四川省近4年高危急性弛缓性麻痹病例的发现及处理

Finding and Handling of High Risk Acute Flaccid Paralysis Case in Sichuan Province in last 4 years

目的 探讨早期发现与处理高危急性弛缓性麻痹 (AFP)病例。方法 开展高危AFP病例早期流行病学调查与评估 ,针对性实施脊灰疫苗应急强化免疫。结果 发现高危AFP16例 ,发病年龄 0～ 3岁 ,1岁占 5 6 2 5 % ;2例有聚集性 ;13例检出脊灰疫苗病毒 ,其中 4例为Ⅱ型疫苗重组株 ,密切接触者检出 3株与病例同源脊灰Ⅱ型疫苗重组株病毒 ;13例残留麻痹 ;14例为超生儿童其基础免疫为“0”剂次 ,15县病例当地乡镇脊灰疫苗接种率平均值 72 18% ,低于 85 %者 9个县 ,且流动和超生儿童明显低于常住和计生儿童 ,病例所在县均实施脊灰疫苗应急强化免疫 ,评估接种率均达95 %以上。结论 四川省曾有脊灰Ⅱ型疫苗变异病毒在自然界的局部循环 ,脊灰疫苗应急强化免疫能有效阻断该变异病毒。增强AFP监测敏感性 ,尽早发现和及时调查处理高危AFP病例 ,有利于提高敏锐发现、有力阻断输入性脊灰野病毒传播循环的整体能力。

Objective To explore the timely finding and handling of high risk acute flaccid paralysis (AFP) cases Methods To carry out early investigation and evaluation of epidemiology for high risk AFP cases and apply supplementary immunization accordingly Results Of all the high risk 16 AFP cases, Age of onset ranged 0-3 years old, and 1 year group accounted for 56 25%,2 cases were with cluster Of all 13 polio-positive cases, 4 cases were tested Type II Sabin vaccine-recombined poliovirus, 3 polio viruses out of close contacts shared the same type II recombinant vaccine viruses with 2 high risk AFP cases in the very place 13 cases remained residual paralysis, 14 cases were born out of family-planning and were administered 0-dose vaccine, Average immunization coverage was 72 18% in 15 case-based counties,coverage were less than 85% in 9 counties and remarkably lower for floating children and children out of family-planning than for resident children and children of family-planning After supplementary immunization, the estimated coverage reached above 95% Conclusions Polio type II recombinant vaccine virus was ever circulated in limited area and its transmission had been effectively interrupted by supplementary immunization To enhance AFP surveillance sensitivity, promptly find, investigate and handle high risk AFP case can further strengthen integrated ability to interrupt imported polio wild virus transmission