我国消灭脊髓灰质炎后期监测工作的任务

我国已进入消灭脊髓灰质炎（脊灰）后期，监测作为消灭脊灰策略之一，已在我国得到很好落实，我们已经建立起一个完善、高质量的急性弛缓性麻痹（ＡＦＰ）病例监测系统，一些监测指标已经达到或接近消灭脊灰所要求的标准。我国１９９６～２０００年消灭脊灰行动计划确定的...     

菏泽市2001～2002年急性弛缓性麻痹病例监测分析

急性弛缓性麻痹(AFP)病例监测是消灭脊髓灰质炎(脊灰)工作的重要内容,我市自1991年开始逐步建立专门的急性弛缓性麻痹病例监测系统以来,AFP监测质量不断提高,已连续12 a 15岁以下儿童非脊灰AFP病例报告发病率达到1/10万的指标;连续7 a各项监测指标基本达到国际无脊灰证实的要求,特别是自1991年来至今未发现脊灰野病毒引起的脊灰确诊病例,为无脊灰证实和保持无脊灰状态工作提供了有力的科学依据.为保持无脊灰状态工作提供科学指导,现将菏泽市2001～2002年AFP病例的流行病学情况分析如下.     

辽宁省消灭脊髓灰质炎工作的回顾及进展

目的：通过回顾消灭脊髓灰质炎工作，评价所采取的策略，以巩固消灭脊灰成果和保持无脊灰状态，为其它疫苗针对疾病的控制和消除提供借鉴。方法：应用流行病学、病毒学、血清学等研究方法进行综合分析。结果：辽宁省消灭脊灰工作，在常规免疫的基础上，通过开展强化免疫活动，使目标人群不断提高并保持了高水平的OPV免疫覆盖率，形成了有效的免疫屏障，建立并完善了AFP病例监测系统，各项监测指标已达到无脊灰证实要求，自1993年以来未发现脊灰野病毒病例。结论：我省实现了无脊灰目标并具备迅速发现和阻断脊灰野病毒的能力。     

无脊灰证实后消灭脊髓灰质炎工作有关问题的探讨

自 198 8年卫生部提出了全国 1995年消灭脊髓灰质炎 (以下简称脊灰 )的目标并下发消灭脊髓灰质炎行动计划以来 ,通过采取在脊灰疫苗 (ＯＰＶ)常规免疫的基础上实施强化免疫、广泛开展病毒学监测、加强消灭脊灰工作的管理等策略 ,1994年 9月以来全国未发现本地脊灰野病毒病例。 2 0 0 0年 10月 ,世界卫生组织西太平洋地区宣布达到了无脊灰证实的要求 ,消灭脊灰工作已取得了初步成功。但随着工作发展 ,新问题不断出现 ,需要制定相应策略以便进一步完善和提高工作质量。1　充分认识消灭脊灰工作的长期性消灭脊灰工作是一项长期的工作 ,达到无脊…     

江苏省1996年脊髓灰质炎监测工作状况分析

江苏省１９９１年建立起急性弛缓性麻痹（ＡＦＰ）病例监测系统，１９９６年各项监测指标达到或基本达到消灭脊髓灰质炎（脊灰）工作的要求。１９９６年共报告ＡＦＰ病例１９１例，其中临床诊断脊灰３例，１５岁以下儿童非脊灰ＡＦＰ病例报告发病率以市为单位均已达到１／１０万。我省已连续４年未发现由脊灰野病毒引起的麻痹病例，标志着我省已进入消灭脊灰后期关键阶段     

衡阳市消灭脊髓灰质炎工作质量评析

目的　通过评析消灭脊灰工作质量 ,及时发现问题 ,修正对策 ,巩固成果。　方法　根据卫生部规定的 AFP病例监测系统质量控制指标评价监测质量 ,以服苗数据评析服苗质量。　结果　我市已连续 11年无脊灰野病毒病例报告 ,1997～ 2 0 0 1年 15岁以下儿童 AFP病例报告共 111例 ,各项监测指标均达到卫生部的要求。常规免疫接种率在 95 %以上 ,强化免疫接种率超过 98%。　结论　我市实施的消灭脊灰策略效果显著 ,已成功阻断了脊灰野病毒的传播 ,实现了本市的无脊灰证实目标     

珠海市消灭脊髓灰质炎工作策略和效果评价

目的 评价珠海市消灭脊髓灰质炎（脊灰）工作策略和效果。方法 对珠海市历年脊灰疫情，OPV免疫接种资料及脊灰免疫学，病原学监测资料进行统计分析。结果 珠海市消灭脊灰工作主要经历了四个时期；使用口服脊灰疫苗（OPV）前期（1961-1964年），无有效预防措施，每年均有脊灰病例发生，年均发病率4.73/十万；使用OPV时期（1965-1978年），发病率下降，年均发病率1.56/十万；计划免疫时期（1979-1992年）和消灭脊灰时期（1993-2000年），连续22年无脊灰病例发生，主要采取策略有：（1）常规免疫；初期不定期上门接种或突击接种，1979年实行计划免疫统一免疫程序，1987年实行冷链运转和集中门诊规范接种，1988-1996年实现儿童免疫接种率三个85%目标；（2）强化免疫；1993年开展消灭脊灰工作，在常规免疫基础上开展强化免疫活动，8年间21轮强化免疫接种率均达96.0%以上；（3）急性弛缓性麻痹（AFP）监测；建立AFP监测系统，开展常规报告，病例快速报告和对哨点医院进行主动监测，系统敏感性，特异性，及时性指标达到无脊灰证实要求；（4）不断加强计划免疫组织，管理和制度建设，结论 珠海市消灭脊灰工作效果显，常规免疫是预防和控制脊灰的有效措施；强化免疫对消除免疫空白，阻断脊灰野病毒传播发挥重要作用；建立敏感，特异的AFP监测系统对准确发现疑似病例，及时报告处理，防止脊灰疫情蔓延必不可少。     

闽东地区急性弛缓性麻痹病例监测系统建立的应用研究

[目的]评价闽东地区AFP监测系统的工作质量和应用性。[方法]利用EpiInfo软件对全区AFP监测系统上报数据进行分析。[结果]监测系统的敏感性，及时性和完整性逐年提高。15岁以下儿童非脊灰AFP病例报告发病率、合格粪便采集率等各项监测指标连续多年达到WHO和卫生部消灭脊灰的证实要求。[结论]AFP监测系统的建立和应用，在查明闽东地区脊灰发病状况、制定免疫策略，指导消灭脊灰工作中发挥了重要作用，并为无脊灰的证实提供可靠的科学依据。     

潍坊市2000年急性弛缓性麻痹监测报告分析

我国消灭脊髓灰质炎工作已进入无脊灰证实阶段.我市自1991年建立急性弛缓性麻痹病例(AFP)监测系统以来,已连续10年未发现脊灰野病毒病例.为进一步完善我市AFP监测系统,总结经验,找出薄弱环节,现将我市2000年AFP检测报告工作分析如下:     

江苏省消灭脊髓灰质炎的回顾及策略

江苏省历史上是脊髓灰质炎 (以下简称脊灰 )的高发省份之一 ,在无有效预防措施前 ,每年均有病例发生 ,并时有局部暴发。广泛使用脊灰疫苗后 ,发病率大幅度下降 ;制定消灭脊灰策略后 ,全省自 1993年起已无脊灰野病毒引起的麻痹病例。为系统总结、评价江苏省所采取的消灭脊灰策略 ,并为其它疾病的控制提供借鉴 ,特对江苏省消灭脊灰的进程及采用的策略进行回顾和分析。1　资料来源　　脊灰疫情资料来自全省法定传染病报告系统和 AFP病例监测系统 ,脊灰疫苗免疫接种资料来自全省接种率报告系统 ,脊灰免疫监测和病毒学监测资料来自江苏省卫生防…     

Progress towards the global eradication of poliomyelitis.

Poliomyelitis has been virtually eliminated from the industrialized countries by mass campaigns conducted with oral polio vaccine (OPV). In 1988, the World Health Assembly set the goal of global eradication of poliomyelitis by the year 2000. The current WHO strategy for eradication uses three primary activities beyond routine immunization with OPV. They are: (i) improved disease surveillance, (ii) building a global network of laboratories, and (iii) supplemental immunization strategies which include mass immunization campaigns with OPV at the national level, and targeted campaigns at the local level. Eradication of polio from the Region of the Americas is close and may have already been achieved. In other regions, the number of reported polio cases has declined, largely as a result of high immunization coverage. As more countries implement polio eradication strategies, the number of polio cases will continue to fall until eradication is achieved.     

Global eradication of polio: the case for "finishing the job"

While seven years have passed since 2000, the target set for the eradication of polio, success remains elusive. In 2006, despite coordinated international efforts, there was no major breakthrough in containing the polio virus, which persists in a few pockets in the four countries in which it is endemic. The polio eradication programme faces new hurdles such as importation, re-emergence and failure of political and community mobilization. The decreasing morale of health workers and volunteers, doubts about the efficacy of oral polio vaccine and ever-increasing programme costs and funding challenges are other issues to be addressed. This paper describes the ongoing conventional strategy adopted for polio eradication, then analyses existing challenges and some possible solutions. The author suggests that major modifications and additions to the ongoing conventional strategy are required in order to create a multi-pronged, area-specific strategy that can finish the job of polio eradication. This should include an area-specific approach, community dialogue, enhanced political advocacy and compulsory vaccination, as well as the use of inactivated polio vaccine in endemic countries even before the transmission of wild polio virus has been halted. This appears to be the best way to achieve eradication at the earliest opportunity.     

湖南省1991～2000年AFP病例及接触者病毒学监测结果分析

目的　通过在全省建立急性弛缓性麻痹 ( AFP)病例监测系统并开展脊髓灰质炎 (脊灰 )病毒学监测工作 ,证实湖南省实现无脊灰目标。　方法　收集全省 15岁以下 AFP病例及其接触者粪便标本 ,采用 WHO规定方法进行病毒分离与鉴定 ,脊灰阳性毒株送国家脊灰实验室进行型内鉴别。　结果　 10年共检测 AFP病例粪便标本 14 0 4例 ( 2 760份 ) ,接触者粪便标本 2 16例 ,病毒分离阳性的 4 5 9例 ,其中脊灰 I型野病毒 7例 ,脊灰疫苗相关株病毒 92例 ,脊灰疫苗相关株病毒与肠道病毒混合 10例 ,非脊灰肠道病毒 3 5 0例 ,自 1993年 7月以后未再检出脊灰野病毒。　结论　监测结果表明我省实施的消灭脊灰策略效果显著 ,已成功地阻断了脊灰野病毒的传播 ,按期实现了区域无脊灰的目标     

Smallpox and its eradication in the Democratic Republic of Congo: lessons learned

Smallpox eradication is considered to be one of the most remarkable accomplishments of the 20th century. Lessons learned from the campaign during the 1960s and 1970s in the Democratic Republic of Congo (DRC) can provide important information for the development of other eradication programs including polio. The DRC is the third largest country in Africa; the population suffers from extreme poverty, deteriorating infrastructure and health systems, and long periods of civil strife. Despite these challenges, DRC's smallpox eradication campaign was successful, eradicating smallpox only 41 months after initiation. DRC had been polio free since 2001; however, in 2006, imported cases were identified in the country. Polio transmission has since been re-established and DRC now has the second greatest number of reported polio cases in the world. Challenges which existed during the smallpox campaign in DRC are still present today; additionally, the polio vaccine itself poses unique challenges which include requiring multiple doses to confer immunity. In the fight against polio in DRC, it will be important to draw from the smallpox eradication experience. A number of important themes emerged during the campaign that could be beneficial to eradicating polio and future eradication programs that may follow. During the smallpox campaign, a standard vaccination program was implemented, surveillance was intensified, and there were strong collaborative programs with community involvement. These successful elements of the smallpox campaign should be adapted and applied in DRC in polio eradication programs.     

Role of genetic factors in polio eradication: new challenge for policy makers

In 1988 the World Health Assembly passed resolution WHA 41.28, for global eradication of poliomyelitis by the year 2000 by providing immunization exclusively with oral polio vaccine (OPV). India happens to be the largest country in the world, where polio cases are occurring in large numbers. Despite increase in number of pulse polio immunization (PPI) rounds and introduction of monovalent oral polio vaccines mOPV1 and mOPV3, polio has not been eradicated from India. Global polio eradication cannot be achieved unless polio is eradicated from India because of the risk of exportation of wild poliovirus to other countries. India cannot become polio free unless Uttar Pradesh and Bihar become polio free. Because of genetic and some other factors, OPV cannot eradicate polio from Bihar and Uttar Pradesh. The present scenario strongly suggests that due to some host factors in recipients OPV cannot eradicate polio. Rather than extending the deadline for polio eradication again and again, it is time to prepare strategy for final push to polio.     

Why polio has not been eradicated in India despite many remedial interventions?

Oral polio vaccine has reduced the incidence of polio in India and many states have been polio free for a long time while occasional polio cases are occurring in some states. On the other hand more than 96% of polio cases being reported in India are occurring in Uttar Pradesh and Bihar. The current polio scenario indicates that oral polio vaccines cannot eradicate polio from Uttar Pradesh and Bihar because some children from these two states show poor response to OPV. There is an urgent need for re-appraisal of polio eradication strategy.     

Polio Eradication Initiative: Contribution to improved communicable diseases surveillance in WHO African region

IntroductionSince the launch of the Global Polio Eradication Initiative (GPEI) in 1988, there has been a tremendous progress in the reduction of cases of poliomyelitis. The world is on the verge of achieving global polio eradication and in May 2013, the 66th World Health Assembly endorsed the Polio Eradication and Endgame Strategic Plan (PEESP) 2013–2018. The plan provides a timeline for the completion of the GPEI by eliminating all paralytic polio due to both wild and vaccine-related polioviruses.MethodsWe reviewed how GPEI supported communicable disease surveillance in seven of the eight countries that were documented as part of World Health Organization African Region best practices documentation. Data from WHO African region was also reviewed to analyze the performance of measles cases based surveillance.ResultsAll 7 countries (100%) which responded had integrated communicable diseases surveillance core functions with AFP surveillance. The difference is on the number of diseases included based on epidemiology of diseases in a particular country. The results showed that the polio eradication infrastructure has supported and improved the implementation of surveillance of other priority communicable diseases under integrated diseases surveillance and response strategy.ConclusionAs we approach polio eradication, polio-eradication initiative staff, financial resources, and infrastructure can be used as one strategy to build IDSR in Africa. As we are now focusing on measles and rubella elimination by the year 2020, other disease-specific programs having similar goals of eradicating and eliminating diseases like malaria, might consider investing in general infectious disease surveillance following the polio example.     

Endgame for polio eradication? Options for overcoming social and political factors in the progress to eradicating polio

In 1988, the Global Polio Eradication Initiative (GPEI) was launched with the goal of eradicating polio by the year 2000. After 25 years, several dynamics still challenge this large public health campaign with new cases of polio being reported annually. We examine the roots of this initiative to eradicate polio, its scope, the successes and setbacks during the last 25 years and reflect on the current state of affairs. We examine the social and political factors that are barriers to polio eradication. Options are discussed for solving the current impasse of polio eradication: using force, respecting individual freedoms and gaining support from those vulnerable to fundamentalist ‘propaganda’. The travails of the GPEI indicate the need for expanding the Convention on the Rights of the Child to address situations of war and civic strife. Such a cultural and structural reference will provide the basis for global stakeholders to engage belligerent local actors whose local political conflicts are barriers to the eradication of polio. Disregard for these actors will result in stagnation of polio eradication policy, delaying eradication beyond 2018.     

Global polio eradication: Where are we in Europe and what next?

The world was never so close to reach the polio eradication: only 37 cases notified in 2016 in only three countries, but the game is not yet at the end. The risk of polio outbreaks in the EU is smaller than it has ever been in the past, but it is not so small that we can ignore it. The EU MS must remain alert and plan and prepare for managing polio events or outbreaks because of the possible dire consequences. The IPV only vaccination schedule universally applied in EU has achieved satisfactory coverage, but constantly leaving small accumulating pockets of susceptible individuals. Moreover the IPV only schedule is not an absolute barrier against poliovirus silent transmission as demonstrated in the recent Israel outbreak. The availability of annually revised S.O.P. from WHO GPEI on the identification and response of a polio event, without local poliovirus transmission or a polio outbreak with sustained transmission, helps and challenge EU countries to update their polio national preparedness plans. The EU/EEA area, in fact, is a peculiar area regarding the polio risk both for its vaccination policy, the large polio vaccines manufactures and the constant immigration from areas at polio high risk, but also EU include cultural and financial potentials crucial to sustain the polio end game strategy and reach the benefit of a world without polio risk. Poliovirus eradication will continue to be challenged as long as there is the worldwide presence of polioviruses in laboratories and vaccine production plants. Most of the world’s OPV vaccines are produced in the EU and many laboratories and research centers store and handle polio viruses. EU Member States are engaged actively in implementing the poliovirus biocontainment plans that are part of the polio eradication strategy and to certify the destruction of poliovirus strains and potentially contaminated biological materials.