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目的通过对2007年中国(未包括香港、澳门特别行政区和台湾地区,下同)脊髓灰质炎(脊灰)实验室网络监测数据进行分析,评估实验室网络的运转情况,为中国维持无脊灰状态提供实验室依据。方法分析中国免疫规划监测信息管理系统数据库中31个省(自治区、直辖市,下同)上报的急性弛缓性麻痹(Acute Flaccid Paralys-is,AFP)病例个案调查表,和中国疾病预防控制中心(CDC)病毒病预防控制所国家脊灰实验室(National Polio Lab-otatory,NPL)的监测数据库,评价实验室网络的各项运转指标。结果2007年全国脊灰实验室网络共收集了4984例AFP病例的9771份粪便标本,合格粪便标本采集率为90.5%。按世界卫生组织(WHO)第4版《脊灰实验室手册》的要求进行病毒分离和鉴定,28d内完成病毒血清型定型的及时率为94.8%。AFP病例中分离到脊灰病毒(Poliovirus,PV)的214例,分离率为4.29%;分离到非脊灰肠道病毒(Non-Polio Enterovirus,NPEV)的471例,分离率为9.45%。2007年NPL收到脊灰实验室网络送检的316份PV阳性分离物,由于酶联免疫吸附试验(ELISA)型内鉴定的试剂供应短缺,因此对PV型内鉴定改为直接进行VP1基因核苷酸序列测定与分析,所以调整之前仅对10株I型PV、14株Ⅱ型PV进行了ELISA型内鉴定;对14株PV进行了聚合酶链反应-限制性酶切片段长度多态性分析型内鉴定;对其余的397株单血清型PV进行了VP1基因核苷酸序列测定和分析,均未发现脊灰野病毒。在山东省的2例AFP病例中,分离到3株Ⅰ型疫苗衍生脊灰病毒(Vaccine-derived Poliovirus,VDPVs),但不属于循环的VDPVs(cVDPVs);在山西省1例AFP病例中分离到2株Ⅰ型VDPVs;在广西壮族自治区的1例AFP病例中分离到1株Ⅰ型VDPV。2007年NPL以优异的成绩通过了WHO盲样标本的能力验证和现场认证考核;31个省CDC脊灰实验室通过了与NPL相同的盲样标本的能力验证;12个省CDC脊灰实验室通过了WHO的实验室现场认证考核。NPL对5个省送检的334份原始粪便标本进行了复核,PV的符合率为99%~100%,NPEV的符合率为88.0%~92.7%。结论2007年中国脊灰实验室网络运转良好,中国继续保持无脊灰状态,实验室网络监测系统敏感有效,为维持无脊灰状态提供了实验室依据。
Objective To analyze the monitoring data of the laboratory network of poliomyelitis (polio) in China in 2007 (excluding Hong Kong, Macao Special Administrative Region and Taiwan, the same below), to assess the operation of the laboratory network and to maintain polio-free status in China Status provides laboratory evidence. Methods Acute Flaccid Paralys-A (AFP) cases reported in 31 provinces (autonomous regions and municipalities directly under the Central Government) in the database of China Immunization Program Monitoring Information Management System were analyzed, and the CDC ) Virus Pollution Prevention and Control Laboratory National Polio Lab-otatory (NPL) monitoring database to evaluate various operational indicators of the laboratory network. Results A total of 9771 stool specimens of 4984 AFP cases were collected from the National Polio Laboratory Network in 2007, and the collection rate of qualified stool specimens was 90.5%. Viruses were isolated and identified as required by the World Health Organization (WHO) 4th edition of the Polio Laboratory Manual, and a timely response rate of 94.8% was achieved within 28 days of finalization of the viral serotype. 214 cases of AFP were isolated from poliovirus (PV), the isolation rate was 4.29%. 471 cases of Non-Polio Enterovirus (NPEV) were isolated with the isolation rate of 9.45%. In 2007, NPL received 316 PV-positive isolates from the polio laboratory network. Due to a short supply of reagents identified in the ELISA type, the PV type was identified as direct VP1 gene core The results showed that only 10 strains of type I PV and 14 strains of type II PV were identified by ELISA before adjustment and 14 strains of PV were analyzed by polymerase chain reaction-restriction fragment length polymorphism Analysis of the type of identification; the remaining 397 single-serotype PV VP1 gene nucleotide sequence determination and analysis, did not find the poliovirus. Three strains of Vaccine-derived Poliovirus (VDPVs) isolated from two AFP cases in Shandong province were not included in circulating VDPVs (cVDPVs). One case of AFP was isolated in Shanxi province 2 strains of type VDPVs. One type Ⅰ VDPV was isolated from one case of AFP in Guangxi Zhuang Autonomous Region. In 2007, NPL passed the proficiency testing and on-the-spot certification examination of blind specimens of WHO with excellent results; 31 provincial CDC polio laboratories passed the capability verification of the same blind specimens as NPL; 12 provincial CDC polio laboratories Passed the WHO laboratory site certification examination. The NPL reviewed 334 original stool specimens from 5 provinces, with a coincidence rate of PV of 99% to 100% and NPEV of 88.0% to 92.7%. Conclusion The Chinese polio laboratory network operated well in 2007, while China continued to maintain a polio-free status. The laboratory network monitoring system was sensitive and effective, providing a laboratory basis for maintaining polio-free status.