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一例脊髓灰质炎减毒活疫苗相关急性播散性脑脊髓炎的病例分析
目的：分析一例疑似疫苗相关麻痹型脊髓灰质炎（ VAPP ）的急性弛缓性麻痹（ AFP ）病例，评估病例与接种疫苗的关系。方法由预防接种异常反应调查诊断专家组根据病例临床表现、实验室和影像学检查结果，结合循证医学证据进行分析论证。结果患儿首次服脊髓灰质炎减毒活疫苗后第14天接种首针b型流感嗜血杆菌结合疫苗，第21天出现发热、肢体乏力，体查：四肢肌力0级，肌张力低，颈部以下皮肤痛觉缺失。麻痹第5天大便标本分离到脊髓灰质炎Ⅲ型病毒疫苗株，实验室检查未发现其他病原体感染，核磁共振检查显示延髓、颈段、下胸段脊髓多发病变，胸11椎体水平以下脊神经前根强化较显著。上述结果符合急性播散性脑脊髓炎的临床表现。结论本病例诊断为脊髓灰质炎疫苗相关ADEM病例，属于疫苗接种异常反应，疾病预防控制人员应注意此类异常反应的发生。
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全球消灭脊髓灰质炎后阶段我国脊髓灰质炎疫苗免疫策略的探讨
Since its launching at the World Health Assembly (WHA) in 1988,the Global Polio Eradication Initiative (GPEI) has reduced the global incidence of polio by over 99 ％,from an estimated 350 000 cases then to 406 reported cases in 2013,and the number of countries with endemic polio from 125 to 3.The reduction is the result of the global effort to eradicate the disease.In 2012,the World Health Assembly declared ending polio a "programmatic emergency for global public health" and developed the Polio Eradication & Endgame Strategic Plan 2013-2018.In the plan,all countries are recommended to introduce at least 1 dose of IPV into their routine immunization programs to reduce the consequences of a subsequent circulating poliovirus after OPV2 cessation.Under certain conditions,how should at least one dose of IPV be introduced into Chinese routine immunization programs,what problems might be met during the process and what lessons we could learn from abroad are of great interest to us.During the meeting,experts shared the experiences of introducing IPV into their routine immunization programs and provided suggestions to us.Proper communication strategy and maintaining the high coverage of vaccination are the primary factors during the vaccine policy changing period.
