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Lancet infect dis:在孟加拉国停用口服三价脊髓灰质病毒疫苗后脊髓灰质炎的传播情况。

2017-07-08 qinqiyun MedSci原创

2016年4月起,在全球范围内,三价口服脊髓灰质炎疫苗(tOPV)被二价I型和3型口服脊髓灰质炎疫苗(bOPV)和一剂量的灭活脊髓灰质炎病毒(IPV)所取代。对于这一改变后II型脊髓灰质炎病毒或Sabin2病毒(脊髓灰质炎病毒的一种)对于II型脊髓灰质炎的再次引入或发生的传播风险尚未完全清楚。

脊髓灰质炎是由脊髓灰质炎病毒引起的严重危害儿童健康的急性传染病,脊髓灰质炎病毒为嗜神经病毒,主要侵犯中枢神经系统的运动神经细胞,以脊髓前角运动神经元损害为主。

2016年4月起,在全球范围内,三价口服脊髓灰质炎疫苗(tOPV)被二价I型和3型口服脊髓灰质炎疫苗(bOPV)和一剂量的灭活脊髓灰质炎病毒(IPV)所取代。对于这一改变后II型脊髓灰质炎病毒或Sabin2病毒(脊髓灰质炎病毒的一种)对于II型脊髓灰质炎的再次引入或发生的传播风险尚未完全清楚。本文对脊髓灰质炎疫苗改革后接受单价II型口服脊髓灰质疫苗(mOPV2)的情况下Sabin2病毒的传播风险进行评估。

在孟加拉国的部分区域进行一开放性随机试验。随机将新生儿分组,一组是在6周、10周和14周时接种tOPV;一组在6周、10周和14周时接受bOPV和14周时接种一剂量的IPV或在14周和18周大时接种两剂量的IPV。此外,还进行了一个mOPV2疫苗活动,目标为40%5岁以下的幼儿,并忽略其登记时的状态。主要评估项目为在活动后10周内符合方案分析的未接种mOPV2疫苗的新生儿中Sabin2的发病率(通过RT-qPCR检测Sabin2病毒来评定)。之前免疫情况对发病率的影响通过观察Sabin2病毒的患病率和发病率的脊髓灰质炎传播的动态模型来估算。

2015年4月30日-2016年1月14日,该研究涉及67个村庄。22个村庄(300个新生儿)随机接种tOPV,23个村庄(310个新生儿)接种bOPV和一剂量的IPV,22个村庄(329个新生儿)接种bOPV和两剂量的IPV。未接种mOPV2疫苗的新生儿中Sabin2病毒的排泄脱落情况与接种bOPV和一或两剂量的IPV的幼儿以及接种tOPV的幼儿没有差别。但是,与接种tOPV相比,接种bOPV和一或两剂量的IPV幼儿的家庭成员中Sabin2的排泄脱落情况明显增加。家庭成员的发病率的动态模型表明家庭成员的免疫可限制传播。

在本研究中,模拟了tOPV中断1年的情况,Sabin2在mOPV2、bOPV联合IPV的接种者的家庭成员中的更容易传播,但是在整体社区中的传播情况没有明显改变。但是,随着tOPV中断的时间的延长,传播风险很可能会随着增高。

原始出处:

Mami Taniuchi,et al.Community transmission of type 2 poliovirus after cessation of trivalent oral polio vaccine in Bangladesh: an open-label cluster-randomised trial and modelling study.The Lancet Infectious Diseases.07 July 2017.http://dx.doi.org/10.1016/S1473-3099(17)30358-4

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    2018-01-17 howi
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    2017-10-17 一闲
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    2017-07-10 1dd8c52fm63(暂无匿称)

    继续关注

    0

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