山东省疑似脊髓灰质炎疫苗相关病例流行病学分析

Epidemiological Analysis on Suspected Vaccine Associated Paralytic Poliomyelitis in Shandong Province

目的 了解山东省脊髓灰质炎 (脊灰 )疫苗相关病例(VAPP)的发病情况。方法 对山东省 1993～ 2 0 0 0年期间通过急性弛缓性麻痹监测系统报告的 81例疑似VAPP病例进行流行病学分析。结果 以脊灰减毒活疫苗 (OPV)投放量计算 ,疑似VAPP发生率为 0 2 7/ 10 0万～ 1 3 3 / 10 0万 ,平均为0 79/ 10 0万 ;首次服苗、再次服苗及全程免疫后 ,疑似VAPP发生率分别为 7 3 4 / 10 0万、2 5 8/ 10 0万和 0 61/ 10 0万。疑似VAPP的发生多为散发 ,男性高于女性 ;病毒分离发现 ,接触病例中以Ⅱ型脊灰病毒为主 ,服苗病例中Ⅱ型和Ⅲ型病毒的分离率基本相同 ;服苗病例的平均潜伏期为 4 5天 ;60天后随访时均残留麻痹。结论 我国应进一步加强对VAPP的研究 ,应考虑以脊灰灭活疫苗 (IPV)替代OPV进行常规免疫 ,以避免VAPP的发生。

Objective To explore the situation of vaccine associated paralytic poliomyelitis (VAPP) in Shandong province.Methods Eighty one suspected VAPP cases reported by acute flaccid paralysis surveillance system were analyzed on the stage of polio-free from 1993 to 2000 in Shandong province.Results The suspected VAPP incidences were from 0.27 to 1.33 (the mean was 0.79) per 1 million usage doses of oral poliovirus attenuated vaccine (OPV).The incidence for first dose, second dose and ≥3 doses of OPV immunization was 7.34, 2.58 and 0.61 per 1 million usage doses of OPV, respectively. All suspected VAPP cases occurred in 55 counties with no obvious clustering distribution. The incidence of suspected VAPP in males was more than that in females. The results of poliovirus(PV) isolation from stools of the suspected VAPP cases showed that PV\-2 was more than PV\-1 and PV\-3 among vaccine-contacted cases, and PV\-2 was almost equal to PV\-3 among other cases. The mean incubation period of suspected VAPP onsed was 45 days. All cases were maintained with residual paralysis by follow-up investigation after 60 days.Conclusion The further study on VAPP should be enhanced and inactivated poliovirus vaccine (IPV) should also be considered to use on routine immunization activity instead of OPV to eliminate the VAPP onset in China.