Vaccine-derived polioviruses
Vaccine-derived polioviruses
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DOI：
10.1016/j.biologicals.2006.02.007
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发表时间：
2006-06-01
期刊：
影响因子：
1.7
通讯作者：
Agol, VI
中科院分区：
文献类型：
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作者：
Agol, VI
沙宾口服脊髓灰质炎疫苗（OPV）非常有效和安全，尽管其固有的遗传不稳定性。虽然在口服脊灰病毒在疫苗接种者或其接触者的胃肠道中开始繁殖后不久，通常就会恢复到接近野生型的表型，但这通常不是一个大问题，只要该疫苗用于大规模疫苗接种或在抗脊髓灰质炎免疫水平相对较高的人群中使用。然而，如果不满足这些条件，疫苗病毒很可能转化为具有接近野生型神经毒力水平的高度传染性病原体。此外，即使在充分免疫的人群中，口服脊髓灰质炎病毒也可能持续存在和进化。目前消灭脊髓灰质炎病毒的“最后阶段”战略设想在最后一次分离出野生脊髓灰质炎病毒后不久停止口服脊髓灰质炎疫苗的使用。如果实施这一战略，在口服脊髓灰质炎疫苗衍生物很可能持续存在的时候，将导致无免疫人群的迅速增长。因此，计划停止口服脊髓灰质炎疫苗接种与由口服脊髓灰质炎疫苗衍生物引起的小儿麻痹症暴发的非常高的风险有关，在提交人看来，这是不可接受的风险。目前唯一可用的控制此类疫情的工具是口服脊髓灰质炎疫苗，本应在全球范围内使用。只有在获得有效的新疫苗或抗脊髓灰质炎病毒药物后，才有可能安全停止口服脊髓灰质炎疫苗接种。为实现这一目标，需要促进脊髓灰质炎病毒研究并消除组织和财政障碍。(c) 2006年国际生物制品协会。Elsevier Ltd.出版。版权所有。
The Sabin oral poliovaccine (OPV) is extremely efficacious and safe, despite its inherent genetic instability. While reversion to nearly wild-type phenotype regularly occurs soon after the onset of OPV reproduction in the gastro-intestinal tract of vaccine recipients or their contacts, this is usually not a big problem, provided the vaccine is used either for mass vaccination or in populations with a relatively high level of anti-polio immunity. However, if these conditions are not met, the vaccine viruses are likely to be converted into highly transmissible agents with a nearly wild-type level of neurovirulence. Moreover, OPV viruses may persist and evolve even in adequately immunized populations. The current strategy for the "endgame" of poliovirus eradication envisions cessation of OPV usage shortly after the last isolation of a wild poliovirus. If implemented, this strategy would result in rapid growth of non-immune human populations at the time when OPV derivatives would very likely be persisting. Therefore, the planned cessation of OPV vaccination is associated with a very high, and in the author's opinion, unacceptable risk of polio outbreaks caused by OPV derivatives. The only currently available tool to curb such outbreaks is OPV, which should have been used at a global scale. Safe discontinuation of OPV vaccination will be possible only after an efficient new vaccine or an anti-poliovirus drug is available. To achieve this goal, stimulation of poliovirus research and elimination of organizational and financial obstacles preventing it are needed. (c) 2006 The International Association for Biologicals. Published by Elsevier Ltd. All rights reserved.