关键词： 灭活脊髓灰质炎疫苗   脊髓灰质炎疫苗转换   影响因素  

摘要： 目的探寻灭活脊髓灰质炎(脊灰)疫苗(IPV)纳入国家免疫规划初期吉林省脊灰疫苗免疫程序中首剂脊灰减毒活疫苗(OPV)向IPV转换工作的影响因素。方法采取普查的方法对IPV接种率较低的12县(市、区)143家接种门诊426名预防接种工作人员进行问卷调查,采用描述性方法分析脊灰疫苗转换工作的影响因素。结果在392名有效调查对象中,97.96%了解IPV/OPV免疫程序,96.68%了解接种方式,63.01%认为IPV接种增添工作量,47.90%认为IPV接种操作有难度;不同年龄、工作年限、单位类别的调查对象对IPV接种工作量、接种操作难度的看法均有显著性差异。调查对象认为疫苗转换工作的主要问题包括担忧IPV接种不良反应、家长对IPV接种方式不接受、增加工作负担。结论担忧不良反应、工作量增加、接种操作难度是影响首剂OPV向IPV转换工作的主要因素,需要加强预防接种人员的相关培训。

关键词： 脊髓灰质炎灭活疫苗   预防接种   死亡  

摘要： 脊髓灰质炎（脊灰）是由脊灰病毒引起的急性消化道传染病,又称小儿麻痹症,其最严重的后果是导致儿童不可逆的肢体残疾,甚至死亡。随着口服脊灰减毒活疫苗（Oral Poliomyelitis Vaccine,OPV）的广泛使用,中国于2000年证实实现了无脊灰状态,但服用OPV导致的疫苗相关麻痹型脊灰（Vaccine Associated Paralytic Poliomyelitis,VAPP）病例逐渐成为困扰医务人员的问题。

关键词： 脊髓灰质炎疫苗   世界卫生组织   文件   卫生政策   联合疫苗   相关疫苗   公共卫生   免疫规划  

摘要： 1前言依据为各成员国提供卫生政策方面指导意见这一职责,世界卫生组织（WHO）就预防具有全球公共卫生影响的疾病的相关疫苗及联合疫苗,发布一系列定期更新的立场文件。这些文件着重关注疫苗在大规模免疫规划项目中的使用。

关键词： 脊髓灰质炎病毒   抗体   中和   免疫   阳性率   几何平均滴度  

摘要： 目的调查北京市房山区常住人口脊髓灰质炎病毒抗体水平。方法用容量比例概率抽样法(probability proportion to size,pps)在房山区随机选取10个村居委会,在当地连续居住6个月以上的10个年龄组人群作为研究对象,共260人。采用调查问卷收集研究对象人口学特征、脊髓灰质炎减毒活疫苗(OPV)免疫史等信息,并采集静脉血5 ml,使用微量中和试验方法检测脊髓灰质炎病毒中和抗体。对不同组别间抗体阳性率和几何平均滴度(geometric mean titer,GMT)进行比较。结果脊髓灰质炎病毒Ⅰ、Ⅱ、Ⅲ型抗体阳性率分别为99.62%(259/260)、97.31%(253/260)、97.69%(254/260),抗体GMT分别为1∶50.58、1∶53.21、1∶37.26。<15岁人群Ⅰ、Ⅱ、Ⅲ型抗体阳性率均为100%,均高于≥15岁人群。<15岁人群Ⅰ、Ⅱ、Ⅲ型抗体GMT远高于≥15岁人群,差异均有统计学意义(P<0.01)。Ⅰ、Ⅱ、Ⅲ型抗体GMT在平原地区人群中最高,在山区最低,地区间差异均有统计学意义(P<0.01)。不同免疫史人群三型抗体GMT差异均有统计学意义(P<0.01)。结论 2012年北京市房山区健康人群脊髓灰质炎病毒抗体水平处于较高水平,特别是15岁以下免疫覆盖人群,建立了稳固的免疫屏障,可有效阻断输入性脊髓灰质炎野病毒及疫苗衍生病毒的传播。

关键词： Emergency response   Poliovirus   Public health   Supplemental immunization   Surveillance   Transmission  

摘要： During 2013/14, Israel witnessed the silent reintroduction and sustained transmission of wild poliovirus type 1 (WPV1) detected through routine environmental surveillance performed on sewage samples. The public health response to silent poliovirus transmission in a population with high inactivated polio vaccine (IPV) coverage poses an emerging challenge towards the 'End Game' of global poliovirus eradication. This paper reviews the risk assessment, risk management and risk communication aspects of this poliovirus incident. Special emphasis is placed on the use of scientific data generated in the risk assessment phase to inform the public health response. Reintroducing a live vaccine in supplemental immunization activities in response to transmission of WPV or vaccine-derived poliovirus should be considered close to the 'End Game' of polio eradication, especially if targeting the population at risk is feasible. Such circumstances require a comprehensive contingency plan that will support the generation of important public health evidence at the risk assessment stage, thereby allowing to tailor the risk management approaches and underpin appropriate risk communication. (C) 2016 European Society of Clinical Microbiology and Infectious Diseases. Published by Elsevier Ltd. All rights reserved.

关键词： 脊髓灰质炎   口服脊髓灰质炎减毒活疫苗   补充免疫活动  

摘要： 目的对云南省2011～2015年口服脊髓灰质炎（脊灰）减毒活疫苗（Oral Poliomyelitis Attenuated Live Vaccine,OPV）补充免疫活动（Supplementary Immunization Activities,SIA）进行分析,为维持和巩固无脊灰免疫策略的调整提供参考。方法收集云南省2011～2015年OPV SIA报表和督导评估资料,进行描述性分析。结果在脊灰野病毒（Wild Poliovirus,WPV）输入与传播风险评估的基础上,云南省2011～2015年共在全省范围内开展了6轮OPV SIA,共接种18 539 740剂OPV,每1轮OPV SIA国内儿童和外籍入境儿童报告接种率均〉95%。共发现＂0剂次＂免疫儿童226 027人,占报告应种总数的1.20%;入境外籍儿童和国内儿童＂0＂剂次比例分别为11.80%、1.03%（χ2=78 180.97,P=0.00）,其中1～6岁入境外籍儿童和国内儿童＂0＂剂次的比例分别为92.66%、17.29%（χ2=32 363.69,P=0.00）。6轮OPV SIA共对189个县次开展了接种率快速评估,平均评估接种率为98.05%,有16个县次评估接种率〈95%。结论云南省SIA运转模式成熟,最大限度填补了国内儿童和入境外籍儿童的免疫空白,有效防止了脊灰野病毒与脊灰疫苗衍生病毒（Vaccine Deprived Poliovirus,VDPV）的输入和VDPV循环的发生。

关键词： 脊髓灰质炎   疫苗,灭活   免疫   临床效力   接种程序  

摘要： 在人类抗击脊髓灰质炎的斗争中，脊髓灰质炎病毒灭活疫苗（IPV）是最早使用的疫苗。虽然在20世纪60年代和70年代被口服脊髓灰质炎减毒活疫苗（OPV）取代，但随着人们认识到继续使用OPV存在的风险，IPV的使用成为必然。继Jonas Salk对IPV开展的先驱性工作并建立了该疫苗的关键原则之后，用灭活野毒株研制的现代型含Salk IPV疫苗多年来已经在许多国家常规应用，并且积累了相当多的使用经验。接种IPV可以使机体产生循环抗体，该抗体可以阻止病毒的感染，进而对麻痹产生非常好的保护作用。暴露于脊髓灰质炎病毒野毒株或疫苗株（OPV）可以产生黏膜抗体和细胞免疫，使机体获得不同程度对抗黏膜感染（以及因此导致的传播）的保护能力。因此使用IPV续接OPV的序贯免疫程序具有既能消除疫苗相关性麻痹型脊髓灰质炎（VAPP）的风险，又能限制疫苗衍生株脊髓灰质炎病毒（VDPV）风险的优势。Sabin IPV作为刚上市的新疫苗，已经开始产生数据以证明其性能。IPV将在全球消灭脊髓灰质炎中发挥无可替代的作用。

关键词： Sabin strain   inactivated vaccine   poliovirus  

摘要： Background. The development of a Sabin strain-based inactivated poliovirus vaccine (Sabin-IPV) is imperative to protecting against vaccine-associated paralytic poliomyelitis in developing countries. Methods. In this double-blinded, parallel-group, noninferiority trial, eligible infants aged 60-90 days were randomly assigned in a ratio of 1: 1 to receive either 3 doses of Sabin-IPV or Salk strain-based IPV (Salk-IPV) at 30-day intervals and a booster at the age of 18 months. Immunogenicity and safety were assessed on the basis of a protocol. Results. Of 1438 infants, 1200 eligible infants were recruited and received either Sabin-IPV or Salk-IPV. From the Sabin-IPV and Salk-IPV groups, 570 and 564 infants, respectively, completed the primary immunization and formed the per-protocol population. The seroconversion rates of the participants who received Sabin-IPV were 100%, 94.9%, and 99.0% (types I, II, and III, respectively), and those of the participants who received Salk-IPV were 94.7%, 91.3%, and 97.9% 1 month after the completion of primary immunization. An anamnestic response for poliovirus types I, II, and III was elicited by a booster in both groups. Except in the case of fever, other adverse events were similar between the 2 groups. Conclusions. The immune response induced by Sabin-IPV was not inferior to that established with Salk-IPV.

关键词： 脊髓灰质炎   疫苗,灭活   尾声战略计划  

摘要： 全球消灭脊髓灰质炎已经进入最终阶段，但依然面临巨大的挑战。《全球消灭脊髓灰质炎最后阶段战略规划（2013—2018）》（尾声战略）设定了至2018年世界无脊髓灰质炎的目标。同时，《世界卫生组织全球行动计划》（GAPⅢ）要求在消灭野生脊髓灰质炎病毒后，需严格封存脊髓灰质炎病毒。为保证尾声战略和GAPⅢ顺利实施，目前，全球每个新生儿需引入至少一剂次脊髓灰质炎灭活疫苗（IPV）。相对于野病毒生产的IPV，Sabin IPV具有生成过程安全性高，生产成本低的特点，可在全球消灭脊髓灰质炎的最后阶段中发挥重要作用。

关键词： Mucosal immunity   Cohorts   Poliovirus   Virus Shedding   Neutralization   Clinical Trial   Latin   Randomized Controlled Trial  

摘要： Background Identification of mechanisms that limit poliovirus replication is crucial for informing decisions aimed at global polio eradication. Studies of mucosal immunity induced by oral poliovirus (OPV) or inactivated poliovirus (IPV) vaccines and mixed schedules thereof will determine the effectiveness of different vaccine strategies to block virus shedding. We used samples from a clinical trial of different vaccination schedules to measure intestinal immunity as judged by neutralisation of virus and virus-specific IgA in stools. Methods In the FIDEC trial, Latin American infants were randomly assigned to nine groups to assess the efficacy of two schedules of bivalent OPV (bOPV) and IPV and challenge with monovalent type 2 OPV, and stools samples were collected. We selected three groups of particular interest-the bOPV control group (serotypes 1 and 3 at 6, 10, and 14 weeks), the trivalent attenuated OPV (tOPV) control group (tOPV at 6, 10, and 14 weeks), and the bOPV IPV group (bOPV at 6, 10, and 14 weeks plus IPV at 14 weeks). Neutralising activity and poliovirus type-specific IgA were measured in stool after a monovalent OPV type 2 challenge at 18 weeks of age. Mucosal immunity was measured by in-vitro neutralisation of a type 2 polio pseudovirus (PV2). Neutralisation titres and total and poliovirus-type-specific IgG and IgA concentrations in stools were assessed in samples collected before challenge and 2 weeks after challenge from all participants. Findings 210 infants from Guatemala and Dominican Republic were included in this analysis. Of 38 infants tested for mucosal antibody in the tOPV group, two were shedding virus 1 week after challenge, compared with 59 of 85 infants receiving bOPV (p<0.0001) and 53 of 87 infants receiving bOPV IPV (p<0.0001). Mucosal type 2 neutralisation and type-specific IgA were noted primarily in response to tOPV. An inverse correlation was noted between virus shedding and both serum type 2 neutralisation at challenge (p<0.0001)