济南市污水中监测到Ⅱ型疫苗高变异脊髓灰质炎病毒/疫苗衍生脊髓灰质炎病毒后的流行病学调查和处置

Epidemiological Investigation and Emergency Measure of Type 2 Vaccine Hypervariable Poliovirus/Vaccine-derived Poliovirus which Monitored from Sewage in Jinan City

目的对济南市环境污水中监测到Ⅱ型（Type2）疫苗高变异脊髓灰质炎（脊灰）病毒（Vaccine Hypervariable P0liovirus，VHPVⅡ）/疫苗衍生脊灰病毒（Vaccine-derived Poliovirus，VDPVII）后，进行流行病学调查和处置，为维持无脊灰提供参考。方法对济南市口服脊灰减毒活疫苗（Oral Poliomyelitis Attenuate dLive Vaccine，OPV）常规免疫和补充免疫活动进行评估，开展0～47月龄儿童OPV接种率调查，对急性弛缓性麻痹（Acute Flaccid Paralysis，AFP）病例监测情况进行评价，继续采集污水标本开展脊灰病毒监测。结果济南市适龄儿童OPV各剂次接种率均〉99％，2010～2012年全市〈15岁儿童非脊灰AFP病例报告发病率均〉1/10万，合格粪便标本采集率均〉90％，AFP病例监测系统灵敏，能够及时发现病例，后续采集的污水中未检测到VHPV/VDPV。结论VHPV/VDPV在当地引起传播的风险较小，但污水采集点辐射范围内流动人口较多，应进一步加强AFP病例监测和OPV接种，防止VHPV/VDPV在人群中循环。

Objective To conduct the epidemiological investigation and emergency management on type 2 vaccine hypervariable poliovirus （VHPV）/vaccine-derived poliovirus （VDPV） which monitored from sewage in Jinan, and to provide reference for maintaining poliomyelitis free status. Method To survey coverage of oral poliomyelitis attenuated live vaccine （OPV） routine and supplementary immunization activities and carry out rapid assessment of OPV coverage among children 0-47 months old, evaluate the sensitivity of acute flaccid paralysis （AFP）surveillance system in Jinan city, continue to collect sewage specimens to monitor poliovirus. Result Coverage rate of OPV in jinan was 99%, AFP reporting rate was above 1/100,000 and adequate stool sampling rate was 90%, AFP surveillance system is sensitive and can find polio related cases immediately, noVHPV/VDPV were found from sewage. Conclusion VHPV/ VDPV circulation risk is low. It is necessary to strengthen AFP surveillance and OPV immunization for preventing VHPV/VDPV circulation among public due to there many floating population in the areas of waste water.