一例脊髓灰质炎疫苗衍生病毒病例流行病学研究

目的分析疫苗衍生脊髓灰质炎病毒（VDPV）病例的发病原因并探索控制对策。方法对发生的1例VDPV病例进行个案调查，检测脊髓灰质炎、麻疹及艾滋病抗体，测定免疫功能，并定期采集标本分离病毒；对全县所有医院进行急性驰缓性麻痹（AFP）病例主动搜索；对适龄儿童开展121服脊髓灰质炎减毒活疫苗（OPV）接种率调查；对密切接触者和周围儿童进行粪便标本带毒率调查和脊灰、麻疹抗体检测以及免疫球蛋白测定。结果病例的临床诊断为X-连锁低／无丙种球蛋白血症，最终分类诊断为免疫缺陷脊灰疫苗衍生病毒病例，在中国是首次发现。病例持续排毒直到死亡。丙种球蛋白持续治疗13个月，并未阻断VDPV在病例体内的复制。病例发生后，在全县开展了两轮OPV强化免疫，继续保持高水平的常规免疫接种率，加强了对各级医疗的AFP监测工作。到目前未发现有VDPV引起的脊灰病例。结论该病例由VDPV引起，因免疫缺陷而持续排毒，采取消毒、OPV强化免疫及监测等措施，有效阻断VDPV的循环。

The Study on epidemic Characteristics of A Case Infected with Vaccine-derived Poliovirus

Objective To analyze the cause of vaccine-derived poliovirus(VDPV) case and explore the control approaches.Methods The VDPV case was investigated,whose polio,measles and HIV antibody as well as immunity function were detected and stool samples were collected regularly for poliovirus isolation.Meanwhile an active search for acute flaccid paralysis cases was conducted in case-oriented area and local hospitals.At the same time,the oral poliovirus vaccine(OPV) immunization coverage of children from local area.and the rate of carried poliovirus of stool samples from close contacts and healthy children were investigated.Their polio,measles antibody and immunoglobulin were detected.Results The clinical diagnosis of the case was X-Linked Agammaglobulinemia and fell into the category of immunodeficient vaccine-derived poliovirus case through classified diagnosis which was the first finding in China.The 40 stool samples collected in more than year after from paralysis(on July 31,2005) to death(on March 31,2007) were province illness to control center tested and showed that the polioviruses had been still releasing.It had been 13 months since the r-globulin treatment began but it could not interrupt the replication of polioviruses in guts.After the case occurred,OPV supplementary immunization activities were conducted in local area.High level of OPV vaccination coverage should be maintained,strengthened to all levels of medical AFP monitor work.The VDPVs did not cause circulation in local area.Conclusion The case was inpecled with VDPV and persistantly gonee the vrirus to onter enreironmort.Some measwres such as striliring reinforcing immunioation and mornitoring should be taken to effectivly interrupt the circulation of vdpvs.