Samoilovich E O, Feldman E V, Yermalovich M A, Protas I I, Titov L P
Research Institute for Epidemiology and Microbiology, Ministry of Health, Minsk, Republic of Belarus.
Cent Eur J Public Health. 2003 Dec;11(4):213-8.
According to the WHO global polio eradication initiative acute flaccid paralysis (AFP) surveillance has been conducted in Belarus since 1996. For the period 1996-2002, 295AFP cases were reported. The main indices ofAFP surveillance in Belarus met the WHO criteria. A11 AFP cases, with the exception of one, were virologically examined. Polioviruses (PV) were isolated from 28 (9.5%) of them. Results of intratypic differentiation (a neutralization test with type-specific monoclonal antibodies and a restriction fragment length polymorphism assay) proved vaccine origin of all isolated PV. According to the final classification, 11 AFP cases were classified as vaccine-associated paralytic poliomyelitis (VAPP). Nine VAPP cases were recipient [six of them developed after the first, two--after the third and one--after the fourth oral poliovirus vaccine (OPV) dose] and two cases in non-vaccinated children were classified as contact VAPP cases. PV of all three serotypes were isolated with an equal frequency from the recipient cases and only PV2--from contact ones. Immunological investigations of children with VAPP showed that the majority of them had disorders in B-cell immunity. A risk of one VAPP case per 96,000 first OPV doses and per 745,000 distributed ones was estimated. The other 284 AFP cases were classified as AFP of non-polio etiology (non-polio AFP). Among them Guillain-Barré syndrome (118 cases, 41.5% of all non-polio AFP cases), traumatic neuritis (63 cases, 22.2%), transient monoparesis of limb (35 cases, 12.3%), myelitis (26 cases, 9.2%) were registered most frequently. Vaccine PV were isolated from 19 (6.7%) children with non-polio AFP, 28 (9.9%) children excreted non-polio enteric viruses. In contrast to VAPP, other AFP with PV isolation had no clinical picture typical of poliomyelitis, and had no any residual paralysis 60 days after the onset of paralysis. PV isolation from them seemed to be not related to the etiology of the disease, but was a mere coincidence of paralysis with the recent vaccination. Results of AFP surveillance supported the previous data on the absence of classical poliomyelitis cases caused by wild PV in Belarus for more than 35 years.
根据世界卫生组织全球根除脊髓灰质炎行动，白俄罗斯自1996年起开展急性弛缓性麻痹（AFP）监测。在1996 - 2002年期间，共报告了295例AFP病例。白俄罗斯AFP监测的主要指标符合世界卫生组织标准。除1例之外，所有AFP病例均接受了病毒学检查。从其中28例（9.5%）中分离出了脊髓灰质炎病毒（PV）。型内鉴别结果（用型特异性单克隆抗体进行中和试验以及限制性片段长度多态性分析）证明所有分离出的PV均源自疫苗。根据最终分类，11例AFP病例被归类为疫苗相关麻痹型脊髓灰质炎（VAPP）。9例VAPP病例为疫苗接种者[其中6例在首次口服脊髓灰质炎病毒疫苗（OPV）后发病，2例在第三次后发病，1例在第四次后发病]，2例未接种疫苗儿童的病例被归类为接触性VAPP病例。在疫苗接种者病例中，3种血清型的PV分离频率相同，而在接触性病例中仅分离出了PV2。对VAPP患儿的免疫学调查表明，他们中的大多数存在B细胞免疫紊乱。估计每96,000剂首剂OPV和每745,000剂分发的OPV中有1例VAPP病例的风险。其他284例AFP病例被归类为非脊髓灰质炎病因的AFP（非脊髓灰质炎AFP）。其中，格林 - 巴利综合征（118例，占所有非脊髓灰质炎AFP病例的41.5%）、创伤性神经炎（63例，22.2%）、肢体短暂性单瘫（35例，12.3%）、脊髓炎（26例，9.2%）最为常见。从19例（6.7%）非脊髓灰质炎AFP患儿中分离出了疫苗PV，28例（9.9%）患儿排出了非脊髓灰质炎肠道病毒。与VAPP不同，其他分离出PV的AFP没有脊髓灰质炎典型的临床表现，且在麻痹发作60天后没有任何残留麻痹。从这些病例中分离出PV似乎与疾病病因无关，只是麻痹与近期接种疫苗的巧合。AFP监测结果支持了此前关于白俄罗斯35多年来未出现由野生PV引起的经典脊髓灰质炎病例的数据。
