health Organization, including China, achieved the polio-free goal. And then China implemented a series of Strategies and measures of maintaining polio-free. However, circulation of imported WPV occurred in Xinjiang Uygur Autonomous Region in 2011. The challenges of maintaining polio-free in China in current period include threat of imported WPV, occurrence of vaccine-derived poliovirus （VDPV） and vaccine-associated paralytic poliomyelitis cases, weakness of routine immunization and switch of OPV to inactive poliovirus vaccine （IPV）. In order to maintain polio-free until poliomyelitis eradication in the world, China should strengthen routine immunization, switch from OPV to IPV, keep high quality of AFP surveillance, timely and rigorous response to imported WPV and cVDPV and contain WPV, VDPV and infectious and potentially infectious materials.