2016年菏泽市15岁以下非脊髓灰质炎急性弛缓性麻痹监测结果

Surveillance results of non-polio acute flaccid paralysis cases below 15 years old in Heze City in 2016

目的对2016年菏泽市15岁以下非脊髓灰质炎(脊灰)急性弛缓性麻痹(AFP)监测结果进行分析研究,评价我市非脊灰AFP诊断、治疗与保持无脊灰状态进展,为非脊灰AFP诊断、治疗与保持无脊灰状态提供科学依据。方法根据AFP专病管理系统资料、个案调查资料、临床诊断资料和脊灰实验室病毒检测结果分析研究。结果 2016年菏泽市共报告各类AFP病例24例,无脊灰野病毒病例、脊灰疫苗衍生病毒病例和脊灰疫苗高变异病毒病例,确诊1例脊灰疫苗相关病例,均为非脊灰AFP;15岁以下儿童非脊灰AFP报告发病率为1.29/10万;分布在全市的8县区,呈高度散发状态;非脊灰AFP48小时及时调查率为100.00%;双份合格大便标本采集率87.50%;未检测到脊灰野病毒、脊灰疫苗衍生病毒和脊灰疫苗高变异病毒;分离到1株Ⅲ型脊灰疫苗变异病毒(有2个碱基对变异);脊灰疫苗病毒分离率为4.17%;COX.ECHO、EV71等非脊灰肠道病毒分离率为12.50%;引起非脊灰AFP的疾病有多种,脊髓炎、脑脊髓炎、格林巴利综合征、脑炎、其他非脊灰麻痹病例,分别占33.33%、20.83%、20.83%、8.33%、12.50%。结论菏泽市市非脊灰AFP诊断、治疗、监测与保持无脊灰取得了较大进展,但仍有不足之处。非脊灰AFP诊断、治疗、监测与消灭脊灰工作仍需努力。仍要加强非脊灰AFP诊断、治疗和监测,进一步做好脊灰疫苗免疫策略转换,完善消灭脊灰免疫策略,严格把握I+Ⅲ型脊灰减毒活疫苗接种禁忌症,不断提高脊灰疫苗全程接种率。

[Objective]To analyze the surveillance results of non-polio acute flaccid paralysis（AFP） cases below 15 years old in Heze City in 2016, evaluate the diagnosis and treatment of non-polio AFP and the progress on consolidating the polio-free status in Heze City, and provide the scientific basis for the diagnosis and treatment of non-polio AFP and maintaining polio-free status.[Methods] The analysis was performed on the basis of disease management system of AFP cases, epidemiological survey,clinical diagnosis and laboratory virus separation results. [Results] Totally AFP cases were reported in Heze City in 2016, there were no cases of wild poliovirus, polio vaccine derived virus and high variant virus of polio vaccine, one polio related case was confirmed, and all were non-polio AFP. The reported incidence rate of non-polio AFP in children below 15 years old was 1.29/lakh.The cases were distributed in eight counties/districts of the city, showing a highly sporadic state. The timely investigation rate within 48 hours of non-polio AFP cases was 100.00%, and the the adequate collected rate of stool specimen was 87.50%. The wild poliovirus, polio vaccine derived virus and polio vaccine highly variant virus were not detected. One strain of type III polio vaccine variant virus was isolated, with 2 base pairs variation. The separation rate of polio vaccine virus was 4.17%. The separation rate of non-polio virus（COX.ECHO, EV71 and other enterovirus） was 12.50%. The non-polio AFP cases were caused by many diseases, which the myelitis, encephalomyelitis, guillain-Barre syndrome, encephalitis and other non-polio AFP cases accounted for 33.33%, 20.83%, 20.83%, 8.33% and 12.50%, respectively. [Conclusion] Diagnosis, treatment and surveillance of non-polio AFP cases and the work of maintaining polio-free status have made a great progress in Heze City, but there are still shortcomings. The efforts on diagnosis, treatment and surveillance of non-polio AFP cases and the elimination of polio should be strengthened. It is necessary to strengthen the diagnosis, treatment and surveillance of non-polio AFP cases, improve the polio vaccine immunization strategy transformation, complete the polio eradication immunization strategy, strictly grasp the contraindications to vaccination of Ⅰ＋Ⅲ polio live attenuate vaccine, and constantly enhance the whole course inoculation rate of polio vaccine.