Shindarov L M, Chumakov M P, Voroshilova M K, Bojinov S, Vasilenko S M, Iordanov I, Kirov I D, Kamenov E, Leshchinskaya E V, Mitov G, Robinson I A, Sivchev S, Staikov S
J Hyg Epidemiol Microbiol Immunol. 1979;23(3):284-95.
In May-September, 1975, an outbreak of epidemic disease clinically and pathomorphologically simulating nearly all known forms of poliomyelitis occurred predominantly among young infants in Bulgaria. Most cases presented benign aseptic meningitis, sometimes with a short period of general cerebra- symptoms. Paralytic forms, such as bulbar polioencephalitis, anterior poliomyelitis, isolated pareses of the facial nerve, occasional cases of encephalomyocarditis, etc., were observed in about 21% of all cases. Over one-fourth of the paralytic cases with bulbar symptoms ended fatally. In March, 1976 another sporadic fatal case of this disease was examined. No new cases occurred in 1977. Histopathological examinations in all fatal cases regularly revealed lesions in the grey matter of the medulla and spinal cord typical of acute anterior poliomyelitis and bulbar polioencephalitis, with some peculiar features of localization and depth of the involvement of the brain stem. The similarity to poliomyelitis and precariously rapid increase in the incidence led to the decision to urgently vaccinate the entire human population with Sabin's live poliovirus vaccine simultaneously in the whole country in order to produce interference with the circulating agent. This aim appeared to have been achieved partially because soon the number of new cases of the disease began to decrease; however, no sharp and complete break in the curve of the incidence occurred. By the time of mass vaccination, the results of virological examinations started before were not yet available. Later, comprehensive complete evidence was obtained that over 25 fatal and many other typical cases of the disease were associated with an enterovirus proved to be antigenically related to enterovirus 71. The diseases in Bulgaria, 1975, differ considerably in the frequency of paralytic forms and in severity from the epidemics caused by enterovirus 71 in Sweden, 1973, Australia, 1972--1973, USA, 1969--1972, and Japan, 1972--1973.
1975年5月至9月期间，保加利亚主要在幼儿中爆发了一种流行病，其临床和病理形态学表现几乎模拟了所有已知形式的脊髓灰质炎。大多数病例表现为良性无菌性脑膜炎，有时伴有短暂的全身性脑症状。在所有病例中，约21%出现了麻痹形式，如延髓脑灰质炎、脊髓灰质炎、面神经孤立性麻痹、偶发的脑心肌炎等。超过四分之一有延髓症状的麻痹病例死亡。1976年3月，对该疾病的另一例散发性致命病例进行了检查。1977年未出现新病例。对所有致命病例的组织病理学检查均定期显示延髓和脊髓灰质有典型的急性脊髓灰质炎和延髓脑灰质炎病变，脑干受累的定位和深度有一些特殊特征。由于与脊髓灰质炎相似且发病率急剧上升，决定在全国同时紧急用萨宾口服脊髓灰质炎活疫苗对全体人群进行接种，以便对传播媒介产生干扰。这一目标似乎部分实现了，因为很快该疾病的新病例数量开始减少；然而，发病率曲线并未出现急剧且完全的下降。在大规模接种疫苗时，之前开始的病毒学检查结果尚未可得。后来，获得了全面完整的证据，证明超过25例致命病例以及许多其他典型病例与一种肠道病毒有关，该肠道病毒经证实与肠道病毒71型抗原相关。1975年保加利亚的这种疾病在麻痹形式的频率和严重程度上与1973年瑞典、1972 - 1973年澳大利亚、1969 - 1972年美国以及1972 - 1973年日本由肠道病毒71型引起的疫情有很大差异。
