Circulation and Molecular Epidemiology of Enteroviruses in Paralyzed,Immunodeficient and Healthy Individuals in Tunisia,a Country with a Polio-Free Status for Decades

This report is an overview of enterovirus (EV) detection in Tunisian polio-suspected paralytic cases (acute flaccid paralysis (AFP) cases), healthy contacts and patients with primary immunodeficiencies (PID) during an 11-year period. A total of 2735 clinical samples were analyzed for EV isolation and type identification, according to the recommended protocols of the World Health Organization. Three poliovirus (PV) serotypes and 28 different nonpolio enteroviruses (NPEVs) were detected. The NPEV detection rate was 4.3%, 2.8% and 12.4% in AFP cases, healthy contacts and PID patients, respectively. The predominant species was EV-B, and the circulation of viruses from species EV-A was noted since 2011. All PVs detected were of Sabin origin. The PV detection rate was higher in PID patients compared to AFP cases and contacts (6.8%, 1.5% and 1.3% respectively). PV2 was not detected since 2015. Using nucleotide sequencing of the entire VP1 region, 61 strains were characterized as Sabin-like. Among them, six strains of types 1 and 3 PV were identified as pre-vaccine-derived polioviruses (VDPVs). Five type 2 PV, four strains belonging to type 1 PV and two strains belonging to type 3 PV, were classified as iVDPVs. The data presented provide a comprehensive picture of EVs circulating in Tunisia over an 11-year period, reveal changes in their epidemiology as compared to previous studies and highlight the need to set up a warning system to avoid unnoticed PVs.     

康复训练联合高压氧治疗手足口病所致弛缓性麻痹的疗效研究

目的探讨康复训练联合高压氧治疗手足口病所致弛缓性麻痹的疗效。方法将70例手足口病所致弛缓性麻痹患儿随机分为治疗组和对照组,每组各35例。对照组予隔离、抗感染、营养支持、护脑、鼠神经生长因子穴位注射等常规治疗,治疗组在对照组基础上加用康复训练及高压氧。通过徒手肌力评定、日常生活活动能力(ADL)评定和FMA运动功能评分评定疗效。结果治疗组肌力恢复程度好于对照组,BI指数评分、FMA评分均高于对照组,差异有统计学意义(P0.05)。结论康复训练联合高压氧治疗手足口病所致弛缓性麻痹可明显提高麻痹肢体的肌力,提高患儿BI指数评分及FMA评分,减轻致瘫致残比例,提高患儿日常生活能力,其总体效果优于常规治疗。     

小儿脑瘫的推拿治疗

目的:观察推拿手法治疗小儿脑瘫的疗效.方法:选取背腰部穴区、头颈部穴区、四肢部穴区进行手法治疗;益气健脑、理筋整复.及早发现,及早诊断、及早治疗,达最佳治疗效果.结果:推拿手法可益气通经,健脑补肾,改善头部血液循环,促进血栓吸收,达到治病效果.结论:推拿手法治疗小儿脑瘫可以起到较好的效果,值得推广.     

2005年广西急性弛缓性麻痹病例流行病学分析

目的 了解2005年广西急性弛缓性麻痹(AFP)病例监测系统运转状况,进一步做好AFP病例监测,巩固无脊髓灰质炎(脊灰)成果.方法 采用描述性流行病学方法对广西2005年AFP监测数据进行分析.结果 2005年广西AFP监测系统共报告病例307例,其中AFP病例262例,非AFP病例45例.AFP病例中,经实验室标本检测和专家诊断小组诊断,260例被排除脊灰,2例为临床符合脊灰病例.＜15岁儿童非脊灰AFP病例报告发病率2.40/10万,82.70%的县报告AFP发病率＞1/10万;合格粪便标本采集率为90.50%;12例病例分离出脊灰疫苗病毒,脊灰疫苗病毒分离率为4.62%;分离出其他肠道病毒25例,肠道病毒分离率为9.62%;AFP病例监测系统各项指标均达到要求.首诊报告率为76.72%,但乡村级仅为36.46%;8.01%的病例未完成全程免疫,零剂次儿童占总病例的2.67%. 结论 广西仍需进一步加强常规免疫,提高AFP监测敏感性和乡村级首诊报告率.     

铁岭市2001-2010年急性弛缓性麻痹病例监测情况分析

目的分析铁岭市2001-2010年急性弛缓性麻痹(AFP)病例监测情况,保持全市无脊髓灰质炎(脊灰)状态。方法对2001-2010年全市报告的AFP病例进行描述流行病学分析。结果 2001-2010年铁岭市共报告AFP病例69例,无脊灰确诊病例,AFP病例报告发病率在1.17/10万~2.16/10万之间。各县(市、区)年均报告发病率在1.02/10万~3.94/10万之间,其中昌图县有5年报告发病率未达到1/10万的标准。下半年报告病例49例,占71.01%。AFP发病者中以5岁以下儿童为主,占53.62%。病例中服苗史≥3剂次53例,占76.81%。合格粪便样本采集率为92.75%。从3例AFP病例粪便样本中分离到非脊灰肠道病毒,分离率为4.35%。结论铁岭市AFP病例监测系统各项指标,以市为单位,均达到国家标准。为保持无脊灰状态,应保持高水平脊灰疫苗免疫接种率,提高AFP病例监测系统质量。     

运用Topsis法综合评价湖南省AFP病例监测质量

目的尝试运用Topsis法对湖南AFP病例监测质量进行综合评价，并探讨引入县级AFP病例报告合格率这一指标评价市州监测质量的可行性。方法运用Topsis法对湖南省1994—2005历年的AFP监测8个指标进行纵向评价，并引入AFP病例报告县级报告合格率共六个指标对各市州在2001—2005年间的监测质量进行横向评价。结果全省以1999年监测质量最好，2005年次之，1994年最差；在全省14个市州中，运用五个指标评价，结果是株洲最优、长沙次之，如果六个指标评价则长沙最优、娄底次之；张家界的监测质量最差。结论Topsis法可用于AFP病例监测质量评价，结果客观，公平；县级报告合格率这一指标可用于对省、市州级AFP病例监测质量评价。     

湖南省2003年保持无脊髓炎质炎状态进展

目的　提高急性弛缓性麻痹 (AFP)病例监测系统工作质量 ,保持无脊髓灰质炎 (脊灰 )状态。方法　按照卫生部《全国 2 0 0 3～ 2 0 1 0年保持无脊灰状态行动计划》的要求 ,开展口服脊灰疫苗 (OPV)常规免疫、强化免疫和AFP病例监测工作。结果　 2 0 0 3年报告 1 99例AFP病例 ,分布在 1 4个市 (州 )的 84个县 (区、市 ) ,<1 5岁儿童非脊灰AFP病例报告发病率 1 4 3/ 1 0万 ,合格粪便标本采集率 85 9% ,粪便标本及时送检率 96 0 % ,随访表及时送达率94 5%。OPV常规免疫报告接种率 96 5% ,加强免疫接种率为 95 8% ,OPV查漏补种活动第 1轮接种率为92 8% ,第 2轮 91 8%。结论　 2 0 0 3年AFP病例各项监测指标均达到世界卫生组织和卫生部无脊灰证实标准     

Acute flaccid paralysis in Australian children

OBJECTIVES: To describe the epidemiology and causes of acute flaccid paralysis (AFP) in Australian children, and the clinical features of the two most common causes of AFP, Guillain-Barré syndrome and transverse myelitis. METHODS: Monthly active surveillance for AFP was carried out through the Australian Paediatric Surveillance Unit, with AFP defined as 'acute onset of flaccid paralysis in one or more limbs or of bulbar paralysis in any child less than 15 years of age'. RESULTS: Between March 1995 and December 1999, 143 cases of AFP were reported (approximately 0.8 per 100000 children < 15 years of age per annum). The age range was 2 months-14 years and 59% were boys. Out of these children, 137 (96%) were hospitalized and 47 required intensive care. No case of wild or vaccine-associated poliomyelitis was identified. The most common causes of AFP were Guillain-Barré syndrome in 67 (47%) and transverse myelitis in 27 (19%). Other diagnoses included acute disseminated encephalomyelitis, trauma, tick-bite paralysis and infantile botulism. CONCLUSION: The participation of paediatricians in AFP surveillance contributed to the accreditation of Australia (along with the other 36 countries of the western Pacific region) as 'polio free' by the World Health Organization in October 2000. The surveillance also provided data on the frequency of AFP and identified Guillain-Barré syndrome and transverse myelitis as the most common diagnoses. In this large national series, many other conditions that may present as non-polio AFP were identified.     

北京市怀柔区1994-2005年急性弛缓性麻痹病例的流行病学分析

目的对怀柔区AFP监测系统的敏感性、及时性、完整性进行评价。方法对怀柔区1994-2005年AFP监测系统报告的11例急性弛缓性麻痹病例进行流行病学分析。结果病例呈散发分布,男女比例为7∶4,发病年龄以0-4岁儿童为主,格林巴利综合征6例,为AFP病例的主要病种,12年平均报告发病率2.16/10万,14 d内双份合格便采集率、标本3 d内送检率、病例监测报告及时率、60 d随访调查率均>90%;24 h调查率、病例摘抄及时率均100%。结论怀柔区AFP监测系统各项指标均达到WHO规定的标准,表明AFP监测系统运行良好,监测质量可靠。     

安徽省1993～1997年非脊髓灰质炎急性弛缓性麻痹病例流行病学分析

对安征省１９９３～１９９７年非脊髓灰质炎（脊灰）急性弛缓性麻痹（ＡＦＰ）病例进行了流行病学分析。结果显示，安徽省自１９９４年以来，非脊灰ＡＦＰ病例报告发病率一直在１／１０万以上，１９９３～１９８７年全省有半数的地区、市非脊灰ＡＦＰ病例年平均报告发病率达到１／１０万。非脊灰ＡＦＰ病例构成比，除了病因不明又无残留麻痹和其它非脊灰ＡＦＰ病例（指周期性麻痹、单瘫、肌病等），非脊灰肠道病毒（ＮＰＥＶ）感染、创伤性神经炎和格林巴利综合征（ＧＢＳ）依次为前三位，ＧＢＳ年平均发病率只有０．０８／１０万。非脊灰ＡＦＰ病例主要发生在０～４岁儿童，有明显的季节性分布，男性多于女性。提示我省仍然存在着监测薄弱地区和病例漏报现象，今后应继续加强ＡＦＰ病例监测，尤其在流行季节，并且重点侧重于小年龄儿童；抓好常规免疫，开展强化免疫，重点是流动儿童、超生儿童及偏远地区儿童；继续对临床医生加强培训，提高他们的报病意识及对ＡＦＰ病例的病因诊断能力，提高临监测系统的质量。