Gaebler J W, Kleiman M B, French M L, Chastain G, Barrett C, Griffin C
J Pediatr. 1986 Jun;108(6):878-81. doi: 10.1016/s0022-3476(86)80920-9.
Between April 1982 and June 1983 four children 3 to 24 months of age were referred for evaluation of neurologic abnormalities found to be compatible with vaccine-related poliovirus infection, which had not been suspected by referring physicians. Patients were epidemiologically unrelated residents of Indiana, and none had prior symptoms suggestive of immunodeficiency. All had received poliovirus vaccine orally (first dose in three, fourth dose in one) and a diphtheria-tetanus-pertussis injection in the left anterior thigh within 30 days of symptoms. A vaccine-like strain of poliovirus was isolated from each patient, and each had symptoms (left leg paralysis in three; developmental regression, spasticity, and progressive fatal cerebral atrophy in one) persisting for at least 6 months. Immune function was normal in two with poliovirus type 3 infection, and abnormal (hypogammaglobulinemia, combined immunodeficiency) in two with type 1 and type 2 infection, respectively. The incidence of observed vaccine-related poliovirus infection in Indiana recipients of orally administered poliovirus vaccine was 0.058 per 100,000 per year, significantly greater (P less than 0.001) than predicted.
1982年4月至1983年6月期间，4名年龄在3至24个月的儿童因被发现患有与疫苗相关的脊髓灰质炎病毒感染相符的神经学异常而被转诊，转诊医生此前并未怀疑有此类感染。这些患者是印第安纳州在流行病学上无关联的居民，且均无先前提示免疫缺陷的症状。所有患者在出现症状的30天内均口服了脊髓灰质炎病毒疫苗（3人接种首剂，1人接种第四剂），并在左大腿前侧注射了白喉-破伤风-百日咳疫苗。从每位患者身上均分离出一种类似疫苗株的脊髓灰质炎病毒，且每位患者均有持续至少6个月的症状（3人左腿麻痹；1人发育倒退、痉挛和进行性致命性脑萎缩）。3型脊髓灰质炎病毒感染的2名患者免疫功能正常，1型和2型感染的2名患者免疫功能分别异常（低丙种球蛋白血症、联合免疫缺陷）。印第安纳州口服脊髓灰质炎病毒疫苗接种者中观察到的与疫苗相关的脊髓灰质炎病毒感染发病率为每年每10万人0.058例，显著高于预期（P小于0.001）。
