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。

Systematic Review on Application of Poliomyelitis Vaccine and Immunization Strategies

The global eradication of poliomyelitis has made great achievements since the global eradication of poliomyelitis launched in 1988. In 2012, there were 223 poliomyelitis cases globally, which decreased over 60% comparing with the number of cases in 2011, there were only 3 polio endemic countries around the globle, including Nigeria, Pakistan and Afghanistan. Wild poliovirus （WPV） cases dropped to the lowest level in record. However, the WPV transmission has not yet been stopped completely, all the polio-free countries and regions are still at the risk of WPV importation. Meanwhile, some endemic countries are faced with the risk of vaccine-derived poliovirus triggered by administering oral poliomyelitis attenuated live vaccine （OPV）. Currently different countries and regions are assessing the risk factors of importation and circulation of poliovirus, considering the risks and benefits of OPV and inactivated poliovirus vaccine （IPV）. Different immunization strategies were applied in different countries： IPV applied independently, IPV/OPV sequential or OPV independently applied. According to polio eradication and endgame strategic plan made by the world health organization in 2013, WPV transmission will be interrupted in the remaining endemic countries by the end of 2014. All countries should introduce at least 1 dose of IPV in 2015 and cease OPV of type 2. OPV will be no longer administered after certification of poliomyelitis eradication in 2018. The article summarized the characteristics and application of OPV and IPV, and explored the immunization strategies of poliomyelitis eradication.