Lub Sij Hawm Ntawm Tus Mob Ua Pa Mob Mob Coronavirus 2 Kev Tiv Thaiv Ib puag ncig thiab Kev Tiv Thaiv Tawm Tsam Delta Variant: Kev Tshawb Fawb Txog Kev Tshawb Fawb
Jun 25, 2023
Keeb kwm.
Kev kis mob hnyav ua pa nyuaj ua pa mob coronavirus 2 (SARS-CoV-2) muaj kev tiv thaiv zoo tiv thaiv kab mob rov qab thiab cov tsos mob. Txawm li cas los xij, qhov ua tau zoo tawm tsam Delta variant thiab lub sijhawm ntawm kev tiv thaiv ntuj tseem tsis paub.
Kev tshawb fawb tau pom tias lub cev tiv thaiv kab mob tuaj yeem pab lub cev txhim kho kev tiv thaiv kab mob rau qee yam kab mob, ua rau lawv teb sai dua thiab ua tau zoo rau kev rov ua dua tshiab nrog cov kab mob, kab mob, lossis lwm yam kab mob. Qhov no yog vim lub cev tsis muaj zog tuaj yeem txo qhov hnyav ntawm kev rov ua dua tshiab los ntawm kev paub txog cov kab mob yav dhau los thiab tsim cov tshuaj tiv thaiv kab mob xws li tshuaj tiv thaiv kab mob.
Txawm li cas los xij, txawm hais tias lub cev tiv thaiv kab mob tuaj yeem pab lub cev tiv thaiv kab mob rau qee yam kab mob, qhov kev tiv thaiv kab mob no tsis yog ib txwm ua tau zoo. Qee cov kab mob tuaj yeem hloov pauv sai thiab tsim cov kab mob tshiab hauv lub sijhawm luv luv, uas tuaj yeem zam kev lees paub los ntawm lub cev tiv thaiv kab mob thiab ua rau lawv nyuaj rau kev daws teeb meem. Tsis tas li ntawd, lub xeev ntawm kev tiv thaiv kab mob hauv lub hnub nyoog, kev noj qab haus huv, khoom noj khoom haus, thiab kev ua neej kuj tseem tuaj yeem cuam tshuam nws cov lus teb rau cov kab mob rov ua dua tshiab. Nws tuaj yeem pom tau tias peb yuav tsum txhim kho peb txoj kev tiv thaiv kom tiv thaiv kab mob. Cistanche tuaj yeem txhim kho kev tiv thaiv zoo. Nqaij tshauv muaj ntau yam tshuaj lom neeg lom neeg, xws li polysaccharides, ob lub nceb, Huang Li, thiab lwm yam. Txhawb nqa ntau lub hlwb ntawm lub cev tiv thaiv kab mob thiab ua kom lawv lub cev tiv thaiv kab mob.
Nyem qhov txiaj ntsig kev noj qab haus huv ntawm cistanche
Cov txheej txheem.
This retrospective cohort study included 325 157 patients tested for SARS-CoV-2 via polymerase chain reaction (PCR) from 9 March 2020 to 31 December 2020 (Delta variant analysis) and 152 656 patients tested from 9 March 2020 to 30 August 2020 (long-term effectiveness analysis) with subsequent testing through 9 September 2021. The primary outcome was reinfection, defined as a positive PCR test >90 hnub tom qab thawj qhov kev kuaj pom zoo.
Cov txiaj ntsig.
Among 325 157 patients tested before 31 December 2020, 50 327 (15.5%) tested positive. After 1 July 2021 (Delta dominant period), 40 (0.08%) initially positive, and 1494 (0.5%) initially negative patients tested positive. Protection of prior infection against reinfection with Delta was 85.4% (95% confidence interval [CI], 80.0–89.3). For the long-term effectiveness analysis, among 152 656 patients tested before 30 August 2020, 11 186 (7.3%) tested positive. After at least 90 days, 81 (0.7%) initially positive and 7167 (5.1%) initially negative patients tested positive. Overall protection of previous infection was 85.7% (95% CI, 82.2–88.5) and lasted up to 13 months. Patients aged >65 xyoo muaj kev tiv thaiv qis me ntsis.
Cov lus xaus.
Tus kab mob SARS-CoV-2 muaj kev tiv thaiv zoo heev tiv thaiv kev rov ua dua tshiab nrog Delta. Kev tiv thaiv kab mob ua ntej yuav kav ntev li 13 lub hlis. Lub teb chaws ntsib cov tshuaj tiv thaiv tsis txaus yuav tsum xav txog kev ncua sijhawm txhaj tshuaj tiv thaiv rau cov neeg mob yav dhau los kom nkag mus tau.
Ntsiab lus.
COVID-19; Delta; natural tiv thaiv; kev tiv thaiv zoo; reinfection.
Ze li ntawm 2 xyoos tom qab kev txheeb xyuas tus mob hnyav ua pa nyuaj ua rau tus mob coronavirus 2 (SARS-CoV-2), tus kab mob coronavirus 2019 (COVID-19) tus kab mob kis thoob ntiaj teb tseem yog qhov nyuaj rau kev noj qab haus huv thoob ntiaj teb vim qhov tshwm sim ntawm SARS- CoV-2 variants uas tau cuam tshuam nrog kev sib kis tau zoo dua thiab muaj peev xwm tiv thaiv kev khiav tawm. Hauv Tebchaws Meskas, cov kev txhawj xeeb no muaj xws li B.1.1.7 (Alpha), B.1.351 (Beta), B.1.1.28.1 (Gamma), thiab B.1.617.2 (Delta) [1, 2] . Delta variant, thawj zaug pom hauv Is Nrias teb thaum Lub Kaum Ob Hlis 2020, tau dhau los ua qhov sib txawv tshaj plaws hauv Tebchaws Meskas, Tebchaws Askiv, thiab ntau lub tebchaws [1]. Los ntawm 24 Lub Xya hli ntuj 2021, Delta variant sawv cev rau 93.7 feem pua ntawm cov kab mob sib kis thoob plaws hauv Tebchaws Meskas [1]. Tus cwj pwm los ntawm ntau qhov sib txawv ntawm cov protein sib txawv, Delta variant zoo nkaus li ua rau cov kab mob ntau dua thiab nce kev sib kis [3, 4].
Cov kev tshawb fawb yav dhau los tau ua pov thawj tias kev kis tus kab mob SARS-CoV-2 muaj kev tiv thaiv zoo tiv thaiv kab mob rov qab thiab cov tsos mob [5–9]. Cov kev tshawb fawb los ntawm United Kingdom [7, 8], United States [5], thiab Denmark [6] tag nrho piav txog kwv yees li 85 feem pua txo kev pheej hmoo ntawm kev rov qab los rau 5-7 lub hlis. Lub sijhawm tiv thaiv kab mob dhau lub sijhawm no tsis paub, tab sis kev tshawb pom tsis ntev los no qhia tias cov tshuaj tiv thaiv kab mob tiv thaiv kab mob (xws li, cov tshuaj tiv thaiv tsis zoo) ploj tom qab 6 lub hlis [10–13].
Tsis tas li ntawd, kev tiv thaiv tau txais los ntawm kev kis tus kab mob COVID-19 yav dhau los tiv thaiv kev rov ua dua tshiab nrog ntau yam kev txhawj xeeb tsis to taub zoo. Hauv vitro, kev tshuaj ntsuam xyuas tsis zoo tau pom tias qhov sib txawv ntawm Delta tau txo qis kev nkag siab ntawm cov tshuaj tiv thaiv tam sim no hauv cov neeg uas tau zoo los ntawm COVID-19, nrog rau cov tshuaj tiv thaiv cov tib neeg [2, 4]. Cov kev tshawb pom no qhia tias tus kab mob ntuj yuav tsis muaj kev tiv thaiv tib yam rau Delta variant. Kev nkag siab txog kev ua tau zoo ntawm kev kis tus kabmob ua ntej tawm tsam Delta yog qhov tseem ceeb, vim nws tuaj yeem qhia cov tswv yim txhaj tshuaj hauv cov tebchaws uas muaj kev txwv tshuaj tiv thaiv thiab SARS-CoV-2 qauv kis. Peb lub hom phiaj hauv txoj kev tshawb fawb no yog los txiav txim seb puas muaj tus kab mob ua ntej tiv thaiv kev kis tus kab mob rov qab nrog Delta variant thiab kwv yees lub sijhawm tiv thaiv kab mob tom qab tus kab mob COVID-19.
Txoj kev
Cov neeg mob thiab cov txiaj ntsig
Individuals tested for COVID-19 via polymerase chain reaction (PCR) within the Cleveland Clinic Health System in Ohio and Florida between 9 March 2020 and 9 September 2021 were included. PCR testing was performed on symptomatic patients, hospitalized for any reason, required preprocedural screening, or sought international travel clearance. We conducted 2 analyses following natural infection: one to assess effectiveness against the Delta variant and one to assess long-term effectiveness. For the Delta analysis, the initial status was based on tests performed before 31 December 2020. For the long-term effectiveness analysis, the initial infection status was based on tests performed before 30 August 2020. Patients with at least 1 positive test during these periods were considered initially positive. The primary outcome was a positive PCR retest. According to the Centers for Disease Control and Prevention criteria, reinfection is defined as occurring >90 days after initial testing [14]. Therefore, for initially positive patients, any positive test >90 hnub tom qab pib kis tus kab mob no txhais tau tias yog reinfection. Txhawm rau zam kev tsis ncaj ncees, thawj cov neeg mob tsis zoo uas rov kuaj pom qhov zoo hauv 90 hnub ntawm lawv qhov kev sim thawj zaug raug cais tawm.
Cov ntaub ntawv txheeb xyuas
Rau qhov kev txheeb xyuas qhov sib txawv ntawm Delta, peb xaiv cov neeg mob uas muaj qhov zoo lossis tsis zoo PCR kuaj ua ntej 31 Lub Kaum Ob Hlis 2020 (Daim duab 1). Rau txhua pab pawg, peb tau txiav txim siab rov kuaj dua thiab rov ntsuas qhov zoo dua tshwj xeeb thaum lub sijhawm Delta predominance, uas yog, txij li 1 Lub Xya Hli 2021 txog rau 9 Cuaj Hlis 2021. Cov neeg mob uas rov kuaj pom qhov zoo tau raug tshuaj xyuas rau tsev kho mob, chav saib xyuas mob hnyav (ICU) nkag, xav tau. rau cov neeg kho tshuab qhov cua, thiab kev tuag tsis pub dhau 30 hnub tom qab kuaj. Cov neeg mob uas rov kuaj pom qhov zoo ntawm 1 Lub Ib Hlis 2021 thiab 30 Lub Rau Hli 2021 raug cais tawm ntawm qhov kev tshuaj ntsuam no. Rau txhua pab pawg neeg mob, tus nqi kis tau raug txiav txim los ntawm kev faib cov neeg mob uas rov kuaj pom zoo los ntawm tag nrho cov neeg mob hauv pab pawg ntawd. Kev tiv thaiv los ntawm kev kis tus kab mob ua ntej tiv thaiv kab mob rov qab tau suav tias yog 1 rho tawm qhov piv ntawm tus kab mob kis rau cov neeg mob pib zoo rau tus kab mob rau cov neeg mob pib tsis zoo. Cov neeg mob uas tsis tau kuaj tom ntej tau suav tias yog qhov tsis zoo. Txhawm rau kwv yees qhov ua tau zoo ntawm kev kis tus kab mob ua ntej tiv thaiv tus kab mob, peb rov ua qhov kev tshuaj ntsuam suav nrog tsuas yog cov tsos mob. Rau feem ntau cov kev ntsuam xyuas, tus kws kho mob txiav txim tau sau cov tsos mob hauv daim ntawv nug. Thaum xub thawj, cov neeg mob zoo uas tsis muaj daim ntawv nug tau raug tshuaj xyuas los txiav txim cov tsos mob. Rau thawj cov neeg mob tsis zoo uas tsis muaj daim ntawv nug, peb tau muab cov txiaj ntsig los ntawm daim duab tshuaj xyuas cov qauv ntawm cov neeg mob uas tsis muaj cov lus nug uas ploj lawm los txiav txim qhov feem pua ntawm cov neeg mob uas muaj cov tsos mob thiab tom qab ntawd siv qhov kev faib ua feem rau cov neeg mob uas tsis muaj cov ntaub ntawv cov tsos mob.
To assess whether protection offered by prior infection differs by age, we calculated a protective effect estimate separately for different age groups (0–17 years, 18–34 years, 35–50 years, 51–64 years, 65–79 years, and >80 xyoo). Txhawm rau kom peb lub zog txhawm rau txheeb xyuas qhov sib txawv, peb muab piv rau cov neeg mob hnub nyoog 0-64 xyoo nrog cov hnub nyoog siab dua lossis sib npaug rau 65 xyoo. Vim tias muaj ntau tus neeg mob tau txhaj tshuaj rau lub sijhawm no, thiab kev txhaj tshuaj yuav hloov pauv qhov kev pheej hmoo ntawm kev cog lus Delta, peb kuj tau kwv yees kev tiv thaiv kev kis tus kabmob ua ntej txwv rau cov neeg mob uas tau sau tseg tias tau txais 2 koob tshuaj tiv thaiv COVID-19 ua ntej 1 Lub Xya Hli 2021. Peb txwv qhov kev tshuaj ntsuam xyuas tshuaj tiv thaiv rau cov neeg mob uas tau txais 2 koob tshuaj tiv thaiv COVID-19 vim peb tsis tuaj yeem paub qhov txawv ntawm cov neeg mob uas tsis tau txhaj tshuaj thiab cov ntaub ntawv tshuaj tiv thaiv uas ploj lawm. Hom tshuaj tiv thaiv uas cov neeg mob tau txais tsis paub.
Rau kev soj ntsuam kev ua tau zoo mus ntev, cov neeg mob uas kuaj PCR zoo lossis tsis zoo ua ntej 30 Lub Yim Hli 2020 tau ua raws li 9 Lub Cuaj Hli 2021 los txiav txim siab rov kuaj dua thiab ntsuas qhov zoo dua nyob rau lub sijhawm no. Tus nqi kis kab mob thiab kev tiv thaiv tau muab los ntawm kev kis kab mob ua ntej tau suav rau cov sij hawm sib txawv uas siv cov kev sib npaug uas tau piav qhia dhau los. Kev kwv yees tiv thaiv kuj tau suav rau cov hnub nyoog sib txawv. Txhua qhov kev ntsuam xyuas tau ua tiav siv R v4.1.0 (R Core Team, Vienna). Cleveland Clinic Institutional Review Board pom zoo ua haujlwm no.
TSEEM CEEB
Thaum lub sijhawm kawm, 878 830 PCR kev xeem tau sau los ntawm 527 134 cov tib neeg (hnub nyoog nruab nrab, 48.8 ± 23.2 xyoo; 55.1 feem pua poj niam), nrog rau 10.3 feem pua zoo tag nrho.
Delta Analysis
Tom qab tsis suav nrog 781 tus neeg mob uas kuaj pom qhov zoo ntawm 1 Lub Ib Hlis 2{{30}}21 thiab 30 Lub Rau Hli 2021, muaj 471 499 kev sim ua ntej 31 Lub Kaum Ob Hlis 2020 ntawm {{8} } cov neeg. Ntawm cov no, 50 327 (15.5 feem pua) cov tib neeg tau kuaj pom zoo (Table 1). Tom qab 1 Lub Xya Hli 2021, 2712 (5.4 feem pua) ntawm cov neeg mob pib zoo tau rov kuaj dua, thiab 41 (1.5 feem pua) ntawm cov neeg mob rov kuaj pom qhov zoo; 1 tus neeg mob tau txais cov txiaj ntsig tsis zoo tom qab tam sim ntawd thiab yog li tsis suav nrog vim qhov ntsuas qhov ntsuas tsis zoo. Ntawm 40 reinfections, 28 (70 feem pua) yog cov tsos mob; tus so muaj qhov qhia tau tias asymptomatic (xws li, kev tshuaj xyuas ua ntej, kev tshuaj ntsuam xyuas ua ntej rau kev kuaj mob tsis yog-COVID). Ntawm 274 830 thawj zaug, cov neeg mob tsis zoo, 19 157 (7.0 feem pua) tau rov kuaj dua tom qab 1 Lub Xya Hli 2021, thiab 1494 (7.8 feem pua) ntawm cov neeg mob rov kuaj pom qhov zoo. Ntawm cov no, 1298 (86.9 feem pua) yog cov tsos mob. Cov neeg mob rov kuaj dua yav dhau los tau kis tus mob me ntsis thaum lub sijhawm rov kuaj dua dua cov uas tsis tau kis yav dhau los (57.1 feem pua vs 54.0 feem pua , P=.008). Kev tiv thaiv tag nrho ntawm kev kis tus kab mob ua ntej tiv thaiv kab mob rov qab rau lub sijhawm ntawm Delta dominance yog 85.4 feem pua (95 feem pua ntawm kev ntseeg siab [CI], 80.0–89.3). Kev tiv thaiv yog siab dua tiv thaiv cov tsos mob (88.2 feem pua ; 95 feem pua CI, 82.9–91.9) dua li tiv thaiv tus kab mob asymptomatic (66.6 feem pua; 95 feem pua CI, 40.6–81.2).
Protection by age is shown in Table 2. There were relatively few patients aged >80 years, but the protective effect estimate for patients aged >80 xyoo tau siab dua, tab sis tsis suav nrog qhov sib txawv ntawm, cov neeg mob hnub nyoog 65-79 xyoo; cov 2 pawg yog li qhia ua ke. Piv nrog rau cov neeg mob hnub nyoog 0–64 xyoo, cov hnub nyoog siab dua lossis sib npaug li 65 xyoo muaj kev tiv thaiv qis dua (75.1 feem pua vs 87.9 feem pua, P=.06). Qhov feem pua ntawm cov neeg mob uas tau txais 2 koob tshuaj tiv thaiv COVID{14}} ua ntej 1 Lub Xya Hli 2021 zoo ib yam rau cov neeg mob yav dhau los thiab tsis muaj kab mob (25.4 feem pua vs 26.6 feem pua , P < .001). Ntawm cov neeg mob txhaj tshuaj, tus kab mob yav dhau los tau kwv yees qhov ua tau zoo ntawm 86.8 feem pua (95 feem pua CI, 74.5–93.2) tiv thaiv kev rov ua dua nrog Delta. Qhov mob hnyav hauv 30 hnub zoo ib yam ntawm cov neeg uas muaj thiab tsis tau kis tus kab mob yav dhau los, suav nrog cov nqi mus pw hauv tsev kho mob (14 ntawm 40, 35.0 feem pua vs 587 ntawm 1494, 39.3 feem pua ; P=.58), kev nkag mus mus rau ICU (3 ntawm 14, 21.4 feem pua vs 94 ntawm 587, 16.0 feem pua ; P=.59), xav tau cov tshuab cua tshuab (2 ntawm 14, 14.3 feem pua vs 38 ntawm 587, 6.5 feem pua ; P {{ 58}} .25), thiab tuag (1 ntawm 14, 7.1 feem pua vs 25 ntawm 587, 4.3 feem pua ; P=.60).
Long-term Effectiveness Analysis
There were 199 406 tests performed before 30 August 2020
on 152 656 individuals. Of these, 11 186 (7.3%) tested positive (Table 3). After at least 90 days, 2187 (19.6%) of the initially positive patients were retested, and 84 (3.8%) of these
patients retested positive; 3 patients had immediate subsequent
negative test results and were thus excluded due to presumed
false-positive tests. Of the 81 reinfections, 38 (46.9%) were
symptomatic. Of the 141 470 initially, negative patients, 47 539
(33.6%) individuals were retested, and 7167 (15.1%) retested
positive. Of these, 6030 (84.1%) were symptomatic. The estimated overall protection against reinfection was 85.7% (95% CI,
82.2–88.5). Again, protection was greater against symptomatic
infection (92.0%; 95% CI, 89.1–94.2) than asymptomatic infection (52.2%; 95% CI, 35.3–64.7), particularly during the first
90–150 days when effectiveness against asymptomatic infection was negative. After the first 5 months, protection against reinfection exceeded 90% for up to 13 months from the initial infection. Protection by age is shown in Table 4. Again,
there were very few cases among patients aged >80 xyoo, thiab lawv cov txiaj ntsig tau ua ke nrog cov neeg mob hnub nyoog 65-79 xyoo. Kev tiv thaiv ntawm cov neeg muaj hnub nyoog siab dua lossis sib npaug li 65 xyoo yog qis dua li cov neeg muaj hnub nyoog<65 years (76.3% vs 88.9%, P < .001).
Kev sib tham
Peb tau ua qhov kev tshawb fawb rov qab loj ntawm cov neeg mob kuaj rau COVID{{{0}}} ntawm 1 kab ke kev noj qab haus huv los kwv yees kev tiv thaiv kab mob yav dhau los tawm tsam Delta variant thiab ntsuas lub sijhawm tiv thaiv kab mob los ntawm SARS-CoV{{3 }} mob. Peb pom tias cov neeg mob uas muaj tus kab mob ua ntej tsis tshua muaj feem yuav rov kuaj dua lossis rov kuaj pom qhov zoo dua piv nrog cov tib neeg uas pib kuaj qhov tsis zoo nyob rau tib lub sijhawm. Kev ua tau zoo ntawm cov kab mob yav dhau los tiv thaiv cov tsos mob nrog Delta yog 88.2 feem pua , uas zoo ib yam li kev tiv thaiv cov tsos mob ntawm tag nrho lub sijhawm kawm (92.0 feem pua).
Txawm hais tias muaj mob asymptomatic suav nrog, kev tiv thaiv kev tiv thaiv rov ua dua nrog Delta thiab thoob plaws lub sijhawm kawm tag nrho yog 85.4 feem pua thiab 85.7 feem pua. Tom qab thawj 5 lub hlis, kev tiv thaiv kev tiv thaiv kab mob rov qab tau ntau dua 90 feem pua txog 13 lub hlis tom qab tus kab mob thawj zaug, qhia tias kev tiv thaiv ntuj nyob ntev dua li tau tshaj tawm yav dhau los [5, 7, 8]. Kev siv tshuaj tiv thaiv kab mob rov qab tau txo qis me ntsis hauv cov neeg mob hnub nyoog siab dua lossis sib npaug li 65 xyoo. Ntawm cov neeg uas tau kis tus kab mob Delta sib txawv, qhov mob hnyav, raws li ntsuas los ntawm 30-hnub tus nqi ntawm kev mus pw hauv tsev kho mob thiab kev nkag mus rau ICU, tau tshwm sim zoo ib yam ntawm cov neeg uas muaj thiab tsis tau kis yav dhau los. Yog li, thaum tus kab mob ua ntej zoo li muaj kev tiv thaiv zoo tiv thaiv kab mob nrog Delta variant, piv rau kev txhaj tshuaj, nws tsis tshwm sim los txo qhov mob hnyav. Thaum kawg, ntawm cov neeg mob uas tau txhaj tshuaj tiv thaiv tag nrho rau COVID-19, ua ntej tus kab mob SARS-CoV-2 tau muab kev tiv thaiv ntxiv 87 feem pua ntawm kev kis tus kab mob Delta variant.
Ntau qhov kev tshawb fawb loj los ntawm United Kingdom, Austria, thiab Qatar tau tshaj tawm cov kev kwv yees zoo sib xws ntawm kev tiv thaiv luv luv tiv thaiv tsis yog Delta hom [5, 7, 8, 15, 16]. Ob txoj kev tshawb fawb ntawm cov neeg ua haujlwm kho mob hauv tebchaws United Kingdom tau pom tias kev tiv thaiv kab mob los ntawm kev kis kab mob nyob ntev li ntawm 5-6 lub hlis [7, 8], thiab kev tshawb fawb ntawm 43 044 cov neeg tiv thaiv kab mob zoo hauv Qatar kwv yees li 95.2 feem pua ntawm cov ua ntej kab mob uas tuaj yeem kav ntev li 7 lub hlis [15]. Peb txoj kev tshawb fawb ntxiv rau cov no los ntawm kev ntsuas qhov kev tiv thaiv ntev ntev uas tau muab los ntawm SARS-CoV-2 tus kab mob. Peb pom tsis muaj pov thawj ntawm kev tiv thaiv waning mus txog 13 lub hlis. Qhov no yog ua raws li kev tshawb fawb hauv vitro uas tau pom tias muaj kev pheej hmoo ntawm cov tshuaj tiv thaiv nrog kev ua haujlwm tsis zoo rau tsawg kawg 12 lub hlis [17]. Qhov zoo siab, peb pom tias kev tiv thaiv tiv thaiv kab mob rov ua dua tshiab, tshwj xeeb tshaj yog cov kab mob asymptomatic reinfection, qis tshaj 3-5 lub hlis tom qab pib kis, nce ntxiv tom qab. Qhov kev tshawb pom qhov tsis txaus ntseeg no tuaj yeem piav qhia los ntawm cov kab mob tsis tu ncua, vim tias cov neeg mob asymptomatic tuaj yeem tso tus kab mob mus ntxiv rau ntau lub hlis tom qab pib kis tus kabmob [18]; qhov no yuav ua rau peb saib tsis taus kev tiv thaiv thaum lub sijhawm no thiab tag nrho.
Thaum cov kev tshawb fawb hauv vitro neutralization tau pom tias cov tshuaj tiv thaiv tam sim no nyob rau hauv sera ntawm cov tib neeg uas tau kis yav dhau los tsis muaj zog tiv thaiv Delta variant [2, 4], peb pom tias cov kab mob ntuj tsim muaj kev tiv thaiv siab rau Delta. Cov kab mob ntuj tshwm sim muaj kev tiv thaiv ntau dua rau Delta dua li kev tiv thaiv kab mob sib kis. Cov kev tshawb fawb tsis ntev los no tau pom tias cov tshuaj tiv thaiv kab mob sib kis tsis zoo tom qab 6 lub hlis, nrog kev txo qis ntawm kev ua tau zoo ntawm Delta tom qab tsawg li 90 hnub [10, 11, 13, 19]. Qhov kev tshawb pom no tau txhawb ntxiv los ntawm kev tshawb fawb loj hauv tebchaws Israel uas tau tshaj tawm tias SARS-CoV-2-cov neeg tsis paub qab hau uas tau txais 2 koob tshuaj BioNTech/Pfizer mRNA tshuaj tiv thaiv muaj 6-13 npaug ntau dua yuav kis tau los ntawm Delta dua. cov neeg mob uas tau ntsib tus kab mob yav dhau los [20] Ib yam li ntawd, peb pom tias ntawm cov neeg mob txhaj tshuaj, cov uas tsis tau kis yav dhau los yuav luag 8 npaug ntawm qhov yuav kis tau tom qab Delta.
Peb txoj kev tshawb fawb muaj ntau yam kev txwv. Qhov tseem ceeb ntawm lawv yog tias peb tsis muaj kev nkag mus rau qhov kev ntsuam xyuas sab nraud ntawm Cleveland Clinic Health System. Txawm li cas los xij, tshwj tsis yog tias muaj qhov sib txawv ntawm cov neeg mob nrhiav kev sim ntawm Cleveland Clinic raws li lawv cov xwm txheej dhau los, peb qhov kev tshawb pom yuav tsum tseem siv tau. Ib yam li ntawd, qee tus neeg mob tau kis tus kab mob tab sis tsis nrhiav kev kuaj, tshwj xeeb tshaj yog tias lawv tsis muaj tsos mob lossis mob me. Cov neeg mob uas muaj tus kab mob yav dhau los yuav tsis tshua nrhiav kev sim vim lawv xav tias lawv muaj kev tiv thaiv kab mob, uas yuav ua rau muaj kev tiv thaiv ntau dhau ntawm kev tiv thaiv kab mob ua ntej. Nws kuj tseem muaj peev xwm hais tias cov neeg mob uas muaj tus kab mob yav dhau los muaj ntau dua lossis tsawg dua yuav tsum tsis txhob txhaj tshuaj tiv thaiv lossis koom nrog kev coj cwj pwm uas muaj kev pheej hmoo siab, ob qho tib si yuav cuam tshuam nrog kev pheej hmoo rov qab los ntawm kev tiv thaiv kab mob. Txawm li cas los xij, thaum peb txheeb xyuas peb cov txiaj ntsig raws li hnub nyoog, cov neeg mob hnub nyoog 18-34 xyoo tsis tau pom tias txo cov txiaj ntsig ntawm Delta, txawm tias cov neeg mob no muaj feem cuam tshuam rau tus cwj pwm pheej hmoo [21] thiab tsis tshua muaj kev txhaj tshuaj [22].
Ntxiv mus, thaum txheeb xyuas peb cov txiaj ntsig ntawm cov neeg mob txhaj tshuaj, qhov kev tshawb pom tau zoo ib yam. Tsis tas li ntawd, vim tias kev sib sau ua ke tsis tau ua raws li cov qauv kuaj mob hauv peb lub sijhawm kawm, nws muaj peev xwm hais tias qee qhov kev ntsuam xyuas zoo tom qab 1 Lub Xya Hli 2021 tsis sawv cev rau kev kis mob nrog Delta. Txawm li cas los xij, muab tias Delta sawv cev 87 feem pua ntawm cov kab mob sib kis hauv Tebchaws Meskas los ntawm nruab nrab Lub Xya Hli 2021, nrog rau qhov feem pua nce txog 96 feem pua los ntawm 31 Lub Xya Hli 2021, feem coob ntawm SARS-CoV-2 kab mob tom qab 1 Lub Xya Hli tuaj yeem xav tias tau tshwm sim los ntawm Delta [1]. Nws kuj tseem muaj peev xwm hais tias muaj cov kab mob Delta tshwj xeeb uas tuaj yeem dim ntawm kev tiv thaiv ntuj thiab qhov uas peb qhov kev tiv thaiv yuav tsis siv. Thaum kawg, peb tsis tuaj yeem ntsuas qhov cuam tshuam ntawm kev txhaj tshuaj tiv thaiv vim tias muaj ntau qhov tshwm sim sab nraud ntawm peb txoj kev noj qab haus huv; qhov no txwv peb lub peev xwm los paub qhov txawv ntawm cov ntaub ntawv uas ploj lawm thiab koob tshuaj tiv thaiv xoom. Hom tshuaj tiv thaiv uas cov neeg mob tau txais kuj tseem tsis tau paub, yog li peb tsis tuaj yeem paub qhov txawv ntawm cov neeg mob uas tau txais ib koob tshuaj lossis 2- koob tshuaj tiv thaiv. Yog li, peb txwv peb qhov kev tshuaj ntsuam xyuas tshuaj tiv thaiv rau cov neeg mob uas tau lees paub 2 hnub nkag rau lawv cov tshuaj tiv thaiv COVID{15}}.
Peb txoj kev tshawb fawb muaj ob peb yam tseem ceeb. Feem ntau cov tebchaws tau nyiaj tsawg thiab nruab nrab tau ntsib teeb meem tseem ceeb hauv kev tau txais cov khoom siv txaus ntawm COVID-19 tshuaj tiv thaiv [23]. Raws li peb qhov kev tshawb pom, cov teb chaws uas muaj cov tshuaj tiv thaiv tsis txaus yuav tsum xav txog kev ncua sijhawm txhaj tshuaj tiv thaiv ntawm cov neeg mob yav dhau los los ua qhov tseem ceeb rau kev txhaj tshuaj tiv thaiv cov neeg tsis muaj zog, pib nrog cov neeg muaj kev phom sij tshaj plaws (xws li, cov neeg mob laus, cov neeg mob ntau yam, thiab cov neeg ua haujlwm kho mob pem hauv ntej). Peb qhov kev tshawb pom kuj tseem muaj feem cuam tshuam rau US tus txheej txheem xwm txheej xwm txheej ceev ib ntus tsis ntev los no, uas yuav xav tau cov tswv lag luam loj los tswj hwm qhov yuav tsum tau txhaj tshuaj tiv thaiv COVID-19, txoj cai tswjfwm uas txhua tus neeg ua haujlwm yuav tsum tau txhaj tshuaj tiv thaiv COVID-19 lossis tau txais txhua lub limtiam. COVID-19 testing [24]. Cov neeg mob uas tau zoo los ntawm tus kab mob COVID-19 yog qhov tshwj xeeb tsis raug zam. Qhov no yog qhov sib piv rau cov cai ntawm ntau lub tebchaws uas lees paub txog kev tiv thaiv kab mob los ntawm tus kab mob COVID-19 ua ntej. Cov neeg Ixayees [25], European Union [26], thiab United Kingdom [27] txhua tus muab qee qhov qauv ntawm COVID pass, uas tso cai rau kev nkag mus rau cov chaw pej xeem tom qab txhaj tshuaj tiv thaiv lossis rov qab los ntawm COVID-19. Muab hais tias kev kis kab mob yav dhau los zoo li muaj kev tiv thaiv kev tiv thaiv tus kab mob Delta, peb txoj kev tshawb fawb qhia tias kev tiv thaiv ntuj yuav tsum raug txiav txim siab hauv Teb Chaws Asmeskas tus qauv xwm txheej ceev ib ntus.
Peb qhov kev tshawb pom kuj qhia tias qee lub tebchaws tuaj yeem tiv thaiv kev tiv thaiv kab mob rau yav tom ntej vim muaj kev tiv thaiv los ntawm kev sib xyaw ua ke ntawm yav dhau los SARS-CoV-2 kab mob thiab COVID-19 txhaj tshuaj tiv thaiv. Nrog rau R0 ntawm 6, Delta variant yuav xav tau ib pab tsiaj tiv thaiv kab mob tsawg kawg yog 85 feem pua [28, 29]. Cov kws tshawb fawb kwv yees tias kwv yees li ib feem peb ntawm Asmeskas, cov pej xeem tau kis tus kab mob COVID-19 los ntawm qhov kawg ntawm 2020, thiab 58.8 feem pua ntawm cov neeg Asmeskas tau txhaj tshuaj tiv thaiv tag nrho rau COVID-19 txij li 15 Kaum Ib Hlis. 2021 [20, 30]. Muab ntau qhov xwm txheej ntxiv ntawm COVID{18}} xyoo 2021, Tebchaws Meskas tuaj yeem ua rau kev tiv thaiv tsiaj txhu [31]. Txawm li cas los xij, cov kev pab cuam txhaj tshuaj loj loj yog qhov tseem ceeb rau kev vam meej mus ntxiv. Kev soj ntsuam phylogenetic tsis ntev los no ntawm evolutionarily kaw cov txheeb ze tus mob coronavirus kwv yees tias kev rov qab los ntawm SARS-CoV-2 yuav tshwm sim ntawm qhov nruab nrab ntawm 16 lub hlis tom qab cov tshuaj tiv thaiv kab mob siab tshaj plaws, qhia tias kev tiv thaiv tsis nyob mus ib txhis [32].
Txawm hais tias peb qhov kev tshawb pom tau hais txog qhov ua tau zoo ntawm kev tiv thaiv ib puag ncig, kev txhob txwm raug rau COVID-19 kom tau txais kev tiv thaiv zoo li no tsis pom zoo. Cov kev tshawb fawb tsis ntev los no los ntawm Canada [33] thiab Singapore [34] tau qhia tias Delta variant tau cuam tshuam nrog kev pheej hmoo siab rau kev mus pw hauv tsev kho mob, ICU nkag, xav tau oxygen, thiab kev tuag. Yog li ntawd, kev ua tiav kev tiv thaiv los ntawm kev txhaj tshuaj tiv thaiv yog qhov zoo dua. Tsis zoo li kev tiv thaiv ib puag ncig, kev txhaj tshuaj tiv thaiv tau txo qis kev pheej hmoo ntawm kev tsim kab mob hnyav [35], nrog rau cov teeb meem mus sij hawm ntev ntawm COVID-19 kab mob [36].
Hauv cov ntsiab lus, peb pom tias yav dhau los tus kab mob nrog SARSCoV-2 muaj kev tiv thaiv muaj zog tiv thaiv kab mob rov ua dua nrog cov kab mob sib kis tau zoo heev Delta. Peb kuj pom tias tej kev tiv thaiv tej yam ntuj tso zoo li no tshwm sim rau tsawg kawg 13 lub hlis. Ua ke, cov txiaj ntsig no txhawb nqa kev txhaj tshuaj tiv thaiv qhov tseem ceeb rau cov neeg mob uas tsis paub txog keeb kwm ntawm kev kis tus kab mob ua ntej thiab qhia tias kev tiv thaiv tsiaj txhu tuaj yeem ncav cuag sai sai.
Nco tseg
Muaj peev xwm tsis sib haum xeeb ntawm kev txaus siab. SMG tau ua haujlwm ntawm pawg kws kho mob kawg rau kev kawm Abbott Heartmate 3 M3PAS. MBR muaj cov khoom lag luam hauv Moderna. Tag nrho lwm cov neeg sau ntawv tshaj tawm tsis muaj kev tsis sib haum xeeb. Txhua tus kws sau ntawv tau xa daim ntawv foos ICMJE rau Kev Tshaj Tawm Txog Kev Muaj Peev Xwm Tsis Txaus Siab. Cov kev tsis sib haum xeeb uas cov kws kho mob xav tias muaj feem xyuam rau cov ntsiab lus ntawm cov ntawv sau tau raug nthuav tawm.
Cov ntaub ntawv
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