为什么我们继续在完全接种疫苗的护理家庭中看到Covid-19爆发?

测试SARS-COV-2特异性抗体

Charité的研究人员分析了从接种疫苗接种的年龄和年轻个体中的血液样本,测试SARS-COV-2特异性抗体(包括免疫球蛋白G,或IgG)。信贷:©Charité|维克多科尔曼

德国曾举行过涉及完全接种疫苗的居民的护理家园的SARS-COV-2爆发。为了更好地了解这种现象,来自Charité - Universitätsmedizin柏林的研究人员在柏林的工厂中使用了爆发,分析了病毒相关数据,并在疫苗接种后的老年居民的免疫应答。研究人员的数据,已发表于此新兴传染病,确认老年人的疫苗效果。然而,它们还表明延迟和略微降低的免疫应答。根据他们的发现,研究人员强调需要接种护理人员并密切接触,以便更好地保护这种高风险组。

Biontech / Pfizer Covid-19疫苗已经表现出高水平的功效。预批准研究显示疫苗能够在第二剂后一周内能够预防超过90%的症状SAR-COV-2感染。疫苗的疗效后来在观察人群的研究中证实。尽管如此,这种功效偶尔会在疫苗接种的个体中发育感染。但是,什么可能解释居民完全接种疫苗的护理家庭中更大爆发的发生?现在已经通过两种联系的研究证实了基于过去的其他疫苗的过去经验,这两项有关医学专家涉及哪些医学专家,这两项联系的研究都是由Charité的跨学科团队进行的。这些研究表明,免疫系统对疫苗接种的反应在老年人的效果效果较小,而不是较年轻的人。

研究人员初步研究了在2月2021年2月在柏林的长期护理设施在柏林的长期护理设施检测到的爆发。在11名护理人员中检测到SARS-COV-2感染,他们没有完全接种疫苗的工作人员,并在20名居民其中有两种剂量的Biontech / Pfizer疫苗。虽然四个未接种的个体的个体发育症状严重足够严重,但需要住院,只有三分之一的全疫苗的个体表现出呼吸系统症状,如咳嗽和呼吸急促。

对个体拭子样本的分析表明,疫苗接种个体倾向于在其喉咙中具有低于未接种的个体的SARS-COV-2浓度。同样,SARS-COV-2脱落的平均持续时间在接种疫苗的个体中短于未接种催化的个体,分别持续约8和31天。尽管爆发了,但是四个接种疫苗的居民仍然没有病毒。虽然遏制措施成功地防止蔓延到设施的其他地区,但16名疫苗的患者中有两个需要住院治疗。其中一名住院患者在患有高血压危机后死亡,导致脑出血。第二名患者在护理家中死亡,但在她死亡前两周以上的病毒测试了阴性。由于这两名患者均未发育呼吸系统症状,研究人员不怀疑与SARS-COV-2的因果关系。

“Vaccination certainly provided protection for the care home residents involved in this outbreak and drastically reduced disease severity,” says one of the study’s three lead authors, Dr. Victor Corman, who is Deputy Director of the Department of Virology’s National Consultant Laboratory for Coronaviruses and a researcher at the German Center for Infection Research (DZIF). He adds: “It is also likely that the shorter duration of shedding was responsible for preventing further infections. However, the high number of infections seen makes it clear that even where a vaccine has a high level of efficacy, this does not always translate into full protection for the elderly.”

根据研究人员,这是一个可能的原因是爆发是由α变体(以前称为B.1.1.7)引起的,这与较高的喉部病毒载荷和更大的传播性相关联。研究人员还确定了第二种原因:个人免疫系统对疫苗接种疫苗接种疫苗的方式。为了测试他们的假设,研究人员将老年患者队列(70多岁以上并与私人家庭惯例注册)进行了比较,与特征工作人员较年轻(平均为34岁)。在第一次剂量显示血液测试中仅服用3周,显示,大约87%的较年轻的队列已经开发出针对SARS-COV-2的抗体。在较旧的队列中,该数字约为31%。第二剂后一个月,几乎整个群体的青少年(99%)测试了SARS-COV-2特异性抗体。在较旧的队列中,该数字约为91%。抗体在较旧的年龄组中也需要更长时间成熟,这意味着它们与病毒结合的能力受损。甚至T细胞介导的免疫力,发现身体免疫应答的第二个重要分支,被发现较弱。

Summing up the team’s findings, Prof. Dr. Leif Erik Sander, vaccine researcher at Charité’s Department of Infectious Diseases and Respiratory Medicine, says: “Our study shows that there is a significant delay in the body’s immune response following vaccination in the elderly, and that this response never reaches the levels seen in the young.” He adds: “Naturally, one cannot determine the effectiveness of vaccination based on a single outbreak. Since the beginning of the vaccination campaign, there has been a dramatic overall decline in the number of infections seen in care homes. However, occasional outbreaks do happen, and the elderly do appear more susceptible than younger people because their immune response proves slightly weaker.”

Emphasizing the significance of the findings, the study’s third leading author, PD Dr. Florian Kurth from the Department of Infectious Diseases and Respiratory Medicine, says: “While only around one in ten fully vaccinated over-70s have no antibodies in their blood, we are not currently in a position to identify individuals with low vaccine-induced immunity. Therefore, if we are to protect this high-risk group, we cannot rely on vaccination alone. Given that large sections of the population remain without immunity, both infection control measures and testing will continue to play an important role in the immediate future. Naturally, the vaccination of both care staff and visitors will be of crucial importance in order to prevent future outbreaks in care homes. Before too long, we are also likely to see booster shots which could be used to help improve immunity in the elderly.”

参考:

“爆发SARS-COV-2 B.1.1.7在长期护理设施疫苗接种后,德国,2月 - 3月2021年”由Pinkus Tober-Lau,Tatjana Schwarz,David Hillus,Jana Sphieckermann,Elisa T. Helbig,Lena J. Lippert,Charlotte Thibeault,Willie Koch,Leon Bergfeld,Daniela Niemeyer,BarbaraMühlemann,Claudia Conrad,Stefanie Kasper,FriederikeMünn,Frank Kunitz,Terry C. Jones,Norbert Suttorp,Christian Drosten,Leif Erik桑德,弗洛里安·库里Victor M. Corman,新兴传染病
DOI:10.3201 / EID2708.210887

“德国老年人的BNT162B2疫苗接种的”延迟抗体和T细胞反应“由Tatjana Schwarz,Pinkus Tober-Lau,David Hillus,Elisa T. Helbig,Lena J. Lippert,Charlotte Thibeault,Willi Koch,Irmgard Landgraf,Janine Michel,莱昂·贝格菲尔德,德尼埃拉·尼姆州,克拉巴尔·塞拉德,Chaudia Conrad,Chantip Dang-Heine,Stefanie Kasper,FriederikeMünn,Kai Kappert,Andreas Nitsche,Rudolf Tauber,Sein Schmidt,Piotr Kopankiewicz,Harald Bias,Joachim Seybold,Christof Von Kalle,TerryC. Jones,Norbert Suttorp,Christian Drosten,Leif Erik Sander,Victor M. Corman和Florian Kurth,新兴传染病
DOI:10.3201 / EID2708.211145

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