菏泽市疫苗衍生脊髓灰质炎病毒的应急处置措施

目的评价疫苗衍生脊髓灰质炎病毒（VDPV）应急处置措施的效果。方法在山东省卫生厅及山东省CDC的指导下,成立调查处理小组,制订调查提纲,研究控制措施,并深入现场调查,包括病例调查及免疫功能测定,所在地及医院急性弛缓性麻痹（AFP）病例主动搜索,评估市、县级AFP病例监测系统运转情况,采集密切接触者和健康儿童粪便标本、血清标本进行病毒分离和脊髓灰质炎抗体测定,对脊髓灰质炎病毒阳性分离物进行血清型和型内鉴定以及核苷酸序列分析,儿童脊髓灰质炎疫苗（OPV）接种率调查与评估等。结果病例确认为VDPV病例,免疫功能基本正常;市、县级AFP病例监测系统运转情况良好;该VDPV病例所在村OPV3接种率为75.86%,所在乡镇及周围相邻乡镇接种率OPV3接种率为85.56%～91.01%,平均为87.78%,不同乡镇差异无统计学意义（χ2=0.19,P〉0.05）;当地医院未发现AFP病例漏报;适龄儿童第一轮OPV应急免疫接种率为95.05%,第二轮则为98.85%;密切接触者、健康儿童和VDPV病例粪便标本经连续监测未再发现VDPV。结论当地脊髓灰质炎病毒学监测和流行病学监测系统的敏感性、及时性、完整性和准确性等指标良好;能够及时启动应急预案,果断实施突发公共卫生事件Ⅵ级应急响应,重点开展了应急免疫活动,适龄儿童OPV应急免疫接种率达到目标,整个应急处置过程严谨规范,快速有效。

Emergency handling measures on vaccine-derived polio virus (VDPV) in Heze City

Objective To estimate the effects of controlling measures on the vaccine-derived polio virus （VDPV）. Methods Under the guidance of the health department of Shandong province and Shandong province CDC, investigation group was established, made survey outline, the control measures, and in-depth field survey, included case investigation and immune function determination, seat and hospital acute flaccid paralysis （AFP） cases active search, assessmented of city, county AFP cases monitoring system running situation, acquisition close contact person and healthy children stool specimens, serum specimens were virus separation and poliomyelitis antibody were determined, for polio virus positive isolate on serum type and type internal appraisal and nucleotide sequence were analyzed, the rate of investigation and evaluation in children′s polio vaccine （OPV）, etc. Results The VDPV case was confirmed with basically normal immune function. The AFP surveillance systems of the city-level and the county-level were running well. The OPV3 vaccination rate of the VDPV village was 75.86% while that of township and surrounding adjacent township was 87.78% with an range of 85.56% to 91.01%, difference was not statistically significant （χ2=0.19, P 0.05）; No omission AFP cases were found in the local hospitals and the inoculation rates of the first round and the second round of emergency immunization for 0-4-year-old children were 95.05% and 98.85%. No VDPV was found again in the stool specimens from close contacts, healthy children and the VDPV case during the dynamic monitoring. Conclusion The sensitivity, timeliness, integrity and accuracy of targets of the local polio surveillance and epidemiological surveillance system were good; After the contingency plans are started in time, the emergent events of public health emergency response grade VI is implemented resolutely. The development of emergency immunization activities is focused on and the school-age children OPV inoculation rate achieved the goal. The emergency handling process of stringent norms is fast and effective.