Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia.
World Health Organization, Geneva, Switzerland.
J Infect Dis. 2014 Nov 1;210 Suppl 1:S283-93. doi: 10.1093/infdis/jiu295.
The attenuated oral poliovirus vaccine (OPV) has many properties favoring its use in polio eradication: ease of administration, efficient induction of intestinal immunity, induction of durable humoral immunity, and low cost. Despite these advantages, OPV has the disadvantage of genetic instability, resulting in rare and sporadic cases of vaccine-associated paralytic poliomyelitis (VAPP) and the emergence of genetically divergent vaccine-derived polioviruses (VDPVs). Whereas VAPP is an adverse event following exposure to OPV, VDPVs are polioviruses whose genetic properties indicate prolonged replication or transmission. Three categories of VDPVs are recognized: (1) circulating VDPVs (cVDPVs) from outbreaks in settings of low OPV coverage, (2) immunodeficiency-associated VDPVs (iVDPVs) from individuals with primary immunodeficiencies, and (3) ambiguous VDPVs (aVDPVs), which cannot be definitively assigned to either of the first 2 categories. Because most VDPVs are type 2, the World Health Organization's plans call for coordinated worldwide replacement of trivalent OPV with bivalent OPV containing poliovirus types 1 and 3.
口服脊髓灰质炎减毒活疫苗（OPV）具有许多有利于消灭脊髓灰质炎的特性：易于管理、有效诱导肠道免疫、诱导持久的体液免疫、成本低。尽管有这些优势，但 OPV 存在遗传不稳定的缺点，导致罕见的、散发性疫苗相关麻痹性脊髓灰质炎（VAPP）病例和遗传上不同的疫苗衍生脊髓灰质炎病毒（VDPV）的出现。虽然 VAPP 是接触 OPV 后的不良事件，但 VDPV 是具有较长复制或传播特性的脊髓灰质炎病毒。已确认有三种类型的 VDPV：（1）在 OPV 覆盖率低的情况下爆发的循环 VDPV（cVDPV）；（2）原发性免疫缺陷个体中的免疫缺陷相关 VDPV（iVDPV）；（3）无法明确归入前两类的不确定 VDPV（aVDPV）。由于大多数 VDPV 为 2 型，世界卫生组织的计划要求全球协调用含有 1 型和 3 型脊髓灰质炎病毒的二价 OPV 替代三价 OPV。
