概述

脊髓灰质炎是一种具有传染性的病毒性疾病,该疾病在最严重的情况下会导致神经损伤,进而导致瘫痪、呼吸困难甚至死亡。

在美国,最后一例自然发生的脊髓灰质炎发生于 1979 年。今天,尽管全世界都在努力消灭脊髓灰质炎,但脊髓灰质炎病毒仍继续影响着亚洲和非洲部分地区的儿童和成人。

疾病控制和预防中心 (CDC) 建议,如果您去任何有脊髓灰质炎风险的地区旅行,要采取预防措施保护自己免受脊髓灰质炎的侵害。

计划前往脊髓灰质炎发生地区的已接种脊髓灰质炎疫苗的成年人应接种加强剂量的脊髓灰质炎灭活疫苗 (IPV)。通过加强剂量疫苗获得的免疫可持续一生。

症状

尽管脊髓灰质炎可导致瘫痪和死亡,但该病毒的大多数感染者不会发病,且不会意识到自己已被感染。

非麻痹性脊髓灰质炎

因脊髓灰质炎病毒而出现症状的一些患者,其所患脊髓灰质炎并不会导致瘫痪(顿挫型脊髓灰质炎)。这种疾病通常会导致与其他病毒性疾病相同的轻微流感样体征和症状。

体征和症状可持续 10 天,包括:

  • 发热
  • 咽喉疼痛
  • 头痛
  • 呕吐
  • 疲劳
  • 背痛或僵硬
  • 颈部疼痛或僵硬
  • 手臂或腿部疼痛或僵硬
  • 肌无力或压痛

麻痹性脊髓灰质炎

这种最严重的脊髓灰质炎很少见。麻痹性脊髓灰质炎的初期体征和症状(如发热和头痛)通常与非麻痹性脊髓灰质炎类似。但其他体征和症状会在一周内出现,包括:

  • 反射消失
  • 严重的肌肉酸痛或无力
  • 四肢松软无力(弛缓性瘫痪)

脊髓灰质炎后综合征

脊髓灰质炎后综合征是一组残障性体征和症状,一些患者在患病多年后才会发生症状。常见的体征和症状包括:

  • 进行性肌肉或关节无力和疼痛
  • 疲劳
  • 肌肉萎缩(萎缩)
  • 呼吸或吞咽问题
  • 睡眠相关呼吸障碍,如睡眠呼吸暂停
  • 耐寒能力降低

何时就诊

前往世界上脊髓灰质炎仍自然发生或仍使用口服脊髓灰质炎疫苗(OPV)的地区(如中美洲和南美洲、非洲和亚洲)之前,请向医生咨询脊髓灰质炎疫苗接种。

此外,如果存在以下情况,也请咨询医生:

  • 您的孩子未完成疫苗接种计划
  • 您的孩子对脊髓灰质炎疫苗有过敏反应
  • 您的孩子除了疫苗接种部位轻微发红或酸痛之外还有其他问题
  • 您在多年前患过脊髓灰质炎,现在出现原因不明的虚弱和疲劳

Nonparalytic polio

Some people who develop symptoms from the poliovirus contract a type of polio that doesn't lead to paralysis (abortive polio). This usually causes the same mild, flu-like signs and symptoms typical of other viral illnesses.

Signs and symptoms, which can last up to 10 days, include:

  • Fever
  • Sore throat
  • Headache
  • Vomiting
  • Fatigue
  • Back pain or stiffness
  • Neck pain or stiffness
  • Pain or stiffness in the arms or legs
  • Muscle weakness or tenderness

Paralytic syndrome

This most serious form of the disease is rare. Initial signs and symptoms of paralytic polio, such as fever and headache, often mimic those of nonparalytic polio. Within a week, however, other signs and symptoms appear, including:

  • Loss of reflexes
  • Severe muscle aches or weakness
  • Loose and floppy limbs (flaccid paralysis)

Post-polio syndrome

Post-polio syndrome is a cluster of disabling signs and symptoms that affect some people years after having polio. Common signs and symptoms include:

  • Progressive muscle or joint weakness and pain
  • Fatigue
  • Muscle wasting (atrophy)
  • Breathing or swallowing problems
  • Sleep-related breathing disorders, such as sleep apnea
  • Decreased tolerance of cold temperatures

When to see a doctor

Check with your doctor for polio vaccination recommendations before traveling to a part of the world where polio still occurs naturally or where oral polio vaccine (OPV) is used, such as Central and South America, Africa and Asia.

Additionally, call your doctor if:

  • Your child hasn't completed the vaccine series
  • Your child has an allergic reaction to the polio vaccine
  • Your child has problems other than a mild redness or soreness at the vaccine injection site
  • You had polio years ago and are now having unexplained weakness and fatigue

病因

脊髓灰质炎病毒的传播途径可以是与病毒感染者直接接触;较少情况下,可以通过受污染的食物和水传播。脊髓灰质炎病毒携带者的粪便可以传播病毒数周。感染了病毒但没有症状的患者也能够将病毒传播给他人。

风险因素

脊髓灰质炎主要影响 5 岁以下的儿童。但是任何没有接种疫苗的人都有可能患病。

并发症

麻痹性脊髓灰质炎可能导致暂时或永久性肌肉麻痹、残疾、骨骼畸形和死亡。

预防

预防脊髓灰质炎最有效的方法是接种疫苗。

脊髓灰质炎疫苗

美国大多数儿童会在以下年龄接受四剂脊髓灰质炎灭活疫苗(IPV):

  • 2 个月
  • 4 个月
  • 6 到 18 个月
  • 4 到 6 岁(孩子刚开始上学时)

脊髓灰质炎灭活疫苗对免疫功能低下的人也具有安全性,但尚不能确定在有严重免疫缺陷的情况下,疫苗有多大保护作用。常见的副作用是注射部位疼痛和发红。

对疫苗产生过敏反应

脊髓灰质炎灭活疫苗可能令部分患者出现过敏反应。因为该疫苗中含有微量抗生素链霉素、多黏菌素 B 和新霉素,所以任何对这些药物有过敏反应的人都不应注射该疫苗。

过敏反应的体征和症状通常会在注射后的几分钟到几小时内出现。留意:

  • 呼吸困难
  • 虚弱
  • 声音嘶哑或哮鸣
  • 心率加快
  • 荨麻疹
  • 头晕

如果您或您的孩子在注射后出现过敏反应,请立即就医。

成人疫苗

在美国,成人并不会统一接种脊髓灰质炎疫苗,因为大多数人已经免疫,感染脊髓灰质炎的可能性很小。然而,对于某些拥有较高脊髓灰质炎患病风险的成人来说,如果已完成脊髓灰质炎灭活疫苗(IPV)或口服脊髓灰质炎疫苗(OPV)的初次接种,那么他们应该再注射一次脊髓灰质炎灭活疫苗以增强抵抗力。

一剂加强剂量的脊髓灰质炎灭活疫苗的效果可以持续一生。存在患病风险的成人包括那些前往世界上仍存在脊髓灰质炎的地区旅行或照顾脊髓灰质炎患者的人。

如果您没有接种疫苗,或者您的疫苗接种情况没有相关记录,则建议您进行脊髓灰质炎疫苗的初始接种,两剂脊髓灰质炎灭活疫苗注射间隔 4 到 8 周,并在第二剂注射后的 6 到 12 个月后注射第三剂。

Polio vaccine

Most children in the United States receive four doses of inactivated poliovirus vaccine (IPV) at the following ages:

  • Two months
  • Four months
  • Between 6 and 18 months
  • Between ages 4 and 6 when children are just entering school

IPV is safe for people with weakened immune systems, although it's not certain just how protective the vaccine is in cases of severe immune deficiency. Common side effects are pain and redness at the injection site.

Allergic reaction to the vaccine

IPV can cause an allergic reaction in some people. Because the vaccine contains trace amounts of the antibiotics streptomycin, polymyxin B and neomycin, it shouldn't be given to anyone who's reacted to these medications.

Signs and symptoms of an allergic reaction usually occur within minutes to a few hours after the shot. Watch for:

  • Difficulty breathing
  • Weakness
  • Hoarseness or wheezing
  • Rapid heart rate
  • Hives
  • Dizziness

If you or your child has an allergic reaction after any shot, get medical help immediately.

Adult vaccination

In the U.S., adults aren't routinely vaccinated against polio because most are already immune, and the chances of contracting polio are minimal. However, certain adults at high risk of polio who have had a primary vaccination series with either IPV or the oral polio vaccine (OPV) should receive a single booster shot of IPV.

A single booster dose of IPV lasts a lifetime. Adults at risk include those who are traveling to parts of the world where polio still occurs or those who care for people who have polio.

If you're unvaccinated or your vaccination status is undocumented, get a series of primary polio vaccination shots — two doses of IPV at four- to eight-week intervals and a third dose six to 12 months after the second dose.

Dec. 01, 2020
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