Alexander James P, Ehresmann Kristen, Seward Jane, Wax Gary, Harriman Kathleen, Fuller Susan, Cebelinski Elizabeth A, Chen Qi, Jorba Jaume, Kew Olen M, Pallansch Mark A, Oberste M Steven, Schleiss Mark, Davis Jeffrey P, Warshawsky Bryna, Squires Susan, Hull Harry F
National Center for Immunizations and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia 30333, USA.
J Infect Dis. 2009 Feb 1;199(3):391-7. doi: 10.1086/596052.
Oral poliovirus vaccine (OPV) has not been used in the United States since 2000. Type 1 vaccine-derived poliovirus (VDPV) was identified in September 2005, from an unvaccinated Amish infant hospitalized in Minnesota with severe combined immunodeficiency. An investigation was conducted to determine the source of the virus and its means of transmission.
The infant was tested serially for poliovirus excretion. Investigations were conducted to detect poliovirus infections or paralytic poliomyelitis in Amish communities in Minnesota, neighboring states, and Ontario, Canada. Genomic sequences of poliovirus isolates were determined for phylogenetic analysis.
No source for the VDPV could be identified. In the index community, 8 (35%) of 23 children tested, including the infant, had evidence of type 1 poliovirus or VDPV infection. Phylogenetic analysis suggested that the VDPV circulated in the community for approximately 2 months before the infant's infection was detected and that the initiating OPV dose had been given before her birth. No paralytic disease was found in the community, and no poliovirus infections were found in other Amish communities investigated.
This is the first demonstrated transmission of VDPV in an undervaccinated community in a developed country. Continued vigilance is needed in all countries to identify poliovirus infections in communities at high risk of poliovirus transmission.
自2000年以来，美国未再使用口服脊髓灰质炎疫苗（OPV）。2005年9月，在明尼苏达州一名因严重联合免疫缺陷住院的未接种疫苗的阿米什婴儿中，发现了1型疫苗衍生脊髓灰质炎病毒（VDPV）。开展了一项调查，以确定病毒来源及其传播途径。
对该婴儿进行脊髓灰质炎病毒排泄的连续检测。对明尼苏达州、周边各州以及加拿大安大略省的阿米什社区进行调查，以检测脊髓灰质炎病毒感染或麻痹性脊髓灰质炎。对脊髓灰质炎病毒分离株的基因组序列进行测定，以进行系统发育分析。
无法确定VDPV的来源。在该索引社区，包括该婴儿在内的23名接受检测的儿童中有8名（35%）有1型脊髓灰质炎病毒或VDPV感染的证据。系统发育分析表明，VDPV在社区中传播了约2个月后才检测到该婴儿感染，且其首剂OPV是在她出生前接种的。该社区未发现麻痹性疾病，在其他接受调查的阿米什社区也未发现脊髓灰质炎病毒感染。
这是发达国家中首次证明VDPV在疫苗接种不足的社区中传播。所有国家都需要持续保持警惕，以识别脊髓灰质炎病毒传播高风险社区中的脊髓灰质炎病毒感染情况。
