Primary and booster vaccination with an inactivated poliovirus vaccine (IPV) is immunogenic and well-tolerated in infants and toddlers in China

IntroductionReplacing live-attenuated oral poliovirus vaccines (OPV) with inactivated poliovirus vaccines (IPV) is part of the global strategy to eradicate poliomyelitis. China was declared polio-free in 2000 but continues to record cases of vaccine-associated-poliomyelitis and vaccine-derived-poliovirus outbreaks. Two pilot safety studies and two larger immunogenicity trials evaluated the non-inferiority of IPV (Poliorix™, GSK Vaccines, Belgium) versus OPV in infants and booster vaccination in toddlers primed with either IPV or OPV in China.MethodsIn pilot safety studies, 25 infants received 3-dose IPV primary vaccination (Study A, www.clinicaltrial.gov NCT00937404) and 25 received an IPV booster after priming with three OPV doses (Study B, NCT01021293). In the randomised, controlled immunogenicity and safety trial (Study C, NCT00920439), infants received 3-dose primary vaccination with IPV (N = 541) or OPV (N = 535) at 2,3,4 months of age, and a booster IPV dose at 18-24 months (N = 470, Study D, NCT01323647: extension of study C). Blood samples were collected before and one month post-dose-3 and booster. Reactogenicity was assessed using diary cards. Serious adverse events (SAEs) were captured throughout each study.ResultsStudy A and B showed that IPV priming and IPV boosting (after OPV) was safe. Study C: One month post-dose-3, all IPV and ≥98.3% OPV recipients had seroprotective antibody titres towards each poliovirus type. The immune response elicited by IPV was non-inferior to Chinese OPV. Seroprotective antibody titres persisted in ≥94.7% IPV and ≥96.1% OPV recipients at 18–24 months (Study D). IPV had a clinically acceptable safety profile in all studies. Grade 3 local and systemic reactions were uncommon. No SAEs were related to IPV administration.ConclusionTrivalent IPV is non-inferior to OPV in terms of seroprotection (in the Chinese vaccination schedule) in infant and toddlers, with a clinically acceptable safety profile.     

不同浓度有机物对二氧化氯灭活脊髓灰质炎病毒的影响

目的研究有机物对二氧化氯灭活脊髓灰质炎病毒的影响。方法采用悬液定量灭活试验方法和细胞感染技术,对病毒悬液中小牛血清白蛋白影响二氧化氯灭活脊髓灰质炎病毒的效果进行了观察。结果用含量30 mg/L二氧化氯作用15 min,对含高浓度小牛血清白蛋白悬液中脊髓灰质炎病毒灭活对数值仅为0.22,对含低浓度小牛血清白蛋白悬液中脊髓灰质炎病毒灭活对数值为3.28。用含量为40 mg/L二氧化氯作用15 min,对含高浓度小牛血清白蛋白悬液中脊髓灰质炎病毒灭活对数值均4.00,对含低浓度小牛血清白蛋白悬液中脊髓灰质炎病毒灭活对数值均4.00。结论病毒悬液内含小牛血清白蛋白明显影响二氧化氯对病毒灭活效果,且随其浓度增加影响程度增加。     

Vaccine-associated paralytic poliomyelitis in an infant with perianal abscesses

We describe a case of vaccine-associated paralytic poliomyelitis (VAPP) in a 7-month-old infant with perianal abscesses. The infant had suffered from perianal abscesses from 3 weeks after birth. The abscesses repeatedly developed and spontaneously drained through the orifice. Twenty-seven days before admission, a live attenuated oral poliovirus vaccine (OPV) was given to the infant for the first time for routine immunization. His body temperature rose to 38°C 19 days after receiving the OPV and fell 4 days later. Flaccid paralysis of the right leg appeared 26 days after receipt of the OPV. A Sabin type 3 poliovirus was isolated from a stool obtained at admission. The DNA sequences of the VP1 region of the isolated virus were more than 99% identical with those of the vaccine strain. Mild muscle atrophy with moderate motor impairment in the right leg persisted at 18 months of age. One VAPP case provoked by a perianal abscess has been reported from the United Kingdom. Database search revealed that one of nine VAPP cases reported during 2003–2008 in Japan had a perianal abscess. Taken together, these reports and our case imply that we should give OPV with caution to infants with a perianal abscess.     

湖北省1995～1999年检出脊髓灰质炎疫苗株病毒的急性弛缓性麻痹病例流行病学分析

对湖北省1995～1999年分离到脊髓灰质炎（脊灰）疫苗株病毒的32例急性弛缓性麻痹（AFP）病例进行了流行病学分析。32例分布在25个县（市、区）,发病时间无明显的聚集趋势,≤3岁儿童占87.5％,未免疫和未全程免疫的占65.4％,Ⅱ型病毒占53.1％。32例中有2例可诊断为服苗相关病例,另有5例怀疑为疫苗接触者相关病例,其特点是①病例分散分布;②病例年龄均＜3岁;③临床特征有发热,非对称性弛缓性麻痹,临床诊断多为脊灰;④发病60天后仍残留麻痹。     

青海省1996～1999年脊髓灰质炎病毒学监测

目的：掌握消灭脊灰工作进展情况和不同人群中脊灰野病毒和消亡状态，为制定有效免疫策略提供依据。方法：在1996－1999年所有AFP病例和AFP病例密切接触，重点地区5岁以下健康儿童中，采集粪便标本776份检测脊灰病毒，应用2种以上敏感传代细胞培养，用基因序列分析方法判断病毒型别。结果：共检测脊灰病毒24株，非脊灰肠道病毒81株，分离率分别为3．09％与13．53％，经国家脊灰实验室和美国CDC最终鉴定：脊灰野病毒Ⅰ型2株，与印度1998年Ⅰ型野病毒符合率＞98％，判定由印度传入野病毒，其它脊灰病毒均为疫苗病毒。结论：1994年以来全省无本土脊灰野病毒流行，各项监测指标达到和接近国家要求，主实我省已阻断本土脊灰野病毒传播，达到无脊灰标准。传入野病毒的及时发现，反映出AFP病例监测系统敏感性和及时性较高，但该病例的发生提示局部地区存在着脊灰疫苗免疫空白或低接种率水平。     

江苏省脊灰病毒阳性AFP病例残留麻痹影响因素

目的 分析脊髓灰质炎(脊灰)病毒阳性、急性弛缓性麻痹(AFP)病例流行病学特征及其残留麻痹影响因素.方法 收集2004 - 2009年江苏省(AFP)病例1 548例,采集粪便标本1 540例,检测脊髓灰质炎病毒(PV),进行描述流行病学分析.结果 1 540例中,检出PV60例,检出率3.90％,均为脊灰疫苗相关株病毒;病例散在发生,男性多于女性;＜1岁组阳性病例均高于1～2岁和≥3岁组;＜1岁组、未服苗或服苗＜3次、服苗与麻痹时间间隔≤60d的PV阳性AFP病例残留麻痹率均较高;首次服苗并分离出混合型脊灰病毒的5例病例均残留麻痹;疫苗相关麻痹型脊灰(VAPP)总发生率为0.29/100万,首次服苗后为1.56/100万.结论 江苏省仍有一定数量的脊灰疫苗株阳性病例和疫苗相关麻痹型脊灰(VAPP)病例发生;年龄、服苗史、服苗与麻痹时间间隔是残留麻痹的主要影响因素.     

河南省2009年急性弛缓性麻痹病原流行病学分析

目的了解河南省2009年急性弛缓性麻痹病例的监测情况。方法采集532例AFP病例标本,进行病原流行病学分析。结果分离到PV15株,阳性率为2.82%,其中PVⅡ型占所有分离PV的40%;分离到NPEV118株,阳性率为22.2%;口服脊灰减毒活疫苗＂零＂剂次免疫的AFP病例的PV分离率依次高于12次和≥3次免疫者;79例60d后随访残留麻痹的病例PVⅡ分离率为7.59%。结论 AFP病例实验室监测系统是敏感的,做好OPV常规免疫和强化免疫同样重要,PVⅡ对部分未完成全程免疫的AFP病例是一种潜在的致麻痹病因。     

山东省临沂市1956-2002年消灭和防控脊髓灰质炎回顾性分析

目的　了解临沂市脊髓灰质炎 (脊灰 )的流行状况及控制效果。方法　按照《全国 1 996— 2 0 0 0年消灭脊髓灰质炎行动计划》等文件要求进行。结果　 1 956— 1 991年全市脊灰共发病 4 81 7例 ,年均发病率为 1 .47/ 1 0万 ;1 991年以来脊灰疫苗常规免疫、强化免疫接种率达 95 %以上 ;1 5岁以下儿童急性迟缓性麻痹 (AFP)监测报告年均发病率在 1 / 1 0万以上 ,报告、调查、采便送检、随访及时率达80 %以上 ;免疫成功率 :调查 435名初免儿童 ,Ⅰ、Ⅱ、Ⅲ型脊灰中和抗体阳转率为 88.0 5 %～ 94.94%。免疫水平 :调查 50 3名健康人群 ,Ⅰ、Ⅱ、Ⅲ型脊灰抗体阳转率分别为 91 .65 %、90 .0 6 %、88.0 7% ;抗体几何平均滴度 (GMT)分别为 1 4 6 .70、96 .47、88.1 4 ;采集AFP患者、密切接触者、健康人群粪便标本 1 653份 ,经病原学检测未检出脊灰野病毒株。结论　由于各项措施的落实 ,脊灰发病率大幅度下降 ,全市已连续 1 3年无脊灰野毒株引起的病例发生。     

安福县脊髓灰质炎免疫水平调查

本文报告了对安福县100名15岁以下人群采用ELISA法检测血清脊髓灰质炎(下称脊灰)IgG抗体,结果各型抗体阳性率均达100％,各型GmT(几何平均滴度)分别为Ⅰ型1:1058.88;Ⅱ型1:1246.66;Ⅲ型1:267.59。结合有关资料分析,认为安福县脊灰免疫状况较好,脊灰免疫预防工作成效显著。消灭脊灰证实工作有了免疫学依据。