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目前大部分人打了二针或三针国产灭火疫苗,加一剂吸入疫苗混打也是不错的选择,道理何在?其实选择机会也许由不得自己,要看疫苗来源,有什么打什么!
1.疫苗的效果
流行病学证据表明,传播的主要驱动因素(年轻人)和毒性(对老年人造成的伤害程度)脱钩。这意味着那些传播最少的人的疾病严重程度更高。一般而言,在呼吸道病毒中,严重疾病与下唿吸道的入侵和复制有关。重要的是要区分病毒的内在毒力和具有不同程度免疫能力(以前的感染和疫苗接种)的人群中的有效毒力。目前 Omicron 的毒力在很大程度上反映了获得性免疫的保护作用,尽管一致认为 Omicron 也表现出降低的内在毒力(表),但疫苗的保护作用与其它变异株相比是大大降低的。
Cold Spring Harb Perspect Med. 2022 May 27;12(5):a041390. doi: 10.1101/cshperspect.a041390.
Clinical significance of variants of concern (VOCs)
VOC/variant being monitored (VBM) | Transmissibility | Disease burden/virulence | Neutralization by monoclonal antibodies | Vaccine efficacy |
Alpha | Increased ~50% | Increased | Susceptible | |
Beta | Increased ~25% | Increased | Susceptible | Reduced |
Delta | Increased ~100% | Increased | AY.1 and AY.2 lineages are not susceptible to some clinically used monoclonal antibodies | Reduced |
Epsilon | Unknown | |||
Gamma | Increased ~30% | Possibly increased | Not susceptible to some clinically used monoclonal antibodies | Modest reduction |
Kappa | Increased | Unknown | Susceptible | Reduced |
Mu | Increased | Unknown | Susceptible | Reduced |
Omicron | Increased >100% | Decreased for BA.1 and BA.2 | Not susceptible to most, but not all clinically used monoclonal antibodies | Greatly reduced |
2. 有效疫苗的策略
下图和表说明了 SARS-CoV-2感染的治疗策略。一种针对所有这些病毒株的有效疫苗将是防止这些有害病毒未来爆发的一个必要的里程碑.
J Virol Methods. 2022 Feb; 300: 114375.
Prophylactic approaches to treat SARS-CoV-2 and its potential targets.
Prophylactic approach | Potential target | References |
Universal Vaccine | Viral analogue Spike and Accessory proteins | |
ACE2 receptor blocking | Renin-angiotensin system (RAS),Type I Ang II receptor | |
Monoclonal antibody | Spike proteins of virus | |
Filibustering HR1 and HR2 receptor | S2 domain of Spike protein, HR1 and HR2 receptor | |
Use of Inhibitors | Various interactions sites of SARS-CoV-2 | |
Antiviral drug therapies | RNA dependent polymerase (RdRp),Type II trans membrane serine protease (TMPRSS2),Viral glycoproteins, Endoplasmic reticulum-Golgi intermediate compartment (ERGIC) | (Savarino et al., 2003; Sheahan et al., 2017; Hoffmann et al., 2020),(Hu et al., 2020) |
Blocking viral endocytic pathway | Protein kinases 1 (AAK1),cyclin G-associated kinase | |
Anti-parasitic agents | Reticence of IMPα1/ β1 mediated nuclear import of viral proteins | |
Targeted immunotherapy | Dendritic cells, B, T cells, release of cytokines and chemokines | |
Mesenchymal Stem Cells | Amplified number of peripheral lymphocytes, the decline in the C-reactive protein, and waning of over-activated cytokine-secreting immune cells (CXCR3+CD4+ T cells, CXCR3+CD8+ T cells, and CXCR3 + NK cells) and CD14+CD11c + CD11bmid regulatory dendritic cell (DC) | |
CRISPR-CAS based study | Application of Cas13a based assay to inhibit replication of SARS-related coronaviruses |
3.疫苗的种类与用法
混打疫苗的道理所在
J Med Virol. 2022 Oct 6 : 10.1002/jmv.28172.
WHO Emergency Use Listing and Prequalification (EUL/PQ)‐approved vaccines and their antigens
Vaccine | Manufacturer | Antigen | Type of vaccine | Reference |
CoronaVac/PiCoVacc | Sinovac, National Institute for Communicable Disease Control and Prevention, China | Whole virus (CN2 strain) | Inactivated virus | [160] |
BBIBP‐CorV | Beijing Institute of Biological Products, Sinopharm and Institute of Viral Disease Control and Prevention, China | Whole virus (HB02 strain) | Inactivated virus | [161] |
Covaxin/BBV152 | Bharat Biotech and Indian Council of Medical Research | Whole virus (NIV‐2020‐770) | Inactivated virus | [90] |
BNT16B2 | BioNTech, Fosun Pharma, and Pfizer, Germany | S‐2P | LNP‐mRNA | [162] |
mRNA‐1273 | Moderna, National Institute of Allergy and Infectious Diseases, USA | S‐2P | LNP‐mRNA | |
ChAdOx1 nCoV‐19/AZD1222 | The University of Oxford, and AstraZeneca, UK | Full‐length S | Nonreplicating viral vector | |
Convidecia™ Ad5‐ CoV | CanSino Biological Inc. and Beijing Institute of Biotechnology, China | Full‐length S | Nonreplicating viral vector | |
Ad26. COV2‐S | Johnson & Johnson, USA | S‐2P | Nonreplicating viral vector | |
NVX‐CoV2373 | Novavax, USA | S‐2P | Protein‐ased | [171] |
六种目前使用的预防冠状病毒疾病 -19大流行的疫苗
吸入法与肌肉注射法免疫反应的对应差异。肌肉免疫诱导抗原指导的先天性和适应性反应,激活 T 细胞和 B 细胞反应。产生、分化和成熟 IgG + 浆细胞以产生抗抗原中和抗体。除了这些免疫反应,吸入免疫还能诱导组织驻留 T 细胞和 IgA + B 细胞产生循环粘膜 IgA 抗体。
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