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目的分析原发性免疫缺陷(PrimaryImm unodeficiency,PID)患者排出疫苗衍生脊髓灰质炎(脊灰)病毒(Vaccine-derived Poliovirus,iVDPV)的流行病学调查和处理情况。方法访谈病例发病前后情况,查阅临床病历,对病例及其密切接触者进行医学观察。对病例进行个案调查和标本检测,测定免疫功能,并定期采集粪便标本分离病毒;对病例所在地及医院进行急性弛缓性麻痹(Acute Flaccid Paralysis,AFP)病例主动搜索;对病例所在地及相邻地进行儿童口服脊灰减毒活疫苗(Oral Poliomyelitis Attenuated Live Vaccine,OPV)接种率调查;采集密切接触者和周围健康儿童的粪便标本,以及病例所在村的污水标本进行病毒分离。结果病例最终分类诊断为Ⅱ型(TypeII)免疫缺陷(Immunodeficiency,ID)VDPV(iVDPVII),核苷酸变异1.8%。病例在麻痹后6个月内定期采集17份粪便标本,未检测到脊灰病毒(Poliovirus,PV)。当地儿童OPV常规免疫接种率100%。采集病例接触者粪便标本50份,除分离到6株非脊灰肠道病毒(Non-polio Enterovirus,NPEV)外,未检出PV。采集病例所在村污水2份,未检出PV。发现iVDPVII后,及时采取了包括隔离治疗、环境消毒、接种率调查、AFP病例主动搜索、在病例所在地及相邻地区开展OPV补充免疫活动等多项措施。结论 iVDPVII未在当地造成循环。iVDPVII的发现,提示有必要对ID人群排出VDPV毒力变异的特点及其对易感人群是否具有致病力进行深入研究。
Objective To analyze the epidemiological investigation and treatment of Vaccine-derived Poliovirus (iVDPV) in patients with Primary Immunodeficiency (PID). Methods Interviews before and after the incidence of cases, access to clinical records, medical records of patients and their close contacts. Case investigation and specimen testing, determination of immune function, and regular collection of stool specimens for virus isolation; active case searching for Acute Flaccid Paralysis (AFP) cases and hospitals; location of patients and their adjacency Inoculation rate of Oral Poliomyelitis Attenuated Live Vaccine (OPV) in children was investigated. Stool samples from close contacts and surrounding healthy children were collected, and the sewage samples of the villages where the cases were located were isolated for virus isolation. Results The final classification of the cases was Type II Immunodeficiency (ID) VDPV (iVDPVII) with nucleotide variation of 1.8%. Seventeen stool specimens were collected regularly within 6 months after paralysis and no poliovirus (PV) was detected. Local children OPV routine immunization rate of 100%. Fifty copies of the stool samples of the contact persons were collected. No PV was detected except for six non-polio Enterovirus (NPEV) isolates. Collection of sewage in the village where the case 2, did not detect PV. After the discovery of iVDPVII, a number of measures such as isolation treatment, environmental disinfection, inoculation rate survey, active search of AFP cases, OPV supplementary immunization activities in the area of the cases and adjacent areas were promptly taken. Conclusion iVDPVII did not cause circulation in the local area. The discovery of iVDPVII suggests that it is necessary to study the characteristics of VDPV virulence variation in ID population and whether it has pathogenicity to susceptible population.