摘要:
In the period 1969-81, the CDC reported 37 cases of paralysis compatible with vaccine related poliovirus (VPV) infection in OPV recipients in the U.S.; no cases were reported in Indiana (pop. 5.5 million). From April 1982 to June 1983 we evaluated 4 children 3-24 mos of age whose neurologic abnormalities were compatible with VPV infection. All were epidemiologically unrelated residents of Indiana without symptoms suggestive of immunodeficiency. VPV infection was unsuspected prior to referral. All had OPV (1st dose in 3, 4th dose in 1) with DPT in the left anterior thigh within 30 days of symptoms, had VPV (confirmed by CDC) isolated at presentation, and had symptoms (left leg paralysis in 3, developmental regression, spasticity, and progressive fatal cerebral atrophy in 1) persisting for at least 6 mos. Immune function was normal in 2 with poliovirus type 3 infection and abnormal (hypogammaglobulinemia, combined immunodeficiency) in 2 with type 1 and type 2 infection. The incidence of observed VPV infection in Indiana OPV recipients was .058/100,000/yr, significantly greater (p = .02) than predicted. Neurologic complications among OPV recipients may: 1) Be increasing in frequency; 2) occur more frequently than estimated; 3) be incompletely reported; or 4) be more accurately detected with active surveillance.