Polio eradication in India: current status

India has reached the final stage of polio eradication. The polio partnership in India, under the leadership of the Government of India, mounted tremendous response to the outbreak. The progress since 2003 is the most significant in the history of polio eradication in India. Surveillance sensitivity was increased to reach the goal for polio eradication. Since nearly all polio cases now occurring in India are caused by type 1 poliovirus in children, monovalent oral polio vaccine type 1 (mOPV1) was introduced in select high-risk districts of UP, Bihar and Mumbai-Thane during the April and May 2005 National Immunisation Days and the June and August 2005 in 6 sub-national immunisation rounds. Strategies were also being implemented to improve the impact of supplementary immunisation activities in the high-risk areas. As a result of supplementary immunisation activities targeted using surveillance data, India has made striking progress towards polio eradication.     

Surveillance for polio eradication: current status and lessons learnt--India, 1999

With the launch of the Universal Immunisation Programme in India in 1985, childhood immunisation was provided to children in all districts of the country in a phased manner by 1990. Surveillance for vaccine preventable diseases (VPD) including polio was started at the same time with monthly reporting from the districts to the Ministry of Health and Family Welfare (MOHFW), Government of India (GOI). In 1995, the Pulse Polio Immunisation (PPI) campaign was launched with the objective of polio eradication. Prior to 1997, surveillance for polio was directed at finding clinical polio cases by passive reporting from health facilities. There was no active surveillance for all cases of acute flaccid paralysis (AFP). In 1996, a scheme for the surveillance of AFP was drawn up. With the support of the Danish and US governments and Rotary International, 59 surveillance medical officers (SMOs) were hired, trained, and posted throughout the country in October 1997 to establish active surveillance of AFP. The number of SMOs was increased to 108 in August 1999. The SMOs along with their government counterparts established 10,069 reporting units nationwide by the end of November 1999 reporting weekly the occurrence of AFP cases to the district, state, and national levels; timely case investigation and collection of stool specimens from AFP cases; linkages to support the polio laboratory network; and extensive training of government counterparts. Data reported to the national level is analysed and put on an internet website which is updated every two weeks. Annualised rates of reported non-polio AFP have increased from 0.22 per 100,000 children aged < 15 years in 1997 to 1.57 in 1999. The number of polio cases associated with isolation of wild poliovirus decreased from 1404 in the third trimester of 1998 to 664 in the third trimester of 1999, yet widespread transmission of wild polioviruses persists throughout the country.     

内蒙古自治区2007年急性弛缓性麻痹病例监测系统运转情况分析

目的为提高内蒙古自治区急性弛缓性麻痹(AcuteFlaccidParalysis,AFP)病例监测系统工作质量,继续保持无脊髓灰质炎(脊灰)状态。方法对2007年内蒙古AFP病例监测系统报告的病例进行描述流行病学分析,对监测系统运转情况进行评价。结果2007年内蒙古自治区AFP病例监测系统共报告病例73例,分布在12个盟(市,下同)的44个旗(县、区,下同)中,占全自治区总旗数的43.6%。<15岁儿童非脊髓灰质炎(脊灰)AFP病例报告发病率为1.5/10万,报告后48h内调查率98.6%,合格粪便标本采集率为89.0%,粪便标本7天内及时送检率91.5%,随访表75d及时送达率为89.5%。结论内蒙古自治区AFP病例监测系统各项指标均达到世界卫生组织(WHO)和卫生部的要求,但个别地区监测质量下降,监测工作发展不平衡,应继续加强培训和主动监测工作,进一步提高监测系统的监测质量。     

Polio outbreak response in Ethiopia

BACKGROUND: Ethiopia had been polio-free for almost four years until December 2004. However, between December 2004 and February 2006, 24 children were paralysed as a result of infection with wild poliovirus imported from the neighbouring country of Sudan. In response, the country has attempted to document the impact of various response measures on the containment of wild poliovirus transmission. OBJECTIVES: This study aims at systematic and epidemiological assessment of the extent of the outbreak, its determinants, and the lessons learned as well as the implications for future control strategies to interrupt wild poliovirus transmission. DESIGN: A cross-sectional study design with qualitative and quantitative data collection approaches was used to conduct the epidemiologic assessment. SUBJECTS: All confirmed wild poliovirus cases, and reported acute flaccid paralysis cases in close proximity to the confirmed polio cases were the study subjects. Child caretakers and health service providers were interviewed as part of the investigation. RESULTS: Between December 2004 and February 2006, eight children from Tigray Regional State, nine children from Amhara Regional State and seven children from Oromia Regional State were paralysed as a result of infection with wild poliovirus type 1. Genetic sequencing demonstrated two separate importations to Ethiopia. Risk factors that may have facilitated spread of the outbreak within the country included gaps in vaccination coverage and interruption of the cold chain system, gaps in acute flaccid paralysis surveillance performance, high population mobility, poor environmental sanitation, crowded living conditions and unsafe drinking water. In response to the outbreak, Ethiopia conducted detailed outbreak investigations within two days of confirmation of the index cases. Large-scale, house-to-house vaccination campaigns were also implemented. As a result, the three regions interrupted the wild poliovirus transmission within the regions within one year of confirmation of the index case. CONCLUSION: Outbreak response activities were successful in interrupting the imported wild poliovirus transmission in Tigray, Amhara and Oromia Regional States of Ethiopia within a one-year period of time. In Ethiopia, programme strategies should be intensified to contain further spread and prevent future importation of wild poliovirus. Large-scale immunisation campaigns should reach every child, including those isolated by geography, poverty and security.     

菏泽地区1998年急性驰缓性麻痹监测分析

本文对菏泽地区1998年急性弛缓性麻痹(AFP)监测进行了报告和分析。菏泽地区1998年共报告AFP42例,无脊灰确诊病例,有1例脊灰临床符合病例,有5例临床脊灰(高度怀疑疫苗相关病例);42例AFP分布于全区的9县市,呈散发;15岁以下儿童非脊灰AFP报告发病率为1.542/10万;AFP病例48小时内调查率为94.7％,14天内合格粪便标本采集率为82.3％;从AFP病例及接触者粪便标本中从未分离出脊质野病毒,而分离出脊疫苗病毒和COX、ECHO等其它肠道病毒,AFP标本脊灰疫苗病毒和其它肠道病毒阳性率均为15.79％;引起AFP的原因是多种的。我区AFP监测及消灭脊灰工作得了很大进展,但有不足之外,如就诊48小时内及时报告完成率等仍较低。建议仍应加强AFP监测和诊断,消灭脊灰工作仍需努力。     

内蒙古自治区2006年急性弛缓性麻痹病例监测状况评价

目的为了评价当前内蒙古自治区急性弛缓性麻痹(AFP)病例监测状况,提高监测系统质量,巩固无脊髓灰质炎成果。方法采用描述流行病学方法对2006年内蒙古自治区AFP病例监测系统报告的病例进行流行病学分析,对监测系统运转情况进行评价。结果2006年内蒙古自治区AFP病例监测系统共报告病例87例,分布在11个盟(市)的53个旗(县、区)中,占全自治区总旗数的52.5%。<15岁儿童非脊灰AFP病例报告发病率为1.8/10万,受地区条件限制,粪便标本7天内送达自治区脊灰实验室及时率未达到80%,其它监测指标均达到世界卫生组织(WHO)和卫生部的要求。结论今后应继续加强AFP病例监测和免疫工作,直到全球消灭脊灰。     

内蒙古自治区2009年急性弛缓性麻痹病例监测系统运转情况分析

目的为提高内蒙古自治区急性弛缓性麻痹(AFP)病例监测系统工作质量,继续保持无脊髓灰质炎(脊灰,下同)状态。方法对2009年内蒙古AFP病例监测系统报告的病例进行流行病学分析,对监测系统运转情况进行评价。结果 2009年内蒙古自治区AFP病例监测系统共报告病例60例,分布在11个盟(市,下同)的33个旗(县、区,下同)中占全自治区总旗数的32.7%(33/101)。15岁儿童非脊髓灰质炎(脊灰)AFP病例报告发病率为1.24/10万,报告后48h内调查率96.7%,合格粪便标本采集率为88.3%,粪便标本7d内及时送检率98.3%,随访表75d及时送达率为91.8%。结论内蒙古自治区AFP病例监测系统各项指标均达到世界卫生组织(WHO)和卫生部的要求,但个别地区监测质量下降,监测工作发展不平衡,应继续加强培训和主动监测工作,进一步提高监测质量,防止脊灰的死灰复燃。     

江门市脊髓灰质炎野病毒输入与传播风险评估

目的评估江门市各辖市区脊髓灰质炎野病毒输入与传播风险，科学指导制定预防控制策略。方法根据输入风险、AFP病例监测、人群免疫情况等指标综合分析评价，评估江门市各市区脊灰野病毒输入与传播的风险。结果2009—2011年报告35例AFP病例．报告后48h内调查率为97．14％；各市区脊灰疫苗接种率和脊灰疫苗快速评估接种率均≥95％：2010年随机抽查56人进行脊灰抗体检测，脊灰I型、Ⅱ型、Ⅲ型IgG抗体阳性率分别为91．07％、94．64％、92．86％。3年麻疹平均发病率为0．51／10万，最高的是蓬江区2．21／10万，其他市区均〈1／10万；开平市、江海区风险评估的综合评分为45、42分，为高风险地区。结论江门市存在脊灰野毒株输入的风险，各市区尤其是高风险市区应完善AFP病例监测工作。     

广东省汕头市2010—2019年急性驰缓性麻痹病例监测系统运转情况

目的 分析汕头市2010—2019年急性驰缓性麻痹（acute flaccid paralysis, AFP）病例监测系统运转情况,及时发现存在的问题,防范输入性脊髓灰质炎（简称脊灰）野病毒病例发生,为脊灰防控提供科学依据。方法 采用描述性流行病学方法、中国免疫规划监测信息管理系统和Excel 2007等软件对汕头市2010—2019年AFP病例监测数据进行分析,并对AFP监测系统运转情况进行评价。结果 汕头市2010—2019年共报告AFP病例273例,2010年报告发病率最低,为1.60/10万;2011年报告发病率最高,为3.19/10万;年均报告发病率2.22/10万,报告273例均为非脊灰病例,无脊灰野病毒病例和疫苗衍生脊灰病毒病例;273例AFP病例分布于全市7个区县,病例地区分布没有明显聚集性;273例AFP病例发病年龄最大14岁,最小3个月龄,以1~<5岁组发病率较高,共有142例,占总病例的52.01%;273例AFP病例中男性170例,女性103例,男女比例为1.65∶1,男性报告发病率高于女性,男女发病差异有统计学意义（χ²=16.44、P<0.05）;每月均有病例报告,以5月份发病最多,共31例（占11.36%）,发病无明显时间聚集性;273例AFP病例中服苗3次以上者263例（占96.34%）,服苗未达3次者10例（占3.66%）;273例AFP病例中有269例AFP病例采集到双份合格粪便标本,合格粪便标本采集率98.53％,均未分离到脊灰病毒。结论 汕头市2010—2019年来的AFP监测系统运转良好,监测系统敏感性和及时性的各项监测指标均达到国家要求,为巩固无脊灰成果,应保持高水平脊灰疫苗免疫接种率,强化医务人员报告意识,提高AFP病例监测系统质量。     

福州市2005～2010年急性弛缓性麻痹病例监测分析

目的 分析福州市急性弛缓性麻痹(AFP)病例流行病学特征,评价AFP监测系统.方法用描述流行病学方法 分析全市AFP病例监测系统上报的个案调查表和病毒检测结果,按照国家监测指标评价间隙系统的敏感性.结果 福州市2005 ～2010年共报告AFP病例125例,15岁以下儿童AFP平均报告发病率为1.53/10万;福...     

深圳市2001-2011年残留麻痹的急性弛缓性麻痹病例情况分析

目的了解深圳市2001-2011年残留麻痹的继续弛缓性麻痹(acute flaccid paralysis,AFP)病例流行病特征,提高AFP监测质量。方法对深圳市2001-2011年残留麻痹AFP病例个案资料和病原学检测结果进行描述性流行病学分析。结果深圳市2001-2011年共报告残留麻痹AFP病例60例,主要发生在小年龄组儿童,<3岁的儿童40例,占66.67%;发病高峰为4～8月,男女比例为1.61∶1;麻痹部位以双下肢麻痹较多,其次为四肢肢体麻痹;残留麻痹的AFP病例以疫苗相关病例(VAPP)和格林巴利综合征(GBS)为主,其次为横贯性脊髓炎、创伤性神经炎等。结论 VAPP的发生是接种脊髓灰质炎减毒活疫苗(OPV)难以克服的弱点,为减少VAPP病例及防止脊灰疫苗衍生病毒(VDPV)的发生,应在消灭脊灰后期科学、合理地调整消灭脊灰的免疫策略。     

海南省2005～2009年急性弛缓性麻痹病例病原学监测分析

目的分析海南省2005—2009年急性弛缓性麻痹（AcuteFlaccidParalysis,FP）病例及其密切接触者病原学监测结果,为维持无脊髓灰质炎（脊灰）状态提供病原学依据。方法按照世界卫生组织（WHO）规定的方法,用RDa和L20B细胞对AFP病例及其密切接触者的粪便进行病毒分离和鉴定。结果2005～2009年从AFP病例及其密切接触者966份粪便标本中分离到33株脊髓灰质炎病毒（PV）毒株,非脊灰肠道病毒（NPEV）196株;33株PV毒株中PVI型8株、PVⅡ型6株、PVⅢ型5株、PV混合型（Pmix）13株、PV＋NPEV混合株1株。所有PV毒株经中国疾病预防控制中心国家脊灰实验室进行型内鉴定,均为脊灰疫苗相关株。结论海南省2005～2009年AFP病例及其密切接触者中未发现脊灰疫苗衍生毒株（VDPV）,且脊灰实验室监测系统各项监测指标都达到WHO的标准,表明海南省AFP病例的病原学监测敏感、高效。     

深圳市2004-2010年急性弛缓性麻痹病例监测分析及监测系统评价

目的进一步做好急性迟缓性麻痹(acute flaccid paralysis,AFP)监测,巩固无脊髓灰质炎成果。方法运用描述性流行病学方法对深圳市2004-2010年AFP监测病例进行分析,同时对该监测系统进行评价。结果深圳市2004-2010年共报告AFP病例134例,AFP病例报告发病率在1.09/10万～4.2/10万范围,AFP监测系统各项指标均达到国家监测方案的要求。134例中确诊脊灰野病毒0例、vapp病例0例,分离到Ⅰ型疫苗株1例(0.75%)、Ⅱ型疫苗株7例(5.22%)、Ⅲ型疫苗株2例(1.49%)、非脊灰肠道病毒13例(9.70%)。报告的134例病例中,无免疫史7例,占5.22%,失访2例,占1.49%。结论做好脊灰疫苗的常规免疫和AFP病例首诊报告及合格便标本的采集、继续保持AFP病例监测系统的敏感性是无脊灰证实阶段重要的工作。     

Polio switch strategy: An obituary in the making?

India was certified free of polio in 2014. Until now, the oral polio vaccine (OPV) was being used in India. As the OPV is a live vaccine, vaccine-associated paralytic poliomyelitis may occur after its use. The aim is to replace the OPV with injectable polio vaccine. The Polio Eradication and Endgame Strategic Plan 2013–2018 has been made to eradicate polio. A switch from the trivalent OPV (tOPV) to bivalent OPV (bOPV) has been undertaken in all countries since April 2016. tOPV vials have been withdrawn and replaced by bOPV. In addition, the inactivated polio vaccine (IPV) has been introduced. The next step would be to remove the type 3 virus component followed by complete cessation of the OPV and a final switch to the IPV. The timeline has been fixed as 2018–2019. Replacement of a vaccine may raise fears in the community that need to be addressed. Re-emergence of circulating vaccine-derived poliovirus after withdrawal of the tOPV may occur. Proper disposal of vaccine vials needs to be ensured. Proper training of vaccinators is important. All stakeholders need to be incorporated, and focus should be more on deprived populations. The switch marks a significant step towards the final goal of polio eradication. Finally, the importance of community participation cannot be overemphasized. Sustained surveillance is the key to prevent occurrence of cases in polio-free countries through importation.     

内蒙古自治区2008年急性弛缓性麻痹病例监测系统运转情况分析

目的通过分析2008年内蒙古自治区急性弛缓性麻痹(Acute Flaccid Paralysis,AFP)病例监测系统运转状况,不断完善监测系统并提高其工作质量,继续维持无脊髓灰质炎(脊灰)成果。方法对2008年内蒙古AFP病例监测系统报告的病例进行描述性流行病学分析,对监测系统运转情况进行评价。结果 2008年内蒙古自治区AFP病例监测系统共报告疑似病例67例,分布在12个盟(市,下同)所辖41个旗(县、区,下同)中,占全自治区总旗数的40.6%(41/101),15岁儿童非脊灰AFP病例报告发病率为1.38/10万,全区监测系统各项监测指标均达到世界卫生组织(WHO)和卫生部的要求。但是12盟市监测工作开展不平衡,有待继续提高。结论今后应继续加强培训和AFP病例监测工作,直到全球消灭脊灰。     

泉州市2002-2007年急性弛缓性麻痹病例的监测

目的了解泉州市2000-2007急性弛缓性麻痹(AFP)病例的发病情况、分布特征及AFP监测系统运转情况,为我市继续保持无脊髓灰质炎(脊灰)决策提供依据。方法采用回顾性调查方法,分析泉州市2002-2007年AFP病例个案调查表、随访表和实验室病毒学检测结果等资料。结果泉州市2002-2007年AFP病例监测系统共报告AFP病例183例,15岁以下儿童非脊灰AFP病例报告发病率为1.7/10万。AFP病例男女比为2.6∶1,以5岁小年龄组居多,全年各月分布无差异。报告AFP病例未完成OPV基础免疫及免疫史不详的病例分别占9.8%(18/183)和6.0%(11/183),其中181例为脊灰排除病例,2例为脊灰临床符合病例。AFP病例合格粪便标本采集率为96.2%(176/183),脊灰病毒分离率为4.0(7/176),其中6例为脊灰疫苗株,1例为脊灰疫苗高变异株。75d内随访及时率为99.4%(180/181)。结论2002-2007年泉州市无脊灰野病毒确诊病例,AFP病例监测系统各项指标均达到《全国急性弛缓性麻痹(AFP)病例监测方案》的要求,但适龄儿童的基础免疫工作仍需加强,还应加强临床医生的培训,提高A...     

2012～2013年长春市急性弛缓性麻痹病例监测结果分析

目的：评价长春市2012～2013年急性弛缓性麻痹（ AFP）病例监测系统的运转情况。方法：采用描述性流行病学方法进行AFP病例的数据分析，并评价AFP病例监测系统。结果：长春市2012～2013年共报告AFP病例43例，平均报告发病率为2．19/10万，48小时内调查及时率为100％，14天内双份合格粪便标本采集率为97．67％，标本7天内送检及时率为97．67％，省级实验室28天内病毒分离及时率为100％，病例75天内随访及时率为100％。结论：2012～2013年长春市AFP监测系统运转良好，各项指标均达到卫生部的要求。     

新疆和田地区脊髓灰质炎急性弛缓性麻痹8例神经电生理检查分析

目的:分析新疆和田地区脊髓灰质炎急性弛缓性麻痹神经电生理检查。方法:对8例脊髓灰质炎患者进行神经电生理检查周围神经传导速度(MNCV SNCV),针极肌电图、F反应。结果:8例中感觉神经传导速度(SCV)及感觉神经动作电位(SNAP)均正常。上肢正中神经、尺神经的F反应均正常,双下肢胫后神经F反应100%异常。亦为F反应未测出或F反应出波率减少。上肢正中神经、尺神经MCV均正常。双下肢胫后神经、腓神经MCV为100%异常,波幅明显降低或未引出。针极肌电图检测静息期可见少量至大量的纤颤电位、正锐波71.4%,与MNCV结果相比有显著意义(P<0.005)。结论:肌电图检查对脊髓灰质炎急性弛缓性麻痹的诊断提供重要依据。     

Plaque and growth characteristics of different polioviruses isolated from acute flaccid paralysis in Northern Nigeria

OBJECTIVE: To determine some virulent trait-related properties of poliovirus isolates from children with acute flaccid paralysis following vaccination with oral polio vaccine (OPV). DESIGN: Six polioviruses earlier characterised into wild, vaccine-derived and OPV-like were studied using the plaque morphology and growth kinetics at supra-optimal temperature. SETTING: Department of Virology, University of Ibadan, Nigeria. SUBJECTS: Polio isolates from six children who developed acute flaccid paralysis following vaccinations with various doses of OPV were used. All the children were located in the Northern part of the country where poliovirus is still circulating. MAIN OUTCOME MEASURES: The two vaccine-derived polioviruses acquired wild type characteristics. RESULTS: All the six poliovirus isolates developed different forms of plaques ranging from tiny, small and large. The plaque formed could however not be used to identify the different isolates. Growth of the different isolates at supra-optimal temperature showed that the three wild polioviruses grew to a higher titre when compared with the Sabin 2 control. The two vaccine derived isolates behaved like the wild poliovirus while the OPV-like virus acquired an intermediate characteristics between wild and sabin. CONCLUSION: The wild polioviruses represented in this study are among the last vestiges of the circulating polioviruses found in the world. It is possible that the observed biological properties of wild types 1 and 3 described in the study are typical of the West African polioviruses. These properties will provide useful previews to the final identification of some important clinical isolates especially type 1 which may grow rapidly in cell culture.     

红河州消灭脊髓灰质炎的策略与效果评析

目的分析红河州消灭脊髓灰质炎工作状况，为消灭脊髓灰质炎提供科学依据。方法制定免疫、监测、健康教育策略，对全州AFP病例监测、常规免疫监测、强化免疫活动情况进行分析。结果红河州消灭脊灰工作得到了各级政府的重视，1994年建立AFP监测系统，15岁以下儿童AFP病例报告发病率已连续5年达1／100000以上，60d随访及时率由50．00％提高到89．47％，粪便标本采集合格率由30．00％提高到84．21％；常规免疫、强化免疫接种率达90％以上，已连续10年无脊髓灰质炎野病毒病例发生。结论通过健康教育、常规免疫、强化免疫和实行AFP监测，红河州建立了敏感、可靠的监测系统和有效的儿童免疫屏障，阻断了脊髓灰质炎野病毒的传播，达到无脊髓灰质炎目标。