MMWR Morb Mortal Wkly Rep. 2009 Sep 18;58(36):1002-6.
In 1988, the World Health Assembly resolved to eradicate poliomyelitis worldwide. Subsequently, the Global Polio Eradication Initiative of the World Health Organization (WHO) reduced the global incidence of polio associated with wild polioviruses (WPVs) from an estimated 350,000 cases in 125 countries in 1988 to 1,651 reported cases in 2008 and reduced the number of countries that have never interrupted WPV transmission to four (Afghanistan, India, Nigeria, and Pakistan). Under current WHO plans, when the goal of eradicating all WPV transmission is attained, oral poliovirus vaccine (OPV) use worldwide eventually will be discontinued. However, because vaccine-derived polioviruses (VDPVs) can produce polio outbreaks in areas with low rates of Sabin OPV coverage and can replicate for years in immunodeficient persons, enhanced strategies are needed to limit emergence of VDPVs. This report updates previous summaries and describes VDPVs detected worldwide during January 2008-June 2009. During this period, 1) two new outbreaks of circulating VDPVs (cVDPVs) (accounting for 4-20 cases) were identified in the Democratic Republic of Congo and Ethiopia; 2) a previously identified outbreak in Nigeria ultimately resulted in a cumulative total of 292 cases; 3) two newly identified paralyzed immunodeficient persons in Argentina and the United States were found to excrete VDPVs; and 4) isolated VDPVs were found among persons and environmental samples in 11 countries. All countries need to maintain 1) high rates of poliovirus vaccination coverage to prevent VDPV spread and 2) sensitive poliovirus surveillance to detect VDPVs.
1988年，世界卫生大会决议在全球根除脊髓灰质炎。随后，世界卫生组织（WHO）的全球根除脊髓灰质炎行动将与野生脊髓灰质炎病毒（WPV）相关的全球脊髓灰质炎发病率从1988年估计的125个国家的35万例降至2008年报告的1651例，并将从未中断WPV传播的国家数量减少到四个（阿富汗、印度、尼日利亚和巴基斯坦）。根据WHO目前的计划，当实现根除所有WPV传播的目标时，最终将停止在全球范围内使用口服脊髓灰质炎疫苗（OPV）。然而，由于疫苗衍生脊髓灰质炎病毒（VDPV）可在Sabin OPV覆盖率低的地区引发脊髓灰质炎疫情，且可在免疫功能低下者体内复制数年，因此需要加强策略以限制VDPV的出现。本报告更新了以往的总结，并描述了2008年1月至2009年6月期间在全球检测到的VDPV。在此期间，1）在刚果民主共和国和埃塞俄比亚发现了两起新的循环VDPV（cVDPV）疫情（4 - 20例）；2）尼日利亚先前确认的疫情最终累计达292例；3）在阿根廷和美国新发现的两名瘫痪免疫功能低下者被发现排出VDPV；4）在11个国家的人员和环境样本中发现了孤立的VDPV。所有国家都需要保持1）高脊髓灰质炎疫苗接种覆盖率以防止VDPV传播，以及2）敏感的脊髓灰质炎病毒监测以检测VDPV。
