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目的分析广东省残留麻痹的急性弛缓性麻痹(AFP)病例的流行病学特征及影响因素,探究预防措施。方法病例资料来自2008—2012年广东省AFP病例监测系统。病例资料包括病例基本情况、临床症状和体征、麻痹后就诊、免疫接种等情况,并采集双份粪便送省脊灰实验室检测。对残留麻痹AFP病例进行描述性流行病学分析,对残留麻痹的有关影响因素作单因素和多因素非条件logistic回归分析。结果广东省2008—2012年共报告1 659例AFP病例,其中231例残留麻痹,占13.92%。残留麻痹病例集中分布于0～4岁,占82.25%(190/231),接种3剂次及以上脊髓灰质炎(脊灰)疫苗者占67.97%(157/231),麻痹前多有发热症状(占71.43%,165/231),以下肢麻痹多见(占67.10%,155/231),粪便标本脊灰病毒分离率为19.82%(45/227)。经多因素回归分析,女性、麻痹前发热、粪便分离出脊灰病毒是使AFP病例残留麻痹风险升高的因素,OR值分别为1.673、1.560、6.535;脊灰疫苗免疫3次以上、发病年龄较大是使AFP病例残留麻痹率降低的因素,OR值分别为0.505、0.570。结论粪便分离出脊灰病毒使AFP病例残留麻痹风险显著升高,残留麻痹病例中可能存在部分脊灰疫苗相关病例,加强对残留麻痹的AFP病例的临床诊断,有利于明确残留麻痹中可能存在的脊灰疫苗相关病例,进而采取防控措施。提高脊灰疫苗接种率,有利于减少AFP病例残留麻痹的发生。
Objective To analyze the epidemiological characteristics and influential factors of acute flaccid paralysis (AFP) cases of residual paralysis in Guangdong Province and to explore preventive measures. Methods Case data were collected from Guangdong AFP case surveillance system during 2008-2012. Case information, including the basic situation of the case, clinical symptoms and signs, paralysis after treatment, immunization and so on, and collect double copies of stool sent to the province polio laboratory testing. Descriptive epidemiological analysis of residual paralyzed AFP cases and univariate and multivariate non-conditional logistic regression analysis of the related influencing factors of residual paralysis. Results A total of 1 659 cases of AFP were reported in Guangdong Province from 2008 to 2012, of which 231 cases were residual paralysis, accounting for 13.92%. The cases of residual paralysis concentrated on 0 to 4 years old, accounting for 82.25% (190/231), 67.97% (157/231) inoculated with 3 doses or more of poliomyelitis (poliomyelitis) vaccine and more febrile symptoms before paralysis (Accounting for 71.43% and 165/231 respectively). Paralysis of the lower limbs was more common (67.10% and 155/231), and rate of poliovirus isolated from stool specimens was 19.82% (45/227). Multivariate regression analysis showed that women with fever before paralysis and poliovirus isolated from feces were the factors that increased the residual paralysis risk of AFP patients, with OR values of 1.673, 1.560 and 6.535, respectively. The poliovaccine immunized more than three times and the age of onset Larger is to make AFP cases residual paralysis rate reduction factors, OR values were 0.505,0.570. Conclusion The poliovirus isolated from feces significantly increases the residual paralysis risk of AFP patients. Some poliovirus-associated cases may be present in residual paralysis cases, and the clinical diagnosis of AFP cases with residual paralysis may be strengthened, which may help to clarify the possible residual paralysis Polio vaccine-related cases, and then take prevention and control measures. Improve the polio vaccination rate is conducive to reducing residual paralysis AFP cases.