北京市1989～2002年疫苗相关麻痹型脊髓灰质炎病例的监测

Surveillance of Vaccine-associated Paralytic Poliomyelitis in Beijing, 1989-2002

北京市急性弛缓性麻痹 (AFP)病例监测系统 1989～ 2 0 0 2年共诊断疫苗相关麻痹型脊髓灰质炎 (脊灰 )(VAPP) 2 0例 ,其中首次服苗VAPP 18例 ,接触服苗VAPP 2例。所有病例均 <2岁 ,<6月龄病例占 85 %。男女发病之比为 9∶1。每年VAPP发生率无明显季节性高峰和地区差异。VAPP总发生率为 1 2 0 / 10 0万剂口服脊灰减毒活疫苗 (OPV)投放量或 1 5 9/ 10 0万剂OPV接种量 ,首次服苗VAPP发生率为 13 18/ 10 0万剂首次服苗量 ,接触服苗VAPP发生率为 0 16 / 10 0万剂OPV接种量。监测结果表明 ,北京市VAPP发生的危险性高于中国其它省份和其它许多国家与地区 ;免疫缺陷和 /或肛门周围脓肿可能是VAPP重要的危险因素。在中国当前尚未改变脊灰疫苗免疫策略的情况下 ,为减少和避免VAPP的发生 ,必须加强接种前儿童病史询问和体检 ,严格掌握接种禁忌证 ;同时要加强对VAPP的监测工作。

From 1989～2002,20 cases of vaccine-associated paralytic poliomyelitis(VAPP) were identified through acute flaccid paralysis surveillance system in Beijing,18 of them were related to the first dose of OPV and 2 to the exposure of contact.All cases were under 2 years old with 85% lower than 6 months of age.The VAPP incidence ratio for male to female was 9∶1 and it had no obvious difference in months or areas each year.The overall estimated risk of VAPP was 1.20 per 1 million OPV doses distributed or 1.59 per 1 million doses administered,and with a risk of 13.18 per 1 million first doses administered for the first time recipients and a risk of 0.16 per 1 million doses administered for the contacts. The risk of VAPP in Beijing was higher than that in other provinces of China and many other countries and regions.The result also indicated that immunodeficiency and/or anal abscess probably were the important risk factors of VAPP.To reduce and aviod the occurrence of VAPP without changing current national routine immunization schedule,the information of illness history of the children must be acquired and a physical examination must be done before vaccination for children.In addition,the surveillance of VAPP needs to be strengthened.