BACKGROUND:China's Expanded Program on Immunization (EPI) has provided 4 doses of oral poliovirus vaccine (OPV) since the 1970s. Inactivated poliovirus vaccine (IPV) became available in 2010 in Hangzhou as a private-sector, parent-chosen alternative to OPV. In 2015, WHO recommended that countries with all-OPV vaccination schedules introduce at least one dose of IPV, to mitigate risk associated with the withdrawal of type 2 OPV. We analyzed polio vaccine coverage and utilization in Hangzhou to determine patterns of IPV use and the occurrence of vaccine-associated paralytic polio (VAPP) in the various patterns identified. METHODS:Children born between 2010 and 2014 and registered in Hangzhou's Immunization Information System (HZIIS) were included. VAPP cases were detected through the acute flaccid paralysis surveillance system. We used descriptive epidemiological methods to determine IPV and OPV usage patterns and VAPP occurrence. RESULTS:HZIIS data from 566,894 children were analyzed. Coverage levels of polio vaccine were greater than 92% for each birth cohort. Percentages of children using OPV-only, IPV-only, and IPV/OPV sequential schedules were 70.57%, 27.01% and 2.41%, respectively. IPV-only schedule utilization increased by birth cohort regardless of geographical area or whether the child was locally-born. The highest use of an all-IPV schedule (79.85%) was among urban, locally-born children in the 2014 birth cohort. Five VAPP cases were identified during the study years; all cases occurred following the first polio vaccine dose, which was always OPV for the cases. Type 2 vaccine virus was isolated from 2 VAPP cases, and type 2 and type 3 vaccine virus was isolated from one VAPP case. The incidence of VAPP in the 2010-2014 birth cohorts was 3.76 per 1million doses of OPV. CONCLUSION:Children in Hangzhou had high polio vaccination coverage. IPV-only schedule use increased by year, and was highest in urban areas among locally-born children. All cases of VAPP were associated with the first dose of OPV.

译文

背景:自1970年代以来,中国的扩大免疫规划(EPI)已提供了4剂口服脊髓灰质炎病毒疫苗(OPV)。灭活的脊髓灰质炎病毒疫苗(IPV)于2010年在杭州上市,作为私营部门的父母选择的OPV替代品。在2015年,世卫组织建议制定了全OPV疫苗接种计划的国家至少注射一剂IPV,以减轻与撤回2型OPV有关的风险。我们分析了杭州的脊髓灰质炎疫苗覆盖率和利用情况,以确定了IPV的使用模式以及所确定的各种模式中与疫苗相关的麻痹性脊髓灰质炎(VAPP)的发生。
方法:纳入2010年至2014年之间出生并在杭州市免疫信息系统(HZIIS)中注册的孩子。通过急性弛缓性麻痹监测系统发现了VAPP病例。我们使用描述性流行病学方法来确定IPV和OPV使用模式以及VAPP的发生。
结果:分析了566894名儿童的HZIIS数据。每个出生队列的脊髓灰质炎疫苗覆盖率大于92%。使用仅使用OPV,仅使用IPV和IPV / OPV顺序时间表的儿童的百分比分别为70.57%,27.01%和2.41%。无论出生地区或孩子在当地出生,仅按IPV计划的使用率都会随出生队列的增加而增加。在2014年出生的队列中,所有IPV计划的使用率最高(79.85%)在城市本地出生的儿童中。在研究年中发现了五例VAPP病例;所有病例均在第一剂脊髓灰质炎疫苗之后发生,对于该病例,该剂量始终为OPV。从2例VAPP病例中分离出2型疫苗病毒,从1例VAPP病例中分离出2型和3型疫苗病毒。每100万剂OPV中,2010-2014年出生队列中VAPP的发生率为3.76。
结论:杭州市儿童脊髓灰质炎疫苗接种率较高。仅使用IPV的时间表使用量逐年增加,在本地出生的儿童中,城市使用率最高。所有VAPP病例均与第一剂OPV相关。

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