河北省脊髓灰质炎疫苗免疫程序转换后急性弛缓性麻痹病例监测分析

Analysis on acute flaccid paralysis case surveillance after polio vaccination schedule change in Hebei province

目的了解河北省脊髓灰质炎(脊灰)疫苗免疫程序转换对15岁以下儿童急性弛缓性麻痹(AFP)病例流行特征的影响,为制定科学的防控措施提供依据。方法对河北省脊灰疫苗免疫程序转换前(2015年5月至2016年4月)和转换后(2016年5月至2017年4月)AFP监测系统报告病例进行描述性分析,使用SPSS 21.0软件对数据进行统计检验,率和构成比的比较采用χ2检验和Fisher′s确切概率法。结果脊灰疫苗免疫程序转换前,河北省报告AFP 312例,转换后报告361例,报告发病率分别为2.38/10万和2.58/10万。AFP病例均在夏秋季高发,男性高于女性,集中在0～4岁组;疾病谱均以吉兰–巴雷综合征(又名"格林巴利综合征")为主,但手足口病及脊髓炎病例增多;残留麻痹率分别为11.86%、17.45%;脊灰病毒阳性分离率分别为2.56%、1.66%,优势毒株分别为Ⅰ、Ⅲ型;非脊灰肠道病毒分离率分别为19.23%、12.74%。结论脊灰疫苗免疫程序转换前后,河北省AFP病例的发病率、季节、地区及人群分布均未发生明显改变;疾病谱构成发生变化,残留麻痹增多,非脊灰肠道病毒分离率下降,脊灰病毒优势株由Ⅲ型取代Ⅰ型。

Objective To analyze the epidemiological characteristics of acute flaccid paralysis（AFP） in children aged 15 years before and after the change of polio vaccination schedule in Hebei province, and explore measures for AFP control and prevention. Methods The incidence data of AFP cases in children aged 15 years during May in 2015-April in 2016（prechange period） and May in 2016-April in 2017（post-change period） in Hebei province were collected from the AFP surveillance system and analyzed by using software SPSS 21.0. The chi square test and the Fisher＇s exact method were used to compare the rate and constituent ratio. Results During the two period, 312 and 361 AFP cases were reported respectively, the cases mainly occurred in summer and autumn. The disease spectrum was mainly Guillain-Barre syndrome, but hand-footmouth and spinitis cases increased. The incidence rates were 2.38/100 000 and 2.58/100 000, respectively. AFP cases were mainly distributed in children aged 0–4 years. The proportion of residual paralysis was 11.86% and 17.45%, respectively; The isolation rate of polio virus was 2.56% and 1.66%, respectively, polio viruses typeⅠand Ⅲ were predominant. The isolation rate of non-polio enterovirus were 19.23% and 12.74%. Conclusion The features of incidence, seasonal, area and population distributions and symptom spectrum of AFP cases did not change greatly before and after the change of polio vaccination schedule in Hebei. Non-polio enterovirus isolation rate decreased significantly, but the proportion of residual paralysis increased, predominant type Ⅰ strain type was replaced by type Ⅲ strain.