Gripas vakcīna. 4. daļa – zinātniskie pētījumi

CDC: Gripa

CDC: Sezonālās gripas kontrola un novēršana ar vakcīnu palīdzību

PVO: Ieteicamais gripas vīrusa vakcīnu sastāvs lietošanai 2021. gada dienvidu puslodes gripas sezonā

Laikā no 2020. gada februāra līdz septembrim A (H1N1) pdm09, A (H3N2) un B gripas vīrusi cirkulēja vienlaikus, lai gan cirkulējošo vīrusu proporcijas dažādos reģionos bija atšķirīgas. Laikā no februāra līdz martam gripas aktivitāte bija paaugstināta lielākajā daļā ziemeļu puslodes valstīs; tomēr, sākot ar marta vidu, gripas aktivitāte visā pasaulē strauji samazinājās. Kopš aprīļa visā pasaulē tiek ziņots par ļoti zemu gripas līmeni, ieskaitot valstis dienvidu puslodes mērenajā zonā.

A tipa gripa

Šajā periodā lielākajā daļā valstu dominēja A gripas vīrusi. Visā pasaulē vairums valstu, apgabalu un teritoriju ziņoja gan par A (H1N1) pdm09, gan A (H3N2) vīrusu cirkulāciju, lielākajā daļā ziņotāju valstu A (H1N1) pdm09 dominēja. Dienvidāfrikā A (H1N1) pdm09 bija vienīgais paziņotais apakštips. Tomēr A (H3N2) vīrusi cirkulēja lielākā proporcijā dažās Āfrikas, Āzijas un Eiropas valstīs, īpaši Burkinafaso, Mali un Mongolijā, kur tas bija vienīgais ziņotais A apakštips.

B tipa gripa

Visā pasaulē gripas B vīrusi parasti izplatās mazāk nekā A gripas vīrusi. Tomēr dažās Amerikas valstīs (Beliza, Salvadora, Nikaragva, Panama, Paragvaja, Trinidāda un Tobāgo), Eiropā (Īrija), Āfrikā (Nigēra un Senegāla) un Āzijā (Azerbaidžāna, Irāna (Islāma Republika), Irāka , Izraēla un Kuveita), dominēja B gripas vīrusi. No B gripas vīrusiem dominēja B / Victoria / 2/87 cilts, atklājot ļoti maz B / Yamagata / 16/88 cilts vīrusi.

Perfekta vētra: genomisko variāciju un sērijveida vakcinācijas ietekme uz zemas gripas vakcīnu efektivitāti 2014. – 2015. gada sezonā

2014./15. gada sezonā A (H3N2) vakcīnas efektivitāte Kanādā bija 53% tiem, kas bija vakcinēti tajā gadā. Starp tiem, kuri tika vakcinēti arī iepriekšējā sezonā, efektivitāte bija negatīva -32%. Starp tiem, kuri tika vakcinēti 3 gadus pēc kārtas, efektivitāte bija -54%.

Vidēji efektivitāte bija -17%.

Atkārtotas vakcinācijas ietekme uz vakcīnu efektivitāti pret A (H3N2) un B gripu 8 sezonu laikā

Vakcīnas A (H3N2) efektivitāte 2004. – 2013. gadā bija 65% tiem, kuri vakcinēti tajā pašā sezonā. Tiem, kuri tiek vakcinēti bieži, efektivitāte bija 24%. Efektivitāte pret B tipa gripas vīrusu bija 75% tiem, kuri vakcinējās tikai šogad, un 48% tiem, kuri vakcinējas bieži.

Gripas vakcīnu efektivitāte sabiedrībā un mājsaimniecībā

Efektivitāte 2010./11. gada sezonā vakcinēto vidū divus gadus pēc kārtas bija negatīva -45%. Starp vakcinētajiem tikai šajā sezonā efektivitāte bija 62%. Efektivitāte starp tiem, kuri inficējās ar gripu mājās, bija -51%. Starp pieaugušajiem, kuri inficējās mājās, efektivitāte bija -283%.

Vakcinācija pret gripu un elpošanas vīrusu iejaukšanās Aizsardzības ministrijas personāla starpā gripas sezonā 2017.-2018

Vakcinācija pret gripu var palielināt citu elpceļu vīrusu risku, fenomenu, kas pazīstams kā vīrusu iejaukšanās. Pārbaudot vīrusu traucējumus ar specifiskiem elpceļu vīrusiem, tika iegūti dažādi rezultāti. Vakcīnu izraisīta vīrusa iejaukšanās bija ievērojami saistīta ar koronavīrusu un cilvēka metapneumovīrusu.

Gripas vakcinācijas ietekme uz sezonālo mirstību ASV vecāka gadagājuma cilvēkiem

Saskaņā ar novērošanas pētījumiem vakcinācija pret gripu vecāka gadagājuma cilvēku mirstību samazina par 50%.

Vakcīnu pārklājums vecāka gadagājuma cilvēku vidū pieauga no 15–20% 1970. gados līdz 65% 2001. gadā. Paradoksālā kārtā gripas izraisītie nāves gadījumi vecāka gadagājuma cilvēku vidū tikai palielinājās.

Mazāk nekā 10% no ziemas nāves gadījumiem ir saistīti ar gripu, kas liecina, ka novērošanas pētījumi ievērojami pārvērtē vakcinācijas priekšrocības.

Kādi patiesībā ir pierādījumi, ka veselības aprūpes darbinieku vakcinēšana pret sezonālo gripu aizsargā viņu pacientus? Kritiskais pārskats

Publicētie pētījumi rāda, ka individuālais labums, vakcinējot veselu, jaunu cilvēku (ne senioru) ir minimāls un nav pierādījumu, ka tas būtu citādāks kā medpersonālam. Pētījumi, kuru mērķis ir pierādīt plaši izplatīto pārliecību, ka veselības aprūpes darbinieku vakcinācija samazina pacientu saslimstību un mirstību, ir ļoti kļūdaini, un ieteikumi vakcinācijai ir neobjektīvi. Nav ticamu publicētu pierādījumu, kas liecinātu, ka veselības aprūpes darbinieku vakcinācijai ir būtisks ieguvums viņu pacientiem – nevis samazinot pacientu saslimstību vai mirstību un pat nepalielinot pacientu vakcinācijas līmeni. Secinājums. Argumenti par vienotu veselības aprūpes darbinieku vakcināciju pret gripu netiek atbalstīti esošajā literatūrā. Lēmums par vakcināciju jāpieņem individuālam veselības aprūpes darbiniekam, izņemot iespējamas ārkārtējas situācijas, bez juridiskas, institucionālas vai vienaudžu piespiešanas.

Veselības aprūpes darbinieku vakcinācija pret gripu

Pētījumā tiek analizēti 4 randomizēti pētījumi par veselības aprūpes personāla vakcinācijas ietekmi uz pacientiem. Saskaņā ar šiem pētījumiem astoņu veselības darbinieku vakcinēšana izglābj vienu pacientu no nāves. No tā izriet, ka katru gadu ārstu vakcinācija ASV glābj 687 tūkstošus cilvēku, kas ir vairāk nekā mirušo skaits 1918. gada Spāņu gripas epidēmijas laikā. Pētījumā tiek attēlots kā pētījumu autori spēlē ar statistiku, lai iegūtu šos pilnīgi vājprātīgos rezultātus, un secina, ka pat visoptimistiskākos aprēķinos ir nepieciešams vakcinēt 6000-32 000 ārstu, lai novērstu vienu nāvi no gripas.

Turklāt saskaņā ar šiem pētījumiem šķiet, ka 90% cilvēku mirst no gripas bez klasiskajiem elpceļu saslimšanas simptomiem, un arī tas, ka vakcinācijas izglābj vairāk cilvēku no nāves nekā kopumā saslimst ar pašu gripu. Autori secina, ka veselības aprūpes sniedzēju obligāto vakcināciju neatbalsta empīriski pierādījumi un ka vakcinācijai iztērētie resursi, iespējams, būtu jānovirza uz citu sfēru, kas būtu zinātniski pierādāma.

Gripa un citas elpceļu infekcijas 2019. – 2020. gada sezonā

SPKC dokuments, kur apskatāmi dati par gripas un citu elcpeceļu saslimšanas statistiku, datiem un informāciju 2019. – 2020. gada sezonā.

Palielināts citu elpceļu vīrusu infekciju risks, kas saistīts ar inaktivētas gripas vakcīnas saņemšanu

Pētījumā piedalījās 115 bērni, kuri tika iedalītii divās grupas: tie, kas saņēma trīsvērtīgu inaktivētu gripas vakcīnu un otra grupa saņēma placebo. Turpmāko 9 mēnešu laikā gripas vakcīnas saņēmējiem bija paaugstināts virusoloģiski apstiprinātu ne gripas infekciju risks (relatīvais risks: 4,40; 95% ticamības intervāls: 1,31–14,8). Aizsargājot pret gripu, gripas vakcīnas saņēmējiem var nebūt īslaicīgas nespecifiskas imunitātes, kas aizsargātu pret citiem elpošanas vīrusiem.

Infekciozs vīruss no izelpas

Vakcinēti pret gripu (2 sezonas pēc kārtas) izelpo 6,3 reizes vairāk vīrusu daļiņu nekā nevakcinētās. Ir arī ziņots, ka šķaudīšana, atšķirībā no klepus, nav būtisks vīrusu izdalīšanās faktors. Bet pat bez klepus izelpas laikā izdalās vīrusu daļiņas.

Gripas vakcīnas kā profilakse veseliem pieaugušajiem

Cochrane sistemātisks pārskats par gripas vakcīnu efektivitāti pieaugušajiem (90 pētījumi). Mazāk nekā 10% pētījumu bija kvalitatīvi.

Vakcinācijai ir ļoti pieticīgs efekts. Nepieciešams vakcinēt 40 cilvēkus, lai novērstu vienu SARS gadījumu, un 71 cilvēku, lai novērstu vienu gripas gadījumu. Vakcinācija neietekmēja gripas hospitalizāciju vai darba dienu trūkumu. Ir nepieciešams vakcinēt 92 grūtnieces, lai novērstu vienu akūtu elpceļu saslimšanas gadījumu grūtniecēm, un 27 sievietes, lai novērstu vienu gripas gadījumu jaundzimušajiem.

Nebija pierādījumu, ka vakcinācija samazina nopietnu komplikāciju risku.

Ir vairāk nekā 200 vīrusu, kas var izraisīt gripai līdzīgus simptomus, kurus nevar atšķirt bez laboratorijas testiem. A un B gripas vīrusi veido aptuveni 10% no visiem šiem vīrusiem.

Spēcīga aizsardzība pret H5N1 un H7N9 gripu, izmantojot bērnības hemaglutinīna nospiedumu

Gripa bērnībā pasargā no bīstamākiem gripas celmiem pieaugušā vecumā.

Ikgadējā vakcinācija pret gripas vīrusu kavē vīrusu specifisko CD8 + T šūnu imunitātes attīstību bērniem

Gripas vakcīna nomāc citotoksisko T šūnu veidošanos bērniem, padarot tos uzņēmīgākus pret infekcijām.

Vakcinācija un gripas antigēnu dreifēšana

Vakcīnas efektivitāte monotoniski nemazinās, palielinoties antigēnu attālumam starp vakcīnu un cirkulējošo celmu. Minimālā vakcīnas efektivitāte notiek zināmā starpposmā starp celmiem. Tā kā vakcīnas efektivitāte šajā starpposma antigēnu attālumā starp vakcīnu un cirkulējošajiem celmiem ir mazāka par lielāku antigēnu attālumu, sākotnējais antigēna grēks var novest pie tā, ka vakcinētie cilvēki kļūst uzņēmīgāki pret vīrusu nekā nevakcinēti.

Šī parādība var izskaidrot, kāpēc tajos gados, kad vakcīnas celms netika uzminēts, vakcīna ir ne tikai bezjēdzīga, bet gluži pretēji, tikai saasina slimības gaitu. Vakcīnas celms tiek uzminēts retāk nekā 50% gadījumu.

Asociācija starp gripas infekciju un vakcināciju grūtniecības laikā un autisma spektra traucējumu risku

Pētījumā apskatīti dati par 197 tūkstošiem bērnu, kas dzimuši 2000.-2010. gadā. Autisms tika diagnosticēts 1,6% (1 no 63).

Pirmajā grūtniecības trimestrī uzņemtā gripa palielināja autisma risku par 20%. Bet pēc vairāku testu korekcijas (Bonferroni korekcija) p vērtība kļūst par 0,1, un autori secina, ka ar 10% varbūtību tā ir tikai nejauša korelācija.

Narkolepsija un hipersomnija Norvēģijas bērniem un jauniešiem pēc 2009. gada A (H1N1) gripas pandēmijas

Narkolepsijas risks 2009. gada cūku gripu vakcinētajiem bija 17 reizes lielāks nekā nevakcinētiem.

Gripas vakcina un vaskulīts: cēloņsakarība vai tikai sakritība?

Gripas vakcīna dažreiz var izraisīt vaskulītu un neiroloģiskas komplikācijas.

Alerģisko reakciju risks pēc vakcinācijas 2015. gadā bija 2 reizes lielāks nekā iepriekšējos gados, un tas nebija atkarīgs no vakcīnas ražotāja. Dzīvās gripas vakcīna pelēm ievērojami palielina pneimokoku un zelta stafilakoja kolonizāciju augšējos elpceļos. Tas arī palielina pelēm pneimokoku kolonizāciju vidusausī, kas var palielināt vidusauss iekaisuma iespējamību.

Probiotiķa Lactobacillus brevis KB290 ietekme uz gripas infekcijas sastopamību skolēnu vidū: atklāts izmēģinājuma pētījums

Noteiktā probiotiķa ietekme un aizsardzība pret gripu.

Probiotiķa ietekme uz saaukstēšanās un gripai līdzīgu simptomu sastopamību un ilgumu bērniem

Probiotiķis samazina klepus biežumu bērniem par 41-62%, iesnas par 28-58%, augstu drudzi par 53-72%. Savukārt, antibiotiku lietošana samazinājās par 68-84%, bet nokavētās dienas bērnudārzā – par 27-31%.

C vitamīna efektivitāte vīrusu izraisītu elpceļu infekciju simptomu novēršanā un atvieglošanā

C vitamīna lietošana lielās devās (1 g katru stundu 6 stundas, pēc tam 3 reizes dienā) samazina gripas un saaukstēšanās simptomus par 85%.

Subklīniskā D vitamīna deficīta asociācija ar smagu akūtu apakšējo elpceļu infekciju Indijas bērniem līdz 5 gadu vecumam

Bērniem ar D vitamīna līmeni virs 22,5 nmol / L pneimonijas saslimšana bija par 91% mazāka. Ekskluzīva mātes piena barošana vismaz 4 mēnešus pēc kārtas samazināja pneimonijas risku par 58%.

Vai mums ir pietiekami daudz pierādījumu par sezonas gripas izplatīšanos un vai to var novērst slimnīcās, lai īstenotu visaptverošu politiku?

Gripas vīruss tiek pārnēsāts galvenokārt ciešā kontaktā (mazāk par 1 metru). Vīruss ilgst visilgāk uz nerūsējošā tērauda (vairākas stundas), un uz raupjām virsmām tas izdzīvo mazāk nekā 15 minūtes. Inaktivē ar 99% ūdeņraža peroksīda tvaiku (10 ppm) 2,5 minūtēs.

Salicilāti un gripas pandēmiskā mirstība, 1918. – 1919. gada farmakoloģija, patoloģija un vēsturiski pierādījumi

Autori secina, ka ievērojamu nāves gadījumu skaitu 1918. gada pandēmijas laikā, iespējams, izraisīja aspirīna lietošana, kuru ārsti toreiz izrakstīja milzīgās devās – vienam cilvēkam varēja izrakstīt no 8-31 g aspirīna dienā.

Portāls Brīvības Platforma iepriekš publicējis - 

“Influvac Tetra” ir paredzēta lietošanai pieaugušajiem un bērniem no 3 gadu vecuma.

Apraksts par gripas vakcīnu, kas paredzēta grūtniecēm un bērniem līdz 2 gadiem

“Fluarix Tetra” vakcīna piemērota pieaugušajiem un bērniem no 6 mēnešu vecuma.

Atsauce uz oriģinālrakstu: vakcinrealitate.lv/gripas-vakcina/

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