关键词： Primary immunodeficiency   Paralysis   Poliomyelitis   Oral poliovirus vaccine   Vaccine-derived poliovirus   Mutation  

摘要： Widespread administration of oral poliovirus vaccine (OPV) has decreased global incidence of poliomyelitis by approximate to 99.9%. However, the emergence of vaccine-derived polioviruses (VDPVs) is threatening polio eradication program. Primary immunodeficiency (PID) patients are at higher risks of vaccine associated paralytic poliomyelitis (VAPP) and prolonged excretion of immunodeficiency-associated VDPV (iVDPV). We searched Embase, Medline, Science direct, Scopus, Web of Science, and CDC and WHO databases by 30 September 2016, for all reports of iVDPV cases. Patient-level data were extracted form eligible studies. Data on immunization coverage and income-level of countries were extracted from WHO/UNICEF and the WORLD BANK databases, respectively. We assessed bivariate associations between immunological, clinical, and virological parameters, and exploited multivariable modeling to identify independent determinants of poliovirus evolution and patient's' outcomes. Study protocol was registered with PROSPERO (CRD42016052931). 4329 duplicate-removed titles were screened. A total of 107 iVDPV cases were identified from 68 eligible articles. The majority of cases were from higher income countries with high polio-immunization coverage. 74 (69.81%) patients developed VAPP. Combined immunodeficiency patients showed lower rates of VAPP (p < .001) and infection clearance (p = .02), compared to humoral immunodeficiency patients. The rate of poliovirus genomic evolution was higher at early stages of replication, decreasing over time until reaching a steady state. Independent of replication duration, higher extent (p = .04) and rates (p = .03) of genome divergence contributed to a less likelihood of virus clearance. PID type (p < .001), VAPP occurrence (p = .008), and income-level of country (p = .04) independently influenced patients' survival. With the use of OPV, new iVDPV5 will emerge independent of the rate of immunization coverage. Inherent features of PIDs contribute to

关键词： Polio virus 2   Polio outbreak response   Polio vaccines  

摘要： Background: Outbreaks of circulating vaccine derived polioviruses type 2 (cVDPV2) remain a risk to poliovirus eradication in an era without live poliovirus vaccine containing type 2 in routine immunization. We evaluated existing outbreak response strategies recommended by the World Health Organization (WHO) for control of cVDPV2 outbreaks. Methods: Seronegative children for poliovirus type 2 (PV2) at 22 weeks of life were assigned to one of four study groups and received respectively (1) one dose of trivalent oral poliovirus vaccine (tOPV);(2) monovalent OPV 2 (mOPV2);(3) tOPV together with a dose of inactivated poliovirus vaccine (IPV);or (4) mOPV2 with monovalent high-potency IPV type 2. Stool and blood samples were collected and assessed for presence of PV2 (stool) and anti-polio antibodies (sera). Results: We analyzed data from 265 children seronegative for PV2. Seroconversion to PV2 was achieved in 48, 76, 98 and 100% in Groups 1-4 respectively. mOPV2 was more immunogenic than tOPV alone (p < 0.001);and OPV in combination with IPV was more immunogenic than OPV alone (p < 0.001). There were 33%, 67%, 20% and 43% PV2 excretors in Groups 1-4 respectively. mOPV2 resulted in more prevalent shedding of PV2 than when tOPV was used (p < 0.001);and tOPV together with IPV resulted in lower excretion of PV2 than tOPV alone (p = 0.046). Conclusion: mOPV2 was a more potent vaccine than tOPV. Adding IPV to OPV improved immunological response;adding IPV also seemed to have shortened the duration of PV2 shedding. mIPV2 did not provide measurable improvement of immune response when compared to conventional IPV. WHO recommendation to use mOPV2 as a vaccine of first choice in cVDPV2 outbreak response was supported by our findings. (C) 2018 The Author(s). Published by Elsevier Ltd.

摘要： The last confirmed wild poliovirus (WPV) case in Democratic Republic of the Congo (DRC) had paralysis onset in December 2011 (1). DRC has had cases of vaccine-derived polioviruses (VDPVs) documented since 2004 (Table 1) (1-6). After an outbreak of 30 circulating VDPV type 2 (cVDPV2) cases during 2011-2012, only five VDPV2 cases were reported during 2013-2016 (Table 1) (1-6). VDPVs can emerge from oral poliovirus vaccine (OPV types 1, 2, or 3; Sabin) polioviruses that have genetically mutated resulting in reversion to neurovirulence. This process occurs during extensive person-to-person transmission in populations with low immunity or after extended replication in the intestines of immune-deficient persons following vaccination (1-6). During 2017 (as of March 8, 2018), 25 VDPV cases were reported in three provinces in DRC: in Tanganyika province, an emergence with one VDPV2 case (pending final classification) in Kabalo health zone and an emergence with one ambiguous VDPV type 1 (aVDPV1) case in Ankoro health zone; in Maniema province, an emergence with two cVDPV2 cases; and in Haut Lomami province, an emergence with 20 cVDPV2 cases that originated in Haut Lomami province and later spread to Tanganyika province (hereafter referred to as the Haut Lomami outbreak area) and an emergence with one aVDPV type 2 (aVDPV2) case in Lwamba health zone (Table 1) (Figure) (6). Outbreak response supplementary immunization activities (SIAs) were conducted during June-December 2017 (Table 2) (6). Because of limitations in surveillance and suboptimal SIA quality and geographic scope, cVDPV2 circulation is likely continuing in 2018, requiring additional SIAs. DRC health officials and Global Polio Eradication Initiative (GPEI) partners are increasing human and financial resources to improve all aspects of outbreak response.

关键词： Poliomyelitis   Silent outbreak   OPV   Mass media  

摘要： Background: During 2013, isolation of a wild type 1 poliovirus from routine sewage sample in Israel, led to a national OPV campaign: During this period, there was a constant cover of the outbreak by the mass media. Aims: To investigate the association of media exposure and OPV and non-OPV vaccines uptake during the,2013 silent polio outbreak in Israel. Methods: We received data on daily immunization rates during the outbreak period from the Ministry of Health (MoH). We conducted a multivariable time trend analysis to assess the association between daily media exposure and vaccines uptake. Analysis was stratified by ethnicity and socio-economic status (SES). Results: During the MoH supplemental immunization activity, 138,799 OPV vaccines were given. There r was a significant association between media exposure and OPV uptake, most prominent in a lag of 3-5 days from the exposUre among Jews (R.R 1.79C.195% 1.32-2.41) and high SES subgroups (R.R 1.71C.I 95% 1.27:2.30). These subgroups also showed increased non-OPV uptake in a lag of 3-5 days from the media exposure, in all vaccines except for MMR. Lower SES and non-Jewish subgroups did not demonstrate the same association. Conclusion: Our findings expand the understanding of public behaviour during outbreaks. The public response shows high variability within specific subgroups. These findings highlight the importance of tailored communication strategies for each subgroup. (C) 2018 Elsevier Ltd. All rights reserved.

关键词： 脊灰疫苗相关病例   监测   诊断  

摘要： 目的通过对菏泽市一例确诊脊髓灰质炎(脊灰)疫苗相关病例的监测、诊断进行分析,探讨脊灰疫苗相关病例的诊断标准及减少脊灰疫苗相关病例发生的策略。方法根据病例的急性驰缓性麻痹(AFP)专病管理系统资料、个案调查资料、预防接种相关资料、临床诊断治疗资料和脊灰实验室病毒检测结果等进行分析研究。结果依据WS294-2016《脊髓灰质炎诊断标准》,以及山东省处置类似病例的意见,菏泽市李××的最终诊断为确诊脊灰疫苗相关病例。结论现行的脊灰诊断标准仍需完善,应严格把握I+Ⅲ型脊灰减毒活疫苗接种禁忌症,进一步完善消灭脊灰免疫策略,减少脊灰疫苗相关病例的发生。

关键词： 预防接种   脊髓灰质炎灭活疫苗   血小板减少性紫癜  

摘要： 3月龄儿童在接种第一剂次脊髓灰质炎灭活疫苗(IPV)后,次日哭闹后周身出现散在红色出血点,血小板计数为6×109/L,诊断为特发性血小板减少性紫癜。区疾控中心组织专家进行疑似异常反应调查诊断,经综合分析,患儿血小板减少性紫癜与接种IPV不相关,不属于IPV预防接种反应。

关键词： 脊髓灰质炎后综合征   生理学特点   文献复习   脊髓灰质炎病毒   肌萎缩症   进行性   症状  

摘要： 脊髓灰质炎后综合征（post-polio syndrome,PPS）也称为进行性脊髓灰质炎后肌萎缩症。患者在感染脊髓灰质炎病毒后,遗留不同程度的单肢或多肢瘫痪,并曾经恢复较好或症状完全消失,而在数年以后症状重新出现或加重,

关键词： 疫苗相关麻痹型脊髓灰质炎   病例分析   桐乡市   脊髓灰质炎减毒活疫苗   预防接种异常反应   VAPP   流行病学调查   出生人口  

摘要： 疫苗相关麻痹型脊髓灰质炎(VAPP)病例是因服用脊髓灰质炎减毒活疫苗(OPV)引起的疫苗相关麻痹型病例,属于预防接种异常反应,严重者可造成儿童终生残疾。虽然VAPP发生率极低,每年每100万出生人口发生2~4例[1],但一旦发生将对患者家庭和社会造成严重负担。2016年4月,浙江省桐乡市发生首例VAPP病例,现将流行病学调查与处理情况报道如下:

关键词： MS2噬菌体   脊髓灰质炎病毒Ⅰ型   二溴海因   抵抗力   灭活对数值   浓时积值  

摘要： 目的比较MS2噬菌体和脊髓灰质炎病毒Ⅰ型(Poliovirus-Ⅰ,PV-Ⅰ)对二溴海因消毒剂的抵抗力大小,筛选用于评价消毒因子灭活肠道病毒效果的指示病毒。方法参考2002年版《消毒技术规范》,灭活病毒效果的评价采用病毒悬液定量灭活试验设计,分别对MS2噬菌体和PV-Ⅰ进行病毒灭活试验。结果二溴海因消毒剂的浓度250 mg/L、作用10 min和375 mg/L、作用5 min,对MS2噬菌体的灭活对数值分别达到4.04和6.11。二溴海因消毒剂的浓度500 mg/L、作用20 min和375 mg/L、作用50 min,对PV-Ⅰ的灭活对数值分别达到4.42和4.27。相同浓度(375 mg/L)的二溴海因消毒剂灭活病毒MS2噬菌体和PV-Ⅰ达到消毒水平(灭活对数值≥4.00)的浓时积值(C·t)分别为1 875 mg·min/L和18 750 mg·min/L。结论病毒MS2噬菌体对二溴海因的抵抗力弱于PV-Ⅰ。

关键词： 脊髓灰质炎   疫苗   胸腺淋巴体质   偶合  

摘要： 目的调查某患儿的死亡原因是否为注射疫苗。方法对患儿开展个案调查,收集患儿出生病历、住院病历、预防接种以及尸检等资料。市级预防接种异常反应调查诊断专家组综合分析,提出诊断意见。结果患儿于当天15:30接种二价脊髓灰质炎减毒活疫苗,15:55出现口唇发紫,鼻腔流白沫;16:45到达市中医院急诊,经抢救45 min无效后宣告死亡。尸检结果符合胸腺淋巴体质,排除过敏反应。市级预防接种异常反应调查诊断专家组调查诊断为不属于预防接种异常反应。结论患儿偶合胸腺淋巴体质,以及心、肺功能衰竭,属于接种疫苗偶合反应。