延安市消灭脊髓灰质炎工作的策略与效果分析

目的:评价延安市消灭脊髓灰质炎工作的策略与效果。方法:描述1956年以来脊髓灰质炎的发病状况和流行特征,分析不同时期该病防制策略。结果:随着脊灰疫苗的广泛使用,以及消灭脊灰活动的深入开展,延安市脊灰发病得到有效控制,发病率逐年下降,自1991年以来,已连续13年无确诊病例发生;主要采取常规免疫、强化免疫与扫荡免疫相结合,病例报告与主动监测相结合的防制策略。结论:延安市已阻断脊灰野病毒的传播;脊灰疫情控制后,免疫策略应作相应调整,以控制疫苗相关病例的发生。     

延安市消灭脊髓灰质炎的策略与效果分析

目的评价延安市消灭脊髓灰质炎工作的策略与效果,为保证消灭脊灰提供依据。方法描述1956年以来脊髓灰质炎的发病状况和流行特征,分析不同时期该病防制策略。结果随着脊灰疫苗的广泛使用,以及消灭脊灰活动的深入开展,延安市脊灰发病得到有效控制,发病率逐年下降,自1991年以来,已连续14年无确诊病例发生;防治对策主要采取常规免疫、强化免疫与扫荡免疫相结合,病例报告与主动监测相结合。结论延安市已阻断脊灰野病毒的传播;脊灰疫情控制后,免疫策略应作相应调整,以控制疫苗相关病例的发生。     

茌平县消灭脊髓灰质炎策略及效果分析

[目的]了解茌平县消灭脊髓灰质炎防治策略及效果。[方法]描述 1950 年以来脊髓灰质炎发病趋势,分析脊灰疫苗计划免疫各类报表和急性驰缓性麻痹病例监测报表。[结果]随着脊灰疫苗的广泛使用和消灭脊髓灰质炎活动的深入开展,茌平县脊灰发病率逐年下降,1990年以来已无确诊病例发生。主要防治策略是在常规免疫的基础上,开展强化免疫;加强免疫监测和急性驰缓性麻痹病例的监测。[结论]茌平县已连续 14 年无脊灰野病毒的传播,以后应重点消除脊灰疫苗免疫空白[1],进一步提高急性驰缓性麻痹病例监测系统的敏感性。     

浙江省消灭脊髓灰质炎成果评价

目的　评价浙江省消灭脊髓灰质炎成果。方法　对全省脊髓灰质炎疫情、免疫措施和监测系统运转情况进行分析评价。结果　儿童脊灰疫苗免疫覆盖率不断提高 ,加上近年开展强化免疫活动 ,已形成有效的免疫屏障 ,阻断了野病毒的传播 ;建立AFP病例监测系统后 ,加强病例报告和监测 ,不断提高监测工作质量 ,1992年以来未发现脊灰野病毒病例 ,已达到无脊灰状态。结论　加强常规免疫工作 ,是消灭脊髓灰质炎的基础。开展高质量强化免疫活动是阻断野病毒传播和消灭脊髓质炎的必要补充。监测是消灭脊髓灰质炎十分重要的策略之一。     

无锡市控制和消灭脊髓灰质炎现状

目的 通过对无锡市控制与消灭脊髓灰质炎（下称脊灰）的现状分析，提出要继续保持高水平的急性驰缓性麻痹（AFP）病例监测系统敏感性，特别要作好流动儿童常规免疫和强化免疫工作，及时发现、应对各种野病毒输入情况，才能巩固无脊灰成果。方法 根据对该市人群免疫水平、疫苗免疫原性监测及15岁以下儿童的（AFP）病例监测系统的敏感性评价等分析该市控制与消灭脊灰的现状。结果 控制与消灭脊灰的现状分析结果表明，人群有较好的免疫水平，AFP监测系统敏感；但是，免疫空白的外来儿童是控制和消灭脊灰的薄弱环节，应引起高度重视。结论 该市的控制和消灭脊灰的现状表明，从上世纪印年代使用脊灰疫苗（OPV），特别是实施儿童计划免疫以来，接种率和人群免疫状况维持和稳定在较高水平。上世纪90年代脊灰发病已得到有效控制，已连续15a无脊灰野毒病例报告。要继续保持高水平的AFP病例监测系统敏感性，特别要作好流动儿童常规免疫和强化免疫工作，及时发现和应对野病毒的输入，才能巩固无脊灰成果。     

珠海市消灭脊髓灰质炎免疫策略分析

珠海市消灭脊髓灰质炎免疫策略分析广东省珠海卫生局（５１９０００）林鸿烈，陈琦珠海市自１９６４年开始使用糖丸疫苗接种以来，经过几十年的努力，脊灰病例已得到有效控制，已连续１６年无脊灰病例报告，通过近年来的主动监测表明，我市已接近消灭脊灰的水平。１糖丸免...     

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…     

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。     

南平市20年来消灭脊髓灰质炎综合预防控制结果与效益分析

[目的]评价南平市消灭脊髓灰质炎(脊灰)工作的效果与效益。[方法]描述1955年以来脊髓灰质炎的发病状况和流行特征;分析从1983年来正式实施脊灰免疫、强化免疫、应急接种对消灭脊灰所取得的效果和经济效益。[结果]南平市脊灰发病得到有效控制,发病率逐年下降,自1994年后已连续10年无脊灰确诊病例发生;所得总效益为3477万元,总投入的成本费为724．64万元,效益为成本的4．8倍。[结论]使用疫苗消灭脊灰有良好的社会效益和经济效益。     

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…     

End phase challenges of poliomyelitis eradication programme realization

The progress of poliomyelitis eradication programme realization, the implementation schedule and strategies for the future, are summarised based on publications of the World Health Organisation. During the following two years wild poliovirus strains should be globally eradicated. This means that potentially in 2010 the global eradication of wild polioviruses will be certified. To eradicate poliomyelitis, cessation of the oral polio vaccine (OPV) is necessary, since the vaccine strains produce cases of vaccine-associated paralytic poliomyelitis (VAPP) and cases of poliomyelitis caused by circulating vaccine-derived poliovirus (cVDPV). However, the WHO plan to stop immunization with OPV and the immunization with inactivated polio vaccine (IPV) shortly after, is alarming in the present situation. The article describes the measures undertaken to prevent or minimise the risk of reintroduction of wild poliovirus strains, which is potentially associated with WHO plan of action.     

脊髓灰质炎疫苗应用现状及免疫策略进展

1988年,全球消灭脊髓灰质炎（脊灰）倡议行动启动以来,取得了重大进展。2012年,全球报告脊灰223例,较2011年减少〉60%,本土脊灰流行国家减少为尼日利亚、巴基斯坦和阿富汗,脊灰野病毒（Wild Poliovirus,WPV）病例数下降到历史最低水平。但WPV传播仍未被阻断,无脊灰国家/地区仍面临输入WPV的风险。同时,有些国家正面临使用口服脊灰减毒活疫苗（Oral Poliomyelitis Attenuated Live Vaccine,OPV）所致疫苗衍生脊灰病毒的风险。目前,不同国家/地区评估各自的脊灰发病风险,依据OPV、脊灰病毒灭活疫苗（Inactivated Poliovirus Vaccine,IPV）的风险和收益,不同国家/地区采用不同的免疫策略：仅使用IPV、序贯使用IPV/OPV和仅使用OPV。2013年,世界卫生组织《全球消灭脊灰终结战略计划》中提出,2014年全球阻断WPV传播,2015年所有国家应至少使用1剂IPV,停用OPV中的Ⅱ型组分;2018年完成消灭WPV证实后,停用OPV。现对OPV和IPV的应用现状以及免疫策略进行简述。     

Poliomyelitis control in Israel, the West Bank and Gaza Strip: changing strategies with the goal of eradication in an endemic area.

Israel has faced the challenge presented by epidemic poliomyelitis by using different immunization strategies. In the 1950s, inactivated poliovirus vaccine (IPV) helped to reduce the total burden of the disease, but cases continued to occur. Introduction of oral poliovirus vaccine (OPV) in mid-1961 had a dramatic effect in controlling an extensive epidemic of poliomyelitis; however, poliovirus activity and cases continued during the 1970s, and at a low level in the 1980s. A localized outbreak of 15 cases of poliomyelitis in 1988 occurred in an area using enhanced potency IPV (eIPV) only. This led to a revision of poliomyelitis immunization policy. The successful poliomyelitis control in the West Bank and the Gaza Strip using both OPV and IPV since 1978 shows the advantages of a combined approach. This programme was therefore adopted in modified form in the whole of Israel, the West Bank and Gaza. Since late 1988, no cases of poliomyelitis have occurred in any of these three areas, indicating the success of the combined poliomyelitis immunization programme. These experiences may be helpful to other countries, especially those where there is a danger of importation of wild poliovirus, and to prevent vaccine-associated disease. The combined approach provides an additional immunization model in the international effort to eradicate poliomyelitis.     

Efficacy of oral poliovirus vaccine in rural communities of North Arcot District, India

The protective efficacy of three doses of oral poliovirus vaccine (OPV) was measured in children under five in the rural blocks of North Arcot District. In 1988, a sample survey of 7% of the total population of the district (population five million) was conducted to determine the immunization coverage with OPV and the incidence of paralytic poliomyelitis in under-fives in the previous 12 months, (n = 42,045). For every case of poliomyelitis, all children matched for exact age in months resident within the same block were taken as controls. Some 67 children had poliomyelitis (prevalence of lameness 1.59/1000, estimated annual incidence 2.57/1000 under-fives). Among cases and controls 24 and 42%, respectively, had received three doses of OPV, while 44 and 33% had received none. In a case-control analysis, the vaccine efficacy (VE) was 62% for all under-fives; for the 12-23 months age group it was 71.4%. For a vaccine with the potential of near 100% VE, this is disappointingly low. Obviously, not only the immunization coverage level, but also the VE should be enhanced if poliomyelitis is to be controlled in India. This may be achieved by a five-dose OPV schedule, annual OPV immunization campaigns in addition to the routine three-dose schedule or by using inactivated poliovirus vaccine of enhanced potency.     

Strategies of Poliomyelitis Eradication and Analysis on Its effects in Anhui Province

安徽省 1988年启动消灭脊髓灰质炎 (以下简称脊灰 )工作 ,在落实保证措施的基础上 ,重点实施了免疫接种和疾病监测策略。 19882 0 0 0年全省共使用了脊灰疫苗 (OPV) 1.5亿人份 ,接种儿童 140 0余万人 ,每名儿童接种 412次 ,每年各县 (市、区 )的适龄儿童OPV接种率均在 90 %以上。全省建立健全了急性弛缓性麻痹 (AFP)病例监测系统 ,各项监测指标均达到卫生部的要求 ;19912 0 0 0年全省共报告和调查了 1987例AFP病例 ,检测AFP病例及其接触者标本 3 70 1份 ,1992年以后分离出的 117株脊灰病毒送国家脊灰实验室进行型内鉴定 ,均为疫苗相关株。 1992年以来 ,全省无脊灰野病毒引起的病例 ,有效地保护了儿童身体健康。 2 0 0 0年世界卫生组织西太区宣布本区为继美洲区后第二个无脊灰地区 ,说明安徽省已成功地阻断脊灰野病毒的传播。     

Eradication of poliomyelitis in Cuba: a historical perspective.

The eradication of poliomyelitis in Cuba, for which effective vaccines had to be acquired, is reviewed in this article. The strategy for eradication was based on mass immunization campaigns for the annual delivery of two doses of trivalent Sabin oral poliovirus vaccine (OPV). Except during the first campaign in 1962, the ages of the children for immunization were determined through national serological surveys of the entire country, including rural and urban areas. The interruption of wild virus transmission had been suspected since 1967 in Cuba, and since 1970 no studies have detected any wild virus. The important role of political and social organizations in the success of the programme and in the execution of the mass immunization campaigns is underscored. Countries that have successfully interrupted poliovirus circulation should maintain high immunization coverage for as long as there are other countries in the world where poliovirus still exists.     

Risk of vaccine-associated paralytic poliomyelitis in Latin America, 1989-91.

A major factor influencing the success of poliomyelitis eradication in the Americas was the reliance on mass immunization campaigns with oral poliovirus vaccine (OPV). As global poliomyelitis eradication activities accelerate and campaign vaccine delivery strategies are applied elsewhere, it is critical to determine whether the risk of vaccine-associated paralytic poliomyelitis (VAPP) is altered when routine delivery strategies are supplemented with mass immunization campaigns. We analysed all 6043 cases of acute flaccid paralysis (AFP) reported in Latin America over the period 1989-91 in order to estimate the risk of VAPP. The overall risk was estimated to be one case per 1.5-2.2 million doses of OPV administered, compared with one case per 1.4 million doses administered in England and Wales (1985-91) and with one case per 2.5 million net doses distributed in the USA (1980-89). These data suggest that to eradicate poliomyelitis globally, strategies that rely on mass immunization campaigns to supplement routine delivery services, as recommended by WHO, do not appear to alter significantly the risk of VAPP.     

Paralytic poliomyelitis associated with Sabin monovalent and bivalent oral polio vaccines in Hungary

Historical records of patients with vaccine-associated paralytic poliomyelitis (VAPP) in Hungary during 1961-1981 were reviewed to assess the risk of VAPP after oral polio vaccine (OPV) administration. A confirmed VAPP case was defined as a diagnosis of paralytic poliomyelitis and residual paralysis at 60 days in a patient with an epidemiologic link to the vaccine. Archived poliovirus isolates were retested using polymerase chain reaction and sequencing of the viral protein 1 capsid region. This review confirmed 46 of 47 cases previously reported as VAPP. Three cases originally linked to monovalent OPV (mOPV) 3 and one case linked to mOPV1 presented after administration of bivalent OPV 1 + 3 (bOPV). The adjusted VAPP risk per million doses administered was 0.18 for mOPV1 (2 cases/11.13 million doses), 2.96 for mOPV3 (32 cases/10.81 million doses), and 12.82 for bOPV (5 cases/390,000 doses). Absence of protection from immunization with inactivated poliovirus vaccine or exposure to OPV virus from routine immunization and recent injections could explain the higher relative risk of VAPP in Hungarian children. In polio-endemic areas in which mOPV3 and bOPV are needed to achieve eradication, the higher risk of VAPP would be offset by the high risk of paralysis due to wild poliovirus and higher per-dose efficacy of mOPV3 and bOPV compared with trivalent OPV.