关键词： POLIOVIRUS   EMERGENCY management   PARALYSIS   ENDEMIC infections   TRANSMISSION   POLIO vaccination  

摘要： On August 10, 2016, 2 years after the most recent wild poliovirus (WPV) case was reported in Nigeria (in July 2014) (1), two WPV cases were reported in the northeastern state of Borno, which has been severely affected by insurgency-related insecurity since 2013. On September 9 and 26, 2016, two additional WPV cases were reported in Borno in children whose families migrated from security-compromised, inaccessible areas of the state. All four cases were WPV serotype 1 (WPV1), with genetic differences indicating prolonged undetected transmission. A large-scale emergency response plan was developed and implemented. The plan initially called for vaccination of 815,791 children during August 15-18 in five local government areas (LGAs) in the immediate vicinity of the first two WPV cases. Subsequently, the plan was expanded to regionally synchronized supplementary immunization activities (SIAs), conducted during August 27-December 6 in five Lake Chad basin countries at increased risk for national and regional WPV1 transmission (Cameroon, Central African Republic, Chad, Niger, and Nigeria). In addition, retrospective searches for missed cases of acute flaccid paralysis (AFP), enhanced environmental surveillance for polioviruses, and polio surveillance system reviews were conducted. Prolonged undetected WPV1 transmission in Borno State is a consequence of low population immunity and severe surveillance limitations associated with insurgency-related insecurity and highlights the risk for local and international WPV spread (2). Increasing polio vaccination coverage and implementing high-quality polio surveillance, especially among populations in newly secured and difficult-to-access areas in Borno and other Lake Chad basin areas are urgently needed.

关键词： Oral polio vaccine   Infant mortality   Sex-differential effects   Non-specific effects   Heterologous effects  

摘要： Three studies from Guinea-Bissau found conflicting effects of OPV-at-birth (OPV0) on child survival. One study from 2004 suggested excess male mortality among children receiving OPV0 compared with children receiving NoOPV0 during a period of shortage of OPV. However, two subsequent studies showed beneficial effects of OPV0. In 2004, two national OPV-campaigns had been conducted in Guinea-Bissau. In a reanalysis of the 2004-study, in a survival analysis the age-adjusted mortality rate of study participants was 67% (95% CI = 42-81%) lower after the OPV-campaigns than before the campaigns. In the OPVO group only 22% (655/3031 person-years (pyrs)) of follow-up time was "after" the OPV-campaigns whereas 55% (473/859 pyrs) of the time in the NoOPV0 group was post-campaign (p < 0.0001, Chi(2)). Censoring for OPV-campaigns in the original study removed excess male mortality and made the three studies more homogeneous. Overall, there is now considerable evidence that OPV, like other live vaccines, has important beneficial non-specific effects. (C) 2016 The Authors. Published by Elsevier Ltd.

关键词： VACCINATION   Guidelines   Polio -- Prevention   Vaccination of children   Polio  

摘要： In 1988, the World Health Assembly resolved to eradicate poliomyelitis (polio). Since then, wild poliovirus (WPV) cases have declined by >99.9%, from an estimated 350,000 cases of polio each year to 74 cases in two countries in 2015 (1). This decrease was achieved primarily through the use of trivalent oral poliovirus vaccine (tOPV), which contains types 1, 2, and 3 live, attenuated polioviruses. Since 2000, the United States has exclusively used inactivated polio vaccine (IPV), which contains all three poliovirus types (2,3). In 2013, the World Health Organization (WHO) set a target of a polio-free world by 2018 (4). Of the three WPV types, type 2 was declared eradicated in September 2015. To remove the risk for infection with circulating type 2 vaccine-derived polioviruses (cVDPV), which can lead to paralysis similar to that caused by WPV, all OPV-using countries simultaneously switched in April 2016 from tOPV to bivalent OPV (bOPV), which contains only types 1 and 3 polioviruses (5). This report summarizes current Advisory Committee on Immunization Practices (ACIP) recommendations for poliovirus vaccination and provides CDC guidance, in the context of the switch from tOPV to bOPV, regarding assessment of vaccination status and vaccination of children who might have received poliovirus vaccine outside the United States, to ensure that children living in the United States (including immigrants and refugees) are protected against all three poliovirus types. This guidance is not new policy and does not change the recommendations of ACIP for poliovirus vaccination in the United States. Children living in the United States who might have received poliovirus vaccination outside the United States should meet ACIP recommendations for poliovirus vaccination, which require protection against all three poliovirus types by age-appropriate vaccination with IPV or tOPV. In the absence of vaccination records indicating receipt of these vaccines, only vaccination or revaccination

关键词： 接种   脊髓灰质炎疫苗   无细胞百白破疫苗   血小板减少症  

摘要： 免疫性血小板减少症是一种获得性自身免疫性疾病,发病原因较复杂。本文报告1例免疫性血小板减少症,分析其发病原因为接种脊髓灰质炎减毒活疫苗和无细胞百白破联合疫苗。

关键词： 乙型肝炎   麻疹   脊髓灰质炎   抗体监测  

摘要： 目的:了解桂林市12县1~8岁健康儿童乙型肝炎、麻疹、脊髓灰质炎疫苗的免疫效果,为制定免疫防控策略及风险评估提供科学的依据。方法:采用分层整群抽样方法抽取桂林市12县1~8岁健康儿童380例,采用ELISA法进行3种抗体检测。结果:桂林市12县1~8岁健康儿童乙型肝炎、麻疹、脊髓灰质炎抗体阳性率分别为70.00%,100%和85.53%。乙型肝炎抗体阳性率在不同年龄段分布差异有统计学意义(P<0.05),脊髓灰质炎抗体阳性率在全市12县间差异有统计学意义(P<0.05)。结论:桂林市12县1~8岁儿童麻疹、脊髓灰质炎两种疾病暴发流行的可能性较低,乙型肝炎疫苗有必要在薄弱地区与人群中开展强化免疫。

关键词： Polio   antiviral   pocapavir   poliovirus   clinical efficacy   drug resistance   virus challenge   transmission   clinical trial design   virus eradication  

摘要： Background. Immunodeficient individuals who excrete vaccine-derived polioviruses threaten polio eradication. Antivirals address this threat. Methods. In a randomized, blinded, placebo-controlled study, adults were challenged with monovalent oral poliovirus type 1 vaccine (mOPV1) and subsequently treated with capsid inhibitor pocapavir or placebo. The time to virus negativity in stool was determined. Results. A total of 144 participants were enrolled;98% became infected upon OPV challenge. Pocapavir-treated subjects (n = 93) cleared virus a median duration of 10 days after challenge, compared with 13 days for placebo recipients (n = 48;P = .0019). Fifty-two of 93 pocapavir-treated subjects (56%) cleared virus in 2-18 days with no evidence of drug resistance, while 41 of 93 (44%) treated subjects experienced infection with resistant virus while in the isolation facility, 3 (3%) of whom were infected at baseline, before treatment initiation. Resistant virus was also observed in 5 placebo recipients (10%). Excluding those with resistant virus, the median time to virus negativity was 5.5 days in pocapavir recipients, compared with 13 days in placebo recipients (P <.0001). There were no serious adverse events and no withdrawals from the study. Conclusions. Treatment with pocapavir was safe and significantly accelerated virus clearance. Emergence of resistant virus and transmission of virus were seen in the context of a clinical isolation facility.

关键词： 脊髓灰质炎   急性弛缓性麻痹   流行病学   疫苗相关  

摘要： 目的为加强急性弛缓性麻痹(AFP),尤其是疫苗相关麻痹型脊灰病例(Vaccine-associated Paralytic Poliomyelitis,VAPP)监测和妥善处理提供依据。方法采用回顾性方法,对江苏省2012—2014年全省报告的AFP病例中检测脊灰疫苗株阳性的病例资料进行汇总分析。结果江苏省2012—2014年共报告AFP病例887例,下肢麻痹的占96.15%,粪便标本采便率96.96%。脊灰病毒检出率3.02%,全部为疫苗株,其中Ⅰ型占26.92%(7例),Ⅱ型占19.23%(5例),Ⅲ型占34.62%(9例),Ⅰ+Ⅱ型占11.54%(3例),Ⅰ+Ⅲ型占3.85%(1例),Ⅰ+Ⅱ+Ⅲ型占3.85%(1例)。南京、苏州、泰州3个市病例占57.69%,病例集中在4—5月,夏季Ⅰ型占54.55%,秋冬季Ⅲ型占87.50%(P=0.007)。男性多于女性,<5岁病例占73.08%。免疫史>3次占84.62%,采便距最后一次服苗时间<30d的混合型占75.00%,≥30d的单型占90.91%(P=0.031)。结论在保持高水平免疫接种率的同时,应继续保持高质量的AFP病例流行病学监测和病毒学监测,及时发现可能的输入病例,及时采取措施控制病毒的进一步传播及疫苗衍生脊髓灰质炎病毒(Vaccine-derived Polioviruses,VDPV)病例的发生。

关键词： 脊髓灰质炎   脊髓灰质炎疫苗   疫苗相关麻痹型脊髓灰质炎  

摘要： 口服脊髓灰质炎减毒活疫苗(OPV)自20世纪60年代中期以来,被全球绝大多数国家的国家免疫规划(NIP)所采用,大规模接种OPV是全球消灭脊灰行动(GPEI)取得成功的决定性因素。但自进入消灭脊灰后期以后,OPV所导致的严重预防接种异常反应—疫苗相关麻痹型脊髓灰质炎(VAPP)的严重性日益增加。为减少VAPP的发生,世界卫生组织在2015年启动了全球脊灰免疫策略调整工作,要求各国尽快在常规免疫中撤销OPV的2型脊灰病毒成分,并采用至少1剂灭活脊髓灰质炎疫苗(IPV)。本文综述了消灭脊灰后期脊灰免疫策略调整的原因和工作进展,并比较了脊灰疫苗不同免疫程序的安全性,以期为我国的相关工作提供参考。

关键词： 脊髓灰质炎疫苗   减毒活疫苗   急性迟缓性麻痹   预防接种异常反应  

摘要： 目的对1例脊髓灰质炎疫苗相关病例(VAPP)进行分析,探讨控制策略和异常反应补偿机制。方法对病例开展流行病学调查,结合临床表现和实验室检测结果,由省级专家组作出诊断。结果患儿有明确服苗史,出现早期发热、面瘫和渐进性单侧肢体瘫痪,粪便分离出疫苗相关株病毒,经国家实验室确认为"脊灰疫苗株Ⅲ型"。主动搜索未发现其他类似症状病例,不能排除VAPP。最后诊断为"急性迟缓性麻痹(AFP)"。结论积极推动灭活脊灰疫苗(IPV)+减毒脊灰活疫苗(OPV)序贯免疫程序,可避免VAPP的发生。国家应尽量完善预防接种异常反应补偿机制,以最大保证补偿的公平性。

关键词： Disease eradication   poliomyelitis   poliovirus   poliovirus vaccines  

摘要： Polio cases due to wild virus are reported by only three countries in the world. Poliovirus type 2 has been globally eradicated and the last detection of poliovirus type 3 dates to November 2012. Poliovirus type 1 remains the only circulating wild strain;between January and September 2016 it caused 26 cases (nine in Afghanistan, 14 in Pakistan, three in Nigeria). The use of oral polio vaccine (OPV) has been the key to success in the eradication effort. However, paradoxically, moving towards global polio eradication, the burden caused by vaccine-derived polioviruses (VDPVs) becomes increasingly important. In this paper circulation of both wild virus and VDPVs is reviewed and implications for the polio eradication endgame are discussed. Between April and May 2016 OPV2 cessation has been implemented globally, in a coordinated switch from trivalent OPV to bivalent OPV. In order to decrease the risk for cVDPV2 re-emergence inactivated polio vaccine (IPV) has been introduced in the routine vaccine schedule of all countries. The likelihood of re-emergence of cVDPVs should markedly decrease with time after OPV cessation, but silent circulation of polioviruses cannot be ruled out even a long time after cessation. For this reason, immunity levels against polioviruses should be kept as high as possible in the population by the use of IPV, and both clinical and environmental surveillance should be maintained at a high level.