一例脊髓灰质炎减毒活疫苗相关急性播散性脑脊髓炎的病例分析

Acute disseminated encephalomyelitis associated with oral polio vaccine: a case report

目的分析一例疑似疫苗相关麻痹型脊髓灰质炎(VAPP)的急性弛缓性麻痹(AFP)病例,评估病例与接种疫苗的关系。方法由预防接种异常反应调查诊断专家组根据病例临床表现、实验室和影像学检查结果,结合循证医学证据进行分析论证。结果患儿首次服脊髓灰质炎减毒活疫苗后第14天接种首针b型流感嗜血杆菌结合疫苗,第21天出现发热、肢体乏力,体查:四肢肌力0级,肌张力低,颈部以下皮肤痛觉缺失。麻痹第5天大便标本分离到脊髓灰质炎Ⅲ型病毒疫苗株,实验室检查未发现其他病原体感染,核磁共振检查显示延髓、颈段、下胸段脊髓多发病变,胸11椎体水平以下脊神经前根强化较显著。上述结果符合急性播散性脑脊髓炎的临床表现。结论本病例诊断为脊髓灰质炎疫苗相关ADEM病例,属于疫苗接种异常反应,疾病预防控制人员应注意此类异常反应的发生。

Objective To analyze and evaluate whether acute flaccid paralysis（ AFP） of vaccine-assoociated paralytic poliomyelitis（ VAPP）,a suspected case,is assoaciated with oral poliovirus vaccine（ OPV） vaccination. Methods The diagnosis made by the experts of investigation and diagnosis for adverse events following immunization（ AEFI） was based on clinical manifestation,laboratory and imaging examination,in combination with the analysis on the principle of evidencebased medicine. Results The infant received the first dose of Hemophilus influenzae type b vaccine（ Hib） on the 14^ thday following the first dose of oral poliovirus vaccine（ OPV）. The infant developed symptoms of fever and muscle weakness on the 21 ^stday following the first dose of OPV. Physical examination showed a zero level of limb muscle strength,hypomyotomia,analgesia of the skin under neck. The stool specimen was positive for polio vaccine virus typeШ on the 5^thday following paralysis. Other pathogen infection was not found in labrotory examnation. The MRI showed multiple lesions of medulla,cervical and lower thoracic spinal cords,and an obvious enhancement in the anterior roots of spinal cord below the 11^ thoracolumbar vertebral arch. The results are in line with the clinical manifestation of acute disseminated encephalomyelitis（ ADEM）. Conclusions The case was diagnosed as ADEM associated with OPV,determined as AEFI. Public health workers should pay attention to adverse events of this type.