关键词： polio   surveillance   outbreak control   eradication   international health regulations  

摘要： Despite substantial progress, global polio eradication has remained elusive. Indigenous wild poliovirus (WPV) transmission in 4 endemic countries (Afghanistan, India, Nigeria, and Pakistan) persisted into 2010 and outbreaks from imported WPV continued. By 2013, most outbreaks in the interim were promptly controlled. The number of polio-affected districts globally has declined by 74% (from 481 in 2009 to 126 in 2013), including a 79% decrease in the number of affected districts in endemic countries (from 304 to 63). India is now polio-free. The challenges to success in the remaining polio-endemic countries include (1) threats to the security of vaccinators in each country and a ban on polio vaccination in areas of Afghanistan and Pakistan;(2) a risk of decreased government commitment;and (3) remaining surveillance gaps. Coordinated efforts under the International Health Regulations and efforts to mitigate the challenges provide a clear opportunity to soon secure global eradication.

关键词： 脊髓灰质炎疫苗   麻痹型脊髓灰质炎   接种  

摘要： 1 病例摘要 患儿，男，2011年7月20日出生，第一胎，妊娠40周，剖宫产。出生时无窒息、青紫史，生后身体发育正常。9月23日该患儿在辖区内预防接种门诊，口服第1剂次脊髓灰质炎（脊灰）减毒活疫苗（ OPV），疫苗由北京天坛生物制品生产。（批号：2009101302，效期：2011年10月22日）。10月1日家长发现患儿肛周出现一包块，一周后包块增大。于10月7日晚到承德医学院附属医院儿外科就诊，查：一般情况好，T：37．3℃，发育正常，神志清。查体不合作。扁桃体无肿大，双肺呼吸音清晰，双侧肺未闻及干湿性罗音。心率120次／min。心律齐，各瓣膜听诊区未闻及杂音。腹平软，肝脾未触及。肛门无畸形，肛周皮肤潮红，膀胱截石位3点钟处隆起，可触及约2．0cm ×2．0cm ×0．5cm 大小肿物，边界不清，质韧，触痛，有波动感，无活动性。初步诊断为“肛周脓肿”收入院。10月8日在全麻下行肛周脓肿切开引流术，术后予以静点“吉他霉素”，抗感染、补液对症治疗。10月9日，患儿出现发热，院内儿科会诊考虑“上感”，继续抗炎、对症治疗。患儿住院期间最高体温达39℃，术后一周患儿肛周切口未愈合。10月15日上午发现患儿四肢不能动，查右上肢肌力Ⅲ级，双下肢肌力Ⅲ级，双侧巴氏征、克氏症阴性，儿科会诊“不除外中枢神经系统感染”。该院建议即刻转上一级专科医院诊治。患儿于15出院。10月17日到北京儿童医院就诊，查体：四肢肌张力减低，左上肢肌力Ⅴ级，右上肢肌力Ⅰ级，左下肢肌力Ⅰ级，右下肢肌力Ⅰ级。医院以“急性弛缓性麻痹”收治入院。入院经过23d治疗，于2011年11月9日出院。出院时：四肢肌张力减低，左上肢肌力Ⅴ级，右上肢肌力Ⅲ级，左下肢肌力Ⅰ级，右下肢肌力Ⅱ级。出院诊断：急性麻痹综合征。虽经康复治疗，但恢复缓慢，患儿仍有残留麻痹。

关键词： decentralization   polio   program review   routine immunization   surveillance  

摘要： Background. Although the Horn of Africa region has successfully eliminated endemic poliovirus circulation, it remains at risk for reintroduction. International partners assisted Kenya in identifying gaps in the polio surveillance and routine immunization programs, and provided recommendations for improved surveillance and routine immunization during the health system decentralization process. *** integral Structured questionnaires collected information about acute flaccid paralysis (AFP) surveillance resources, training, data monitoring, and supervision at provincial, district, and health facility levels. The routine immunization program information collected included questions about vaccine and resource availability, cold chain, logistics, health-care services and access, outreach coverage data, microplanning, and management and monitoring of AFP surveillance. *** integral Although AFP surveillance met national performance standards, widespread deficiencies and limited resources were observed and reported at all levels. Deficiencies were related to provider knowledge, funding, training, and supervision, and were particularly evident at the health facility level. *** integral Gap analysis assists in maximizing resources and capacity building in countries where surveillance and routine immunization lag behind other health priorities. Limited resources for surveillance and routine immunization systems in the region indicate a risk for additional outbreaks of wild poliovirus and other vaccine-preventable illnesses. Monitoring and evaluation of program strengthening activities are needed.

关键词： acute flaccid paralysis   Brazil   inactivated polio vaccine   poliomyelitis   vaccination schedule  

摘要： In August 2012, the Brazilian Ministry of Health introduced inactivated polio vaccine (IPV) as part of sequential polio vaccination schedule for all infants beginning their primary vaccination series. The revised childhood immunization schedule included 2 doses of IPV at 2 and 4 months of age followed by 2 doses of oral polio vaccine (OPV) at 6 and 15 months of age. One annual national polio immunization day was maintained to provide OPV to all children aged 6 to 59 months. The decision to introduce IPV was based on preventing rare cases of vaccine-associated paralytic polio, financially sustaining IPV introduction, ensuring equitable access to IPV, and preparing for future OPV cessation following global eradication. Introducing IPV during a national multivaccination campaign led to rapid uptake, despite challenges with local vaccine supply due to high wastage rates. Continuous monitoring is required to achieve high coverage with the sequential polio vaccine schedule.

关键词： poliovirus   antiviral  

摘要： Chronic prolonged excretion of vaccine-derived polioviruses by immunodeficient persons (iVDPV) presents a personal risk of poliomyelitis to the patient as well as a programmatic risk of delayed global eradication. Poliovirus antiviral drugs offer the only mitigation of these risks. Antiviral agents may also have a potential role in the management of accidental exposures and in certain outbreak scenarios. Efforts to discover and develop poliovirus antiviral agents have been ongoing in earnest since the formation in 2007 of the Poliovirus Antivirals Initiative. The most advanced antiviral, pocapavir (V-073), is a capsid inhibitor that has recently demonstrated activity in an oral poliovirus vaccine human challenge model. Additional antiviral candidates with differing mechanisms of action continue to be profiled and evaluated preclinically with the goal of having 2 antivirals available for use in combination to treat iVDPV excreters.

关键词： polio   primary immunodeficiency disorders   oral poliovirus vaccine   vaccine associated paralytic polio   immunodeficiency-associated vaccine-derived poliovirus (iVDPV)   screening  

摘要： Background. Persons with primary immune deficiency disorders (PIDD) who receive oral poliovirus vaccine (OPV) may transmit immunodeficiency-associated vaccine-derived polioviruses (iVDPVs) and cause paralytic polio. The objective of this study was to identify children with PIDD in Bangladesh, and estimate the proportion with chronic poliovirus excretion. *** integral Patients admitted at 5 teaching hospitals were screened for PIDD according to standardized clinical case definitions. PIDD was confirmed by age-specific quantitative immunoglobulin levels. Stool specimens were collected from patients with confirmed PIDD. *** integral From February 2011 through January 2013, approximately 96 000 children were screened, and 53 patients were identified who met the clinical case definition for PIDD. Thirteen patients (24%) had age-specific quantitative immunoglobulins results that confirmed PIDD. Of these, 9 (69%) received OPV 3-106 months before stool specimen collection. Among 11 patients, stool specimens from 1 patient tested positive for polioviruses 34 months after OPV ingestion. However, the poliovirus isolate was not available for genetic sequencing, and a subsequent stool specimen 45 days later was negative. *** integral The risk of chronic poliovirus excretion among children with PIDD in Bangladesh seems to be low. The national polio eradication program should incorporate strategies for screening for poliovirus excretion among patients with PIDD.

关键词： inactivated poliovirus vaccine (IPV)   oral poliovirus vaccine (OPV)   OPV cessation   OPV withdrawal   polio endgame   polio eradication   poliomyelitis   vaccine-associated paralytic poliomyelitis (VAPP)  

摘要： Background. Vaccine-associated paralytic poliomyelitis (VAPP) is a rare adverse event associated with oral poliovirus vaccine (OPV). This review summarizes the epidemiology and provides a global burden estimate. *** integral A literature review was conducted to abstract the epidemiology and calculate the risk of VAPP. A bootstrap method was applied to calculate global VAPP burden estimates. *** integral Trends in VAPP epidemiology varied by country income level. In the low-income country, the majority of cases occurred in individuals who had received > 3 doses of OPV (63%), whereas in middle and high-income countries, most cases occurred in recipients after their first OPV dose or unvaccinated contacts (81%). Using all risk estimates, VAPP risk was 4.7 cases per million births (range, 2.4-9.7), leading to a global annual burden estimate of 498 cases (range, 255-1018). If the analysis is limited to estimates from countries that currently use OPV, the VAPP risk is 3.8 cases per million births (range, 2.9-4.7) and a burden of 399 cases (range, 306-490). *** integral Because many high-income countries have replaced OPV with inactivated poliovirus vaccine, the VAPP burden is concentrated in lower-income countries. The planned universal introduction of inactivated poliovirus vaccine is likely to substantially decrease the global VAPP burden by 80%-90%.

关键词： 荧光定量聚合酶链反应   非脊髓灰质炎肠道病毒   中和实验  

摘要： 目的在河北省脊灰实验室应用荧光定量聚合酶链反应(PCR)法对非脊髓灰质炎肠道病毒(NPEV)进行定性。方法采用荧光定量PCR法对既往河北省脊灰实验室分离到NPEV进行检测,并将检测结果与中和实验鉴定结果和新流程方法检测结果进行比较分析。结果 75株用中和实验方法定性的NPEV与荧光定量PCR方法检测的符合率为98.7%(74/75),33株用新检测流程定性的NPEV与荧光定量PCR方法检测的符合率为81.8%。结论荧光定量PCR用于NPEV进行定性的检测方法是可行的。

关键词： poliovirus   vaccine-derived poliovirus   VDPV   oral poliovirus vaccine   OPV   poliomyelitis  

摘要： The attenuated oral poliovirus vaccine (OPV) has many properties favoring its use in polio eradication: ease of administration, efficient induction of intestinal immunity, induction of durable humoral immunity, and low cost. Despite these advantages, OPV has the disadvantage of genetic instability, resulting in rare and sporadic cases of vaccine-associated paralytic poliomyelitis (VAPP) and the emergence of genetically divergent vaccine-derived polioviruses (VDPVs). Whereas VAPP is an adverse event following exposure to OPV, VDPVs are polioviruses whose genetic properties indicate prolonged replication or transmission. Three categories of VDPVs are recognized: (1) circulating VDPVs (cVDPVs) from outbreaks in settings of low OPV coverage, (2) immunodeficiency-associated VDPVs (iVDPVs) from individuals with primary immunodeficiencies, and (3) ambiguous VDPVs (aVDPVs), which cannot be definitively assigned to either of the first 2 categories. Because most VDPVs are type 2, the World Health Organization's plans call for coordinated worldwide replacement of trivalent OPV with bivalent OPV containing poliovirus types 1 and 3.

关键词： polioviruses   surveillance   environmental sewage   environmental monitoring   disease eradication  

摘要： This article summarizes the status of environmental surveillance (ES) used by the Global Polio Eradication Initiative, provides the rationale for ES, gives examples of ES methods and findings, and summarizes how these data are used to achieve poliovirus eradication. ES complements clinical acute flaccid paralysis (AFP) surveillance for possible polio cases. ES detects poliovirus circulation in environmental sewage and is used to monitor transmission in communities. If detected, the genetic sequences of polioviruses isolated from ES are compared with those of isolates from clinical cases to evaluate the relationships among viruses. To evaluate poliovirus transmission, ES programs must be developed in a manner that is sensitive, with sufficiently frequent sampling, appropriate isolation methods, and specifically targeted sampling sites in locations at highest risk for poliovirus transmission. After poliovirus ceased to be detected in human cases, ES documented the absence of endemic WPV transmission and detected imported WPV. ES provides valuable information, particularly in high-density populations where AFP surveillance is of poor quality, persistent virus circulation is suspected, or frequent virus reintroduction is perceived. Given the benefits of ES, GPEI plans to continue and expand ES as part of its strategic plan and as a supplement to AFP surveillance.