| ObjectivesThrough the epidemiological study of acute flaccid residual paralysis in Yunnan Province,the influencing factors of acute flaccid residual paralysis cases in Yunnan Province were obtained.By analyzing and analyzing the genetic characteristics of some residual paralysis cases,it provides a scientific basis for the ultimate realization of the elimination of polio and the reduction of residual paralysis rate in AFP cases.Methods1.Collecting data on AFP residual paralysis reported by the AFP case surveillance system in Yunnan Province from 2000 to 2017,and analyzing the data by describing epidemiological methods.AFP cases were divided into AFP residual paralysis cases and non-AFP residual paralysis cases,and case-control study was used to analyze the risk factors of AFP residual paralysis in children under 15 years old in Yunnan Province.2.Using Excel2010 for data sorting,time feature analysis and related chart production,using SPSS 17.0 for statistical analysis.3.Chi-square test analysis rate and composition ratio comparison between groups.The circular distribution method analyzes the temporal characteristics.Univariate chi-square test screened the relevant variables affecting residual paralysis in AFP cases,and unconditional logistic regression analysis was used for statistically significant variables.4.Whole genome sequencing of isolates from some cases was performed for mutation and recombinant analysis.Results 51.From 2000 to 2017,a total of 4,302 cases of AFP were reported in Yunnan Province.99.04%of the cases were followed up after 60 days of paralysis.124 cases were found,accounting for 2.88%,and 876 cases of residual paralysis accounted for 20.36%.The residual paralysis rate of AFP cases in Yunnan Province showed a downward trend from 2000 to 2017.In 2001,the residual paralysis rate was the highest,and the lowest in 2017.2.The residual paralysis of AFP cases is more uniform and has no obvious seasonality.3.The average rate of AFP residual paralysis in Yunnan Province is 0.50/100,000,the highest in Zhaotong City is 0.92/100,000,and the lowest in Xishuangbanna Dai Autonomous Prefecture is 0.25/100,000.4.Among the AFP case residual paralysis registered in Yunnan Province from 2000 to 2017.there were 499 males and 377 females.The number of male and female patients reported was 1.32:1.The incidence of residual paralysis between male and female was 18.68%(499/2671)and 23.11%(377/1631),respectively,and the difference was statistically significant.5.Among the 876 cases of AFP cases with residual paralysis,there were residual paralysis cases in all age groups.The number of residual paralysis cases in AFP cases<5 years old,5-9 years old,10-14 years old were 554 cases,154 cases,168 cases,respectively.It accounted for 63.24%,17.58%,and 19.18%;the proportion of children in the<5-year-old group was the highest;among the children aged<5 years,the children in the 1-year-old and 2-year-old groups accounted for a relatively high proportion.6.Among the 876 cases of residual paralysis,the diseases with the highest disease spectrum included GBS,transverse myelitis,myelitis,traumatic neuritis,and encephalitis.7.Analysis of relevant factors showed that women,small age,divorced children,muscle pain during paralysis,severe paralysis,abnormal sputum reflexes in the deep,poliovirus vaccine isolates from feces,and limb paralysis were factors in the increase of residual paralysis in AFP cases.Among them,the paralysis of limbs during initial paralysis and the detection of poliovirus vaccine strains are important factors for residual paralysis in AFP cases.8.There were 857 cases of double stool samples collected from 876 cases of AFP cases.The etiological examination found that 16.86%of cases with positive poliovirus were detected in polio-positive cases,and type Ⅱ ridges were detected.Gray virus cases accounted for 57.83%,and type Ⅲ poliovirus cases accounted for 44.57%.9.Of the 5 PVs isolated from the key cases,4 of the nt472 back mutations were identical to the PV3 wild virus sequence;4 strains of poliovirus reconstituted more than once during their life cycle,showing the vaccine Recombination between strains of poliovirus is more common in similar cases.ConclusionsThe residual paralysis rate of AFP cases in children under 15 years old in Yunnan Province in 2000～2017 showed a downward trend,and the reported incidence rate was 0.61/100,000.Residual paralysis cases accounted for 20.36%of AFP reported cases.There was no obvious seasonality in the occurrence of the case.The residual paralysis rate of AFP cases in Zhaotong City was high,suggesting that the monitoring work in Zhaotong area should be strengthened in the future and the general sanitation environment should be continuously improved.Female,young age,scattered children,muscle pain during pain,severe paralysis,abnormal sputum reflexes in the deep,polio vaccine isolates from the feces,paralysis of the limbs were the main factors in the occurrence of residual paralysis in AFP cases.The main diseases in the monitored cases of AFP residual paralysis included GBS,transverse myelitis,traumatic neuritis,and encephalitis.In this study,five strains of polio vaccine strains selected from 5 cases of AFP residual paralysis had widespread back mutation and recombination.The site of nucleic acid mutation was an important decision site for neurovirulence recovery. |
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