jofinЖурнал инфектологииJournal Infectology2072-6732IPO “АIDSSPbR"10.22625/2072-6732-2018-10-2-17-29jofin-723Research ArticleОбзорыReviewПОЛИОМИЕЛИТ В СОВРЕМЕННЫХ УСЛОВИЯХ: ДОСТИЖЕНИЯ И ПЕРСПЕКТИВЫPoliomyelitis in modern conditions: achievements and prospectsИвановаО. Е.IvanovaO. E.

руководитель отдела полиомиелита и других энтеровирусных инфекций института полиомиелита Федерального научного центра  исследований и разработки иммунобиологических препаратов им. М.П. Чумакова, профессор кафедры организации и технологии  производства иммунобиологических препаратов института  трансляционной медицины и биотехнологии Первого Московского  государственного медицинского университета им. И.М. Сеченова ,  д.м.н.; тел.: 8(495)841-90- 07, +7-916-677-24-03

Moscow, Russia

ivanova_oe@chumakovs.suФедеральный научный центр исследований и разработки иммунобиологических препаратов им. М.П. Чумакова Первый Московский государственный медицинский университет им. И.М. СеченоваРоссияFederal Scientific Center for Research and Development of Immune-and-Biological Products named after M.P. Chumakov First Moscow State Medical University named after I.M. SechenovRussian Federation2018270620181021729Copyright © Иванова О.Е., 20182018Иванова О.Е.Ivanova O.E.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://journal.niidi.ru/jofin/article/view/723

Создание в середине ХХ в. вакцин против полиомиелита (ПМ) – инактивированной (ИПВ) и  живой оральной из штаммов Sabin (ОПВ), с различными свойствами, преимуществами и  недостатками, но высокоэффективных, сделало возможной реализацию идеи ликвидации  ПМ. С 1988 г. Глобальная программа ВОЗ по искоренению ПМ достигла выдающихся  успехов: заболеваемость ПМ, вызванным диким полиовирусом (ПВ), снижена в 10 тыс. раз,  число эндемичных стран сократилось до 3, циркуляция дикого ПВ прекращена в 4 регионах  мира; искоренен дикий ПВ типа 1, почти 5 лет не выявляется дикий ПВ типа 3. В условиях  снижения заболеваемости ПМ, вызванным дикими ПВ, известные негативные свойства  трехвалентной ОПВ сделали ее дальнейшее применение проблематичным. Этими негативными свойствами являются: 1) способность вызывать поствакцинальные  осложнения; 2) генетическая нестабильность штаммов Sabin, особенно ПВ типа 2, и их  способность при определенных условиях (в первую очередь, в условиях низкого  коллективного иммунитета к ПВ) быстро восстанавливать нейровирулентность, трансформируясь в циркулирующие вакцинородственные ПВ (ВРПВ),  способные вызывать случаи и вспышки ПМ. Для снижения риска, связанного прежде всего с  ПВ типа 2, ВОЗ предложила глобальный переход к применению бивалентной ОПВ из  типов ПВ 1 и 3, завершенный в 2016 г. В 2019 г. ВОЗ планирует завершить искоренение ПВ  типа 1 и 3, а в 2022 г. – полностью отказаться от ОПВ. Условием безопасности такой тактики является поддержание высокого уровня коллективного иммунитета к ПМ.  Существуют несколько угроз безопасности этой стратегии. ПВ способны «молчаливо» циркулировать в человеческой популяции длительное время без клинических  проявлений ПМ, что при неадекватном эпидемиологическом надзоре может привести к  возвращению ПМ. Ре-интродукция как диких ПВ, так и штаммов Sabin может произойти из  учреждений, сохраняющих/работающих с ПВ. Источником ВРПВ могут быть люди с  первичными иммунодефицитами, длительно выделяющие ПВ. Необходимо поддержание надзора за ПМ, расширение дополнительных видов надзора за ПВ, строгий контейнмент  всех ПВ. Единственным способом поддержания коллективного иммунитета будет  иммунизация с помощью трехвалентной ИПВ. Существующий в настоящее время глобальный дефицит ИПВ несет значительную угрозу эпидемиологическому благополучию в мире. Решением проблемы является разработка нового поколения безопасных и  эффективных вакцин, совершенствование способов введения ИПВ, разработка  противовирусных препаратов.

The creation in the middle of the 20th century vaccines against  poliomyelitis (PM) – inactivated vaccine (IPV) and live oral vaccine  from Sabin strains (OPV) with various properties, advantages and  disadvantages, but highly effective, made it possible to implement  the idea of elimination of PM. Since 1988, the WHO Global Program  of PM eradication has achieved remarkable success: the incidence of  PM caused by wild poliovirus (PV) has been reduced by 10 thousand  times, the number of endemic countries has been reduced to 3, the circulation of wild PV has been discontinued in 4 regions of the  world the wild type 2 of PV has been eradicated, and wild type 3 of  PV has not been detected for almost 5 years. Under conditions of a  decrease in the incidence of PM caused by wild PV, the known  negative properties of trivalent OPV made its further use  problematic. These negative properties are: 1) the ability to cause  post-vaccination complications and 2) the genetic instability of Sabin  strains, especially PV of type 2, and their ability under certain  conditions (primarily in conditions of low collective immunity to PV)  to quickly restore neurovirulence, transforming into circulating  vaccinederived PV (VDPV), capable of causing incidents and  outbreaks of PM. In order to reduce the risk associated primarily with type 2 PV, WHO proposed a global switch to the use of bivalent OPV from types 1 and 3, completed in 2016. In 2019, WHO plans to  complete eradication of type 1 and 3 PVs, and in 2022 completely  abandon the OPV. The precondition for the safety of such tactics is  the maintenance of high collective immunity to PM. There are several  threats to the security of this strategy. PVs can “silently”  circulate in the human population for a long time without clinical  manifestations of PM, which, with inadequate epidemiological  surveillance can lead to the return of PM. The reintroduction of both  wild PV and Sabin strains can occur from institutions that preserve / work with PV. The source of VDPV can be people with primary immunodeficiencies, which continuously excrete PV. It is necessary to maintain surveillance over the PM, expand additional types of surveillance for the PV, strict containment of all  PVs. The only way to maintain collective immunity is immunization with trivalent IPV. The current global shortage of IPV poses a  significant threat to the world’s epidemiological well-being. The  solution to the problem is the development of a new generation of  safe and effective vaccines, improving the ways of introducing IPV, developing antiviral drugs.

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The authors declare that there are no conflicts of interest present.