关键词:
POLIO
INTRAMUSCULAR injections
POLIOVIRUS
CHILDREN -- Health
IMMUNIZATION
COMMUNICABLE diseases -- Prevention
PREVENTIVE medicine
ROMANIANS
POLIOMYELITIS vaccine
PARALYSIS
ADMINISTRATION of drugs
VACCINATION
PUBLIC health
RISK factors
摘要:
Background. In Romania the rate of vaccine-associated paralytic poliomyelitis is for unexplained reasons 5 to 17 times higher than in other countries. Long ago it was noted that intramuscular injections administered during the incubation period of wild-type poliovirus infection increased the risk of paralytic disease (a phenomenon known as ''provocation'' poliomyelitis). We conducted a case-control study to explore the association between intramuscular injections and vaccine-associated poliomyelitis in Romania. Methods. The patients were 31 young children in whom vaccine-associated paralytic poliomyelitis developed from 1988 through 1992. Eighteen were vaccine recipients, and 13 had acquired the disease by contact with vaccine recipients. Each of these children was matched with up to five controls according to health center, age, and in the case of vaccine recipients, history of receipt of the live attenuated oral poliovirus vaccine. Data were abstracted from medical records that documented the injections administered in the 30 days before the onset of paralysis. Results. Of the 31 children with vaccine-associated disease, 27 (87 percent) had received one or more intramuscular injections within 30 days before the onset of paralysis, as compared with 77 of the 151 controls (51 percent) (matched odds ratio, 31.2;95 percent confidence interval, 4.0 to 244.2). Nearly all the intramuscular injections were of antibiotics, and the association was strongest for the patients who received 10 or more injections (matched odds ratio for greater than or equal to 10 injections as compared with no injections, 182.1;95 percent confidence interval, 15.2 to 2186.4). The risk of paralytic disease was strongly associated with injections given after the oral poliovirus vaccine, but not with injections given before or at the same time as the vaccine (matched odds ratio, 56.7;95 percent confidence interval, 8.9 to infinity). The attributable risk in the population for intramuscular injecti