与印度瘫痪有关的口腔脊髓灰质炎滴

[新德里]虽然印度的口服脊髓灰质炎疫苗（OPV）驱动器已从该国消除了脊髓灰质炎，但在2000年至2017年期间，它们也导致了超过490,000例麻痹病例。学习基于国家监视统计。

India, a country of 1.3 billion people, was世界卫生组织（WHO）宣布无脊髓灰质炎in May 2014 in what was considered a landmark in the global drive to eradicate polio. Currently, the wild polio virus, which attacks the nervous system leading to childhood paralytic disease, is confined toAfghanistan, Nigeria and Pakistan.

“In the absence of wild polio transmission, it was expected that cases of paralysis would reduce to an acceptable rate of around two per 100,000, but this has not materialised”

雅各布·普利耶尔（Jacob Puliyel），圣史蒂芬医院

The oral vaccine uses live but weakened poliovirus strains to produce antibodies that protectchildren从感染“野生”或天然脊髓灰质炎病毒。大规模口服疫苗接种驱动器每年在印度进行三次进行，以防止人与人的传播野生病毒并保持“饲养的免疫力”。

雅各布·普利耶尔（Jacob Puliyel），儿科主管，St. Stephen’s Hospital, Delhi, and corresponding author of the study published August in the国际环境研究与公共卫生杂志，beplay足球体育的微博说：“发现脉搏脊髓灰质炎的频率与非polio急性松弛瘫痪的发生率直接或间接相关”。

Although India’s last case of polio was reported in 2011, a surveillance system continues to annually investigate some 50,000 cases of acute flaccid paralysis (AFP) — defined as a sudden onset of paralysis or weakness in any part of the body of a child under 15 years of age.

While no case of AFP has tested positive for polio since 2012, the rate of non-polio paralysis has continued to be unusually high, especially in the northern states of Bihar and Uttar Pradesh, which together have a population of 300 million people.

“在没有野生脊髓灰质炎的情况下，预计瘫痪病例将减少至每10万人的可接受率，但这尚未实现，” Puliyel告诉。Net.The study found the paralysis rate to be as high as 30 per 100,000 in Bihar and Uttar Pradesh.

The study showed that the number of pulse polio rounds conducted in a state had a "high correlation" with the non-polio paralysis rate. "We found that the… rates in Bihar and Uttar Pradesh were higher in those years when the number of pulse polio rounds conducted were more frequent," says Puliyel.

The study suggests that OPV were responsible for inducing paralysis and speculates that "repeated doses of the live virus vaccine delivered to the intestine may colonise the gut and alter the viral microbiome of the intestine".

A microbiome is formed of an ecological community of friendly or pathogenic microorganisms that share body spaces. Of these, the gut microbiome is known to change quickly over the first two to three years of life and continues to change according to factors such as diet, environment and treatment with antibiotics or oral vaccines.

"While the mechanism involved is speculative, our findings support the hypothesis that the frequency of pulse polio administration is directly or indirectly related to the incidence of non-polio AFP," the report says. "Now that India has been polio-free for over six years, we may be able to reduce non-polio AFP by further reducing pulse polio rounds."

普利耶尔说，仅由于出色的监视和细致记录的记录而注意到了非Polio AFP的增加数据由政府机构。“否则，没有注意到491,000例瘫痪病例。”

Puliyel and his team members hope that the results of the study will prompt reduction in OPV drives as measure against the relatively high incidence of paralysis in vaccinated children.

儿科医生兼研究人员Dinesh Kumar说：“由于微生物组的变化会产生不利影响，因此需要优化OPV回合的数量和剂量。”圣家庭医院新德里。库玛尔告诉。Net.

谁是Polio Eradication and Endgame Strategic Plan 2013-2018calls for a transition in vaccines requiring removal of all OPVs in the long-term to “eliminate the rare risks of vaccine-associated paralytic polio and vaccine-derived poliovirus”. This results from the attenuated or weakened vaccine strains turning virulent and capable of causing infectious poliomyelitis.

“Rationalising the number of national-level OPV rounds, based on scientific evidence, can have many benefits include huge savings on public health resources,” Yennapu said.

This piece was produced by SciDev.Net’s Asia & Pacific desk.