Grassly Nicholas C
Department of Infectious Disease Epidemiology, St Mary's Hospital Medical School, Imperial College London, United Kingdom.
J Infect Dis. 2014 Nov 1;210 Suppl 1(Suppl 1):S439-46. doi: 10.1093/infdis/jit601. Epub 2014 Mar 14.
The World Health Organization has recommended that all 124 countries currently using only oral poliovirus vaccine (OPV) introduce at least 1 dose of inactivated poliovirus vaccine (IPV) before the global withdrawal of serotype 2 OPV in 2016. A 1- or 2-dose schedule, potentially administered intradermally with reduced antigen content, may make this affordable.
A systematic review and meta-analysis of studies documenting seroconversion after 1 or 2, full or fractional (1/5) doses of enhanced-potency IPV was performed. Studies reporting the clinical efficacy of IPV were also reviewed.
Twenty study arms from 12 published articles were included in the analysis of seroconversion. One full dose of intramuscular IPV seroconverted 33%, 41%, and 47% of infants against serotypes 1, 2, and 3 on average, whereas 2 full doses seroconverted 79%, 80%, and 90%, respectively. Seroconversion increased with age at administration. Limited data from case-control studies indicate clinical efficacy equivalent to the proportion seroconverting. One fractional dose of intradermal IPV gave lower seroconversion (10%-40%), but after 2 doses seroconversion was comparable to that with full-dose IPV.
Routine immunization with 2 full or fractional doses of IPV given after 10 weeks of age is likely to protect >80% of recipients against poliomyelitis if poliovirus reemerges after withdrawal of OPV serotypes.
世界卫生组织建议，目前仅使用口服脊髓灰质炎疫苗（OPV）的所有124个国家，在2016年全球停用2型OPV之前至少引入1剂灭活脊髓灰质炎疫苗（IPV）。1剂或2剂的接种程序，可能采用皮内注射且抗原含量降低，或许能使其费用可承受。
对记录1剂或2剂、全量或分剂量（1/5）强化效力IPV后血清阳转的研究进行系统评价和荟萃分析。还对报告IPV临床疗效的研究进行了综述。
血清阳转分析纳入了12篇已发表文章中的20个研究组。1剂肌内注射IPV平均使33%、41%和47%的婴儿分别对1型、2型和3型产生血清阳转，而2剂全量IPV分别使79%、80%和90%的婴儿产生血清阳转。血清阳转率随接种时年龄增加而升高。病例对照研究的有限数据表明临床疗效与血清阳转比例相当。1剂皮内注射分剂量IPV的血清阳转率较低（10% - 40%），但2剂后血清阳转率与全量IPV相当可比。
如果在停用OPV血清型后脊髓灰质炎病毒再次出现，10周龄后常规接种2剂全量或分剂量IPV可能使超过80%的接种者预防脊髓灰质炎。
