关键词： 脊髓灰质炎病毒疫苗   免疫   黏膜   世界卫生组织  

摘要： 现阶段基于口服脊髓灰质炎疫苗（oralpoliovirusvaccine，OPV）的全球脊髓灰质炎消灭行动发现，该疫苗不太理想的免疫原性已成为根除此疾病的主要障碍，疫苗在部分地区一些人群中无法诱导抗麻痹性脊髓灰质炎的保护作用。2010年12月18—19日在印度新德里召开了关于“黏膜免疫与脊髓灰质炎疫苗：对野型脊髓灰质炎病毒感染、传播以及免疫失败的影响”的会议，旨在更好地了解全球脊髓灰质炎控制现状，并明确增强OPV的免疫应答和效果的方法，以加速全球根除麻痹性脊髓灰质炎。

关键词： 脊髓灰质炎病毒   急性弛缓性麻痹   监测  

摘要： 甘肃省脊髓灰质炎（简称脊灰）病毒实验室自1992年加入世界卫生组织（WHO）亚太区脊灰实验室网络后，各项监测指标和监测质量都在不断提高。该省自1993年以来已无脊灰野病毒病例，但2011年我国新疆自治区发生输入性野病毒疫情，甘肃与新疆接壤，因此甘肃省维持无脊灰状态的任务仍然艰巨。为继续做好维持无脊灰工作，及时总结经验和工作中出现的问题，现将2011年甘肃省急性弛缓性麻痹病例检测情况分析如下。

关键词： 脊髓灰质炎疫苗   异常反应  

摘要： 患儿男，2011年5月18日出生，10月19日因右足活动减弱就诊，诊断：右下肢周围神经损伤，考虑患儿为脊髓灰质炎疫苗相关病例可能性大。根据流行病学调查，临床特征分析，医学鉴定，是一例由脊髓灰质炎疫苗异常反应病例．现将有关情况报告如下：

关键词： 百日咳   白喉   破伤风   脊髓灰质炎   b型流感嗜血杆菌   联合疫苗   不良反应  

摘要： 目的观察吸附无细胞百白破、灭活脊髓灰质炎和b型流感嗜血杆菌(结合)联合疫苗(Diphtheria-tetanus-acellular pertussis-inactivated poliovirus-Haemophilus influenzae type b conjugate vaccine containing a polyribosyl-ribitol-phosphate-tetanus toxoid conjugate,DTacP-IPV//PRP～T)的不良反应发生情况,以评价其安全性。方法采用知情自愿原则,在虹口区4个街道选择100名出生60～74 d符合检测要求的婴儿,分别于2、3、4月龄接种五联疫苗,并进行4次现场和3次电话访视,记录不良反应的发生情况。结果接种五联疫苗后,不良反应发生率前3位为轻度异常哭闹(25.8%)、轻度触痛(23.8%)和轻度食欲下降(23.2%),随着接种剂次增加,局部发红、肿胀的严重程度升高,而呕吐、嗜睡、食欲下降、易激惹的严重程度下降。结论五联疫苗具有良好的安全性,严重不良反应的发生率较低。受主观影响较大的不良反应报告偏多,在日后的接种工作中需注意后续剂次接种后局部不良反应的发生情况,以减轻局部症状。

关键词： Dynamic modeling   outbreak risks   poliovirus  

摘要： The live, attenuated oral poliovirus vaccine (OPV) provides a powerful tool for controlling and stopping the transmission of wild polioviruses (WPVs), although the risks of vaccine-associated paralytic polio (VAPP) and circulating vaccine-derived poliovirus (cVDPV) outbreaks exist as long as OPV remains in use. Understanding the dynamics of cVDPV emergence and outbreaks as a function of population immunity and other risk factors may help to improve risk management and the development of strategies to respond to possible outbreaks. We performed a comprehensive review of the literature related to the process of OPV evolution and information available from actual experiences with cVDPV outbreaks. Only a relatively small fraction of poliovirus infections cause symptoms, which makes direct observation of the trajectory of OPV evolution within a population impractical and leads to significant uncertainty. Despite a large global surveillance system, the existing genetic sequence data largely provide information about transmitted virulent polioviruses that caused acute flaccid paralysis, and essentially no data track the changes that occur in OPV sequences as the viruses transmit largely asymptomatically through real populations with suboptimal immunity. We updated estimates of cVDPV risks based on actual experiences and identified the many limitations in the existing data on poliovirus transmission and immunity and OPV virus evolution that complicate modeling. Modelers should explore the space of potential model formulations and inputs consistent with the available evidence and future studies should seek to improve our understanding of the OPV virus evolution process to provide better information for policymakers working to manage cVDPV risks.

关键词： Real-time PCR   Quantitative PCR   Poliovirus surveillance   Poliovirus excretion   Shedding   Mucosal immunity   Titration  

摘要： Rapid identification and quantitation of polioviruses in clinical specimens is important for surveillance and analysis of virus shedding by vaccine recipients, which could be used to assess the level of mucosal immunity. A quantitative one step RT-PCR was developed for identification and titration of all three poliovirus serotypes. The assay could be an alternative to the traditional procedure based on cell culture isolation and subsequent determination of poliovirus serotype and virus titration. The method is based on quantitative PCR performed with reverse transcription reaction in the same tube. The multiplex assay that quantifies all three serotypes of poliovirus was found to be highly specific, sensitive, and takes only one day to complete. Published by Elsevier B.V.

关键词： Dynamic modeling   expert judgment   polio eradication  

摘要： With the intensifying global efforts to eradicate wild polioviruses, policymakers face complex decisions related to achieving eradication and managing posteradication risks. These decisions and the expanding use of inactivated poliovirus vaccine (IPV) trigger renewed interest in poliovirus immunity, particularly the role of mucosal immunity in the transmission of polioviruses. Sustained high population immunity to poliovirus transmission represents a key prerequisite to eradication, but poliovirus immunity and transmission remain poorly understood despite decades of studies. In April 2010, the U.S. Centers for Disease Control and Prevention convened an international group of experts on poliovirus immunology and virology to review the literature relevant for modeling poliovirus transmission, develop a consensus about related uncertainties, and identify research needs. This article synthesizes the quantitative assessments and research needs identified during the process. Limitations in the evidence from oral poliovirus vaccine (OPV) challenge studies and other relevant data led to differences in expert assessments, indicating the need for additional data, particularly in several priority areas for research: (1) the ability of IPV-induced immunity to prevent or reduce excretion and affect transmission, (2) the impact of waning immunity on the probability and extent of poliovirus excretion, (3) the relationship between the concentration of poliovirus excreted and infectiousness to others in different settings, and (4) the relative role of fecal-oral versus oropharyngeal transmission. This assessment of current knowledge supports the immediate conduct of additional studies to address the gaps.

关键词： Dynamic modeling   polio eradication   risk management  

摘要： Successfully managing risks to achieve wild polioviruses (WPVs) eradication and address the complexities of oral poliovirus vaccine (OPV) cessation to stop all cases of paralytic poliomyelitis depends strongly on our collective understanding of poliovirus immunity and transmission. With increased shifting from OPV to inactivated poliovirus vaccine (IPV), numerous risk management choices motivate the need to understand the tradeoffs and uncertainties and to develop models to help inform decisions. The U.S. Centers for Disease Control and Prevention hosted a meeting of international experts in April 2010 to review the available literature relevant to poliovirus immunity and transmission. This expert review evaluates 66 OPV challenge studies and other evidence to support the development of quantitative models of poliovirus transmission and potential outbreaks. This review focuses on characterization of immunity as a function of exposure history in terms of susceptibility to excretion, duration of excretion, and concentration of excreted virus. We also discuss the evidence of waning of host immunity to poliovirus transmission, the relationship between the concentration of poliovirus excreted and infectiousness, the importance of different transmission routes, and the differences in transmissibility between OPV and WPV. We discuss the limitations of the available evidence for use in polio risk models, and conclude that despite the relatively large number of studies on immunity, very limited data exist to directly support quantification of model inputs related to transmission. Given the limitations in the evidence, we identify the need for expert input to derive quantitative model inputs from the existing data.

关键词： VIRUS diseases   POLIOVIRUS   CELL receptors   POLYPEPTIDES   CELL membranes   NITRILOTRIACETIC acid   CYTOPLASM  

摘要： During infection, the binding of poliovirus to its cell surface receptor at 37 degrees C triggers an expansion of the virus in which internal polypeptides that bind to membranes are externalized. Subsequently, in a poorly understood process, the viral RNA genome is transferred directly across an endosomal membrane, and into the host cell cytoplasm, to initiate infection. Here, cryoelectron tomography demonstrates the results of 37 degrees C warming of a poliovirus-receptor-liposome model complex that was produced using Ni-nitrilotriacetic acid lipids and His-tagged receptor ectodomains. In total, 651 subtomographic volumes were aligned, classified, and averaged to obtain detailed pictures, showing both the conversion of virus into its expanded form and the passage of RNA into intact liposomes. Unexpectedly, the virus and membrane surfaces were located similar to 50 angstrom apart, with the 5-fold axis tilted away from the perpendicular, and the solvent spaces between them were spanned by either one or two long "umbilical" density features that lie at an angle to the virus and membrane. The thinner connector, which sometimes appears alone, is 28 to 30 angstrom in diameter and has a footprint on the virus surface located close to either a 5-fold or a 3-fold axis. The broader connector has a footprint near the quasi-3-fold hole that opens upon virus expansion and is hypothesized to include RNA, shielded from enzymatic degradation by polypeptides that include the N-terminal extension of VP1 and capsid protein VP4. The implications of these observations for the mechanism of RNase-protected RNA transfer in picornaviruses are discussed.

关键词： Policy options   poliovirus   vaccination  

摘要： With the circulation of wild poliovirus (WPV) types 1 and 3 continuing more than a decade after the original goal of eradicating all three types of WPVs by 2000, policymakers consider many immunization options as they strive to stop transmission in the remaining endemic and outbreak areas and prevent reintroductions of live polioviruses into nonendemic areas. While polio vaccination choices may appear simple, our analysis of current options shows remarkable complexity. We offer important context for current and future polio vaccine decisions and policy analyses by developing decision trees that clearly identify potential options currently used by countries as they evaluate national polio vaccine choices. Based on a comprehensive review of the literature we (1) identify the current vaccination options that national health leaders consider for polio vaccination, (2) characterize current practices and factors that appear to influence national and international choices, and (3) assess the evidence of vaccine effectiveness considering sources of variability between countries and uncertainties associated with limitations of the data. With low numbers of cases occurring globally, the management of polio risks might seem like a relatively low priority, but stopping live poliovirus circulation requires making proactive and intentional choices to manage population immunity in the remaining endemic areas and to prevent reestablishment in nonendemic areas. Our analysis shows remarkable variability in the current national polio vaccine product choices and schedules, with combination vaccine options containing inactivated poliovirus vaccine and different formulations of oral poliovirus vaccine making choices increasingly difficult for national health leaders.