疫苗相关麻痹型脊髓灰质炎的研究进展

Advances in Study of Vaccine Associated Paralytic Poliomyelitis.

实现无脊髓灰质炎 (脊灰 )目标后 ,已无本土脊灰野病毒的循环 ,但需维持口服脊灰疫苗 (OPV)的高免疫覆盖率。OPV会在少数的服苗者或其接触者中发生与疫苗相关的麻痹型脊灰 (VAPP)病例 ,现对OPV引发的VAPP发生率、病毒型别分布、人群分布、OPV免疫剂次与VAPP发生的关系等进行综述。世界各地VAPP的发生率存在着明显的差异 ,美国 1/ 2 5 0万 (疫苗分发量 ) ,英国为 1/ 140万 ,我国北京、上海市VAPP的发生率分别为 1 7/ 10 0万和0 5 2 / 10 0万。病毒型别主要为Ⅲ型 ,其次为Ⅱ型。主要发生在 <1岁儿童 ,且多为首次服苗后。VAPP的发生主要与疫苗毒株抗原漂移、毒力回升和基因重组有关。机体免疫缺陷者更易发生。联合应用OPV与增效型灭活脊灰疫苗 (eIPV)或单用eIPV进行免疫是否能有效地减少VAPP的发生目前正在进一步研究中。

After realizing the goal of polio-free,there shall be no circulation of indigenous wild poliovirus,but still requires a high coverage rate of oral polio vaccine(OPV),OPV may induce virus associated paralytic poliomyelitis(VAPP) in few vaccinees and their contacts.We reviewed comprehensively in this paper the OPV induced VAPP,the distribution of VAPP virus types,VAPP distribution in population and the relationship between OPV immunization doses and VAPP occurrence.In various regions of the world, VAPP incidence showed great difference. It was 1/2,500,000(number of vaccine handed out) in America,1/1,400,000 in England and 1.7/1,000,000,0.52/1,000,000 in Beijing and Shanghai of China respectively.The virus type of VAPP was mainly type Ⅲ,next the type Ⅱ.VAPP mostly occurred in children <1 year old after one dose of OPV vaccine.Occurrence of VAPP mainly relates with the antigentic drifting of the vaccine strain,reversion of virus virulence and the gene recombination.VAPP is more easily to occur in body under immunodeficient manner.The combined use of OPV and eIPV or single use of eIPV to reduce VAPP incidence are now under study.