四川与云贵相邻地区加强维持无脊髓灰质炎的AFP监测与强化免疫的评价研究
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摘要
目的通过对四川与云南、贵州相邻地区2000～2006年急性弛缓性麻痹(AFP)监测系统的敏感性、及时性和完整性的分析，以及7年来在该地区开展脊髓灰质炎强化免疫情况的统计分析与培训效果的探讨，找到监测的薄弱环节，总结和推广成功的经验，为下一步干预工作制定策略提供科学依据。
方法收集四川与云南、贵州相邻地区2000～2006年消灭脊髓灰质炎工作数据，采用“中国免疫规划监测信息管理系统”及spss．11.0软件进行分析。
结果2000～2006年相邻地区20个项目县区共报告AFP病例216例，男女比例为1.67：1，无明显的地域性和季节性。年龄分布比较平均。无聚集性病例存在。流动儿童较少(7例)，AFP病例报告级别以县级为主，占49.07％。就诊一次就被发现报告的仅占32.87％。第一次被诊断为AFP病例并进行了报告的占43.06％。216例AFP病例全程服苗的病例占62.96％，“零剂次”儿童占了6.48％。实验室结果，脊灰阳性标本为12例。其中Ⅱ型病毒为7例，占脊灰病毒阳性的58.33％。60天随访结果无残留麻痹的占50％。经过全省AFP专家诊断小组诊断，216例AFP病例均排除脊灰。在2000年～2006年中，相邻地区卫生部的要求。四川省与云南、贵州相邻地区5个项目市州2002～2007年进行脊髓灰质炎疫苗强化免疫活动中，第一轮常住儿童接种率为96.92％，流动儿童接种率为97.45％，；第二轮常住儿童接种率为94.93％，流动儿童接种率为96.06％。其中共免疫了84975名常住“零剂次”儿童，17618名流动“零剂次”儿童。在2006年对全省各市州和项目县市区CDC负责AFP监测的71名专业人员进行的AFP监测培训效果显著，培训前测试平均成绩为52.6分，培训后测试平均成绩提高到93分。
结论县级及县级以下医疗机构工作人员素质不高，造成了AFP病例误诊，漏报，主要症状和临床体征判断不清，给消灭脊髓灰质炎工作带来很大的隐患。虽然AFP监测工作的完整性有一定的提高，但是敏感性和及时性都与WHO和卫生部的要求有一定的差距，监测工作质量有所下降。通过多轮的脊灰疫苗强化免疫工作，免疫了众多零剂次儿童，起到了消除免疫空白和建立免疫屏障的作用。开展业务培训是提高相关专业人员素质有效的方法。
Objective: The sensitivity, betimes, and integrality of 2000-2006 AFP surveillance system and statistics of the intensified immunization program for poliomyelitis in recent 7 years in the part of Sichuan, which borders on Yunnan and Guizhou, were analyzed to find out the weakness , summarize the lessons and experiences, and provide scientific evidence for the policy-making of the next intervention.
Method: Collect 2000-2006 work data of eradicating poliomyelitis in the areas boundering on Yunnan and Guizhou, and analyze those data by "China immunity programming surveillance information manage system" and spss11.0 software.
Result:: From 2000 to 2006, 20 counties, reported AFP 216 cases totally. Male to female ratio was 1.67:1, and without obvious difference among counties and seasons. Age distributing was balanced, without clustering cases, and migrant children were few (7 cases). County level reports were in the majority among AFP cases reports, accounting for 49.7%. There were just 32.87% cases can be found out and reported at the first care-seeking. There were 43.06% cases were reported, which were diagnosed at the first time. There wre 62.96% of 216 AFP cases taking full-course vaccine, among which "zero dose vaccined" children were 6.48%. According to the results of the lab tests, 12 cases were polio virus-positive, among which 7 cases were type II, accounting for 58.33%. And all of the 216 cases were evidenced negative, according to diagnose of provincial AFP professor subcommittee. From 2000 to 2006, the AFP monitoring system's sensitivity and betimes in the areas were not fit the requests of WHO and the Ministry of Health. The 5 counties in Sichuan, bordering on Yunnan and Guizhou had intensified immunization program for poliomyelitis during 2002-2007. The first round inoculation rate in resident children was 96.92%, and the same rate in migrant children was 97.45%; the second round inoculation rate in resident children was 94.93%, and the same rate in migrant children was96.06%. And there were 84975 "zero dose vaccined" resident children and 17618 "zero dose vaccined" migrant children. The training of the 71 career men taking charge of AFP surveillance, had got marked effect. The average score of examination elevated from 52.6 to 93 after the training.
Conclusion: The low professional ability of county or below level career men leaded AFP cases diagnose mistakes and missing, which brought big hidden troubles to the eradication of poliomyelitis. The integrality of AFP surveillance had advanced, but sensitivity and betimes still can not fit the requests of WHO and the Ministry of Health. The surveillance quality had declined. Many "zero take" children were inoculated by several rounds of intensified immunization program, through which immune blanks can be filled up, immune barriers established, wild strain insulated, and VDPV controlled. And special training course is necessary for advancing career men's ability.
方法收集四川与云南、贵州相邻地区2000～2006年消灭脊髓灰质炎工作数据，采用“中国免疫规划监测信息管理系统”及spss．11.0软件进行分析。
结果2000～2006年相邻地区20个项目县区共报告AFP病例216例，男女比例为1.67：1，无明显的地域性和季节性。年龄分布比较平均。无聚集性病例存在。流动儿童较少(7例)，AFP病例报告级别以县级为主，占49.07％。就诊一次就被发现报告的仅占32.87％。第一次被诊断为AFP病例并进行了报告的占43.06％。216例AFP病例全程服苗的病例占62.96％，“零剂次”儿童占了6.48％。实验室结果，脊灰阳性标本为12例。其中Ⅱ型病毒为7例，占脊灰病毒阳性的58.33％。60天随访结果无残留麻痹的占50％。经过全省AFP专家诊断小组诊断，216例AFP病例均排除脊灰。在2000年～2006年中，相邻地区卫生部的要求。四川省与云南、贵州相邻地区5个项目市州2002～2007年进行脊髓灰质炎疫苗强化免疫活动中，第一轮常住儿童接种率为96.92％，流动儿童接种率为97.45％，；第二轮常住儿童接种率为94.93％，流动儿童接种率为96.06％。其中共免疫了84975名常住“零剂次”儿童，17618名流动“零剂次”儿童。在2006年对全省各市州和项目县市区CDC负责AFP监测的71名专业人员进行的AFP监测培训效果显著，培训前测试平均成绩为52.6分，培训后测试平均成绩提高到93分。
结论县级及县级以下医疗机构工作人员素质不高，造成了AFP病例误诊，漏报，主要症状和临床体征判断不清，给消灭脊髓灰质炎工作带来很大的隐患。虽然AFP监测工作的完整性有一定的提高，但是敏感性和及时性都与WHO和卫生部的要求有一定的差距，监测工作质量有所下降。通过多轮的脊灰疫苗强化免疫工作，免疫了众多零剂次儿童，起到了消除免疫空白和建立免疫屏障的作用。开展业务培训是提高相关专业人员素质有效的方法。
Objective: The sensitivity, betimes, and integrality of 2000-2006 AFP surveillance system and statistics of the intensified immunization program for poliomyelitis in recent 7 years in the part of Sichuan, which borders on Yunnan and Guizhou, were analyzed to find out the weakness , summarize the lessons and experiences, and provide scientific evidence for the policy-making of the next intervention.
Method: Collect 2000-2006 work data of eradicating poliomyelitis in the areas boundering on Yunnan and Guizhou, and analyze those data by "China immunity programming surveillance information manage system" and spss11.0 software.
Result:: From 2000 to 2006, 20 counties, reported AFP 216 cases totally. Male to female ratio was 1.67:1, and without obvious difference among counties and seasons. Age distributing was balanced, without clustering cases, and migrant children were few (7 cases). County level reports were in the majority among AFP cases reports, accounting for 49.7%. There were just 32.87% cases can be found out and reported at the first care-seeking. There were 43.06% cases were reported, which were diagnosed at the first time. There wre 62.96% of 216 AFP cases taking full-course vaccine, among which "zero dose vaccined" children were 6.48%. According to the results of the lab tests, 12 cases were polio virus-positive, among which 7 cases were type II, accounting for 58.33%. And all of the 216 cases were evidenced negative, according to diagnose of provincial AFP professor subcommittee. From 2000 to 2006, the AFP monitoring system's sensitivity and betimes in the areas were not fit the requests of WHO and the Ministry of Health. The 5 counties in Sichuan, bordering on Yunnan and Guizhou had intensified immunization program for poliomyelitis during 2002-2007. The first round inoculation rate in resident children was 96.92%, and the same rate in migrant children was 97.45%; the second round inoculation rate in resident children was 94.93%, and the same rate in migrant children was96.06%. And there were 84975 "zero dose vaccined" resident children and 17618 "zero dose vaccined" migrant children. The training of the 71 career men taking charge of AFP surveillance, had got marked effect. The average score of examination elevated from 52.6 to 93 after the training.
Conclusion: The low professional ability of county or below level career men leaded AFP cases diagnose mistakes and missing, which brought big hidden troubles to the eradication of poliomyelitis. The integrality of AFP surveillance had advanced, but sensitivity and betimes still can not fit the requests of WHO and the Ministry of Health. The surveillance quality had declined. Many "zero take" children were inoculated by several rounds of intensified immunization program, through which immune blanks can be filled up, immune barriers established, wild strain insulated, and VDPV controlled. And special training course is necessary for advancing career men's ability.
引文
[1]．张荣珍．全球根除脊髓灰质炎的前景和展望．中华流行病学杂志1989：10(6)：377．
[2] Ofosll, Amaah S, et aL. Is Poliomyelitis is a Serious Problem in Developing Coutries?——Laments in Ghanaian Schools British Medical Journal 1977: 1012.
[3] RB Aylward. Disease Eradication as a Public Health Strategy a Case Study of Poliomyelitis Eradication [J]. Bulletin of the World Health Organization, 2000, (78): 3.
[4] Kaushik Banerjee. Poliomyelitis Surveillance: The Model Used in India for Polio Eradication [J]. Bulletin of the World Health Organization, 2000, (78): 31
[5] EJ Hoestra. Excluding Polio in Areas of Inadequate Surveillance in the Final Stages of Eradication in China [J]. Bulletin of the World Health Organization, 2000, (78): 3.
[6] Melinda Wharton Manual for the Surveillance of Vaccine-Preventable Disease [M]. CDC, 1997: 231
[7] 曹阳，孙美平．北京市2005年口服脊髓灰质炎减毒活疫苗零剂次免疫急性弛缓性麻痹病例的调查和思考[J]，中国计划免疫，2006，12(5)：430
[8] 曹阳，孙美平，刘大伟，等，北京市2004年外来儿童强化查漏补种活动分析[J]，中国计划免疫，2006，12(2)：130
[9] 侯晓晖，张礼壁，冷红英，等，在江苏省发现曾有Ⅰ型脊髓灰质炎疫苗衍生病毒在自然界循环[J]，中国计划免疫，2001，7(6)： 311
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[11] 张礼壁，候晓辉，朱晖，等。脊髓灰质炎重组株病毒在我国的循环及其致病性[J]，中国计划免疫，2001，7(3)：125
[12] 付清培，方刚，罗湘蜀，等，四川省近4年高危急性弛缓性麻痹病例的发现及处理[J]，预防医学情报杂志，2003，19(6)：493
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[6] 侯晓晖，张礼壁，冷红英，等．在江苏省发现曾有Ⅰ型脊髓灰质炎疫苗衍生病毒在自然界循环[J]，中国计划免疫，2001，7(6)：311．
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[8] 方刚，付清培，漆琪，等．疫苗重组脊髓灰质炎病毒引起的聚集性急性弛缓性麻痹病例流行病学调查分析[J]，中国计划免疫，2004，10(1)：1．
[9] CDC Circulation of a type 2 vaccine—derived poliovirus—Egypt, 1982 1993[J]. MMWR, 2001, 50(3): 41.
[10] Kew O, Morris Glasgow V, Landaverde M, et al. Outbreak of poliomyelitis in Hispaniola associated with circulating type 1 vaccine derived poliovirus [J]. Science. 2002, 296.
[11] WHO Acute flaccid paralysis associated with circulating vaccine derivedpoliovirus, Philippines, 2001[J]. WER, 2001, 76(41): 319.
[12] Rousset D, Rakoto—Andfianarivelo M, Razafindrat simandresy R, et al. Recombinant vaccine—derived poliovirus in Madagascar[J]. Emerging infectious Diseases, 2003, 9(7): 885.
[13] 温宁，左树岩，殷大鹏，等．中国疫苗衍生脊髓灰质炎病毒循环事件的流行病学调查[J]，中国计划免疫，2005，44(4)：248．
[14] CDC. Progress Towards Interruption of Wild Poliovirus Transmission—Worldwide. January 2005 March. MMWR, 2006, 55(16): 458.
[15] 刘晓强，杜芳朝．云南省本地儿童与流动儿童口服脊髓灰质炎疫苗免疫状况分析中国计划免疫，2000，6(1)：34．
[16] 张福全，2000年——无脊髓灰质炎的世界，疾病防治(J)：30．
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[19] 田新英，李春岩，曾浔，等．格林—巴利综合征相关空肠弯曲菌fl，za基因的克隆及序列特征，中华微生物学和免疫学杂志[J]，2005，25(10)：846．
[20] 扬保平，张荣珍．消灭脊髓灰质炎策略．中华流行病学杂 志，1991，12(1)：47．
[21] 许爱强，李黎，王爱莲，等．脊髓灰质炎疫苗强化免疫效果的初步评价，中国公共卫生。1993，9(6)：251．
[22] 刘丹青，戴振威．无脊髓灰质炎状态下面临的问题及对策[J]．中国计划免疫。2002，8(3)：165．
[23] 徐爱强，于竞进．全球今后消灭脊髓灭质炎的主要技术问题与展望[J]．中国计划免疫，2001，7(1)：50．
[2] Ofosll, Amaah S, et aL. Is Poliomyelitis is a Serious Problem in Developing Coutries?——Laments in Ghanaian Schools British Medical Journal 1977: 1012.
[3] RB Aylward. Disease Eradication as a Public Health Strategy a Case Study of Poliomyelitis Eradication [J]. Bulletin of the World Health Organization, 2000, (78): 3.
[4] Kaushik Banerjee. Poliomyelitis Surveillance: The Model Used in India for Polio Eradication [J]. Bulletin of the World Health Organization, 2000, (78): 31
[5] EJ Hoestra. Excluding Polio in Areas of Inadequate Surveillance in the Final Stages of Eradication in China [J]. Bulletin of the World Health Organization, 2000, (78): 3.
[6] Melinda Wharton Manual for the Surveillance of Vaccine-Preventable Disease [M]. CDC, 1997: 231
[7] 曹阳，孙美平．北京市2005年口服脊髓灰质炎减毒活疫苗零剂次免疫急性弛缓性麻痹病例的调查和思考[J]，中国计划免疫，2006，12(5)：430
[8] 曹阳，孙美平，刘大伟，等，北京市2004年外来儿童强化查漏补种活动分析[J]，中国计划免疫，2006，12(2)：130
[9] 侯晓晖，张礼壁，冷红英，等，在江苏省发现曾有Ⅰ型脊髓灰质炎疫苗衍生病毒在自然界循环[J]，中国计划免疫，2001，7(6)： 311
??[10] 陈红缨，李敏，郑景山，等，湖北省1995-1999年检出脊髓灰质炎疫苗株病毒的急性弛缓性麻痹病例流行病学分析[J]，中国计划免疫，2001，7(2)：89
[11] 张礼壁，候晓辉，朱晖，等。脊髓灰质炎重组株病毒在我国的循环及其致病性[J]，中国计划免疫，2001，7(3)：125
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