Asunto(s)
Vacunas contra la COVID-19 , COVID-19 , Control de Enfermedades Transmisibles/normas , Inmunidad Colectiva/efectos de los fármacos , Programas de Inmunización , Cobertura de Vacunación , COVID-19/epidemiología , COVID-19/prevención & control , COVID-19/transmisión , Vacunas contra la COVID-19/clasificación , Vacunas contra la COVID-19/farmacología , Vacunas contra la COVID-19/provisión & distribución , Predicción , Humanos , Programas de Inmunización/métodos , Programas de Inmunización/organización & administración , Programas de Inmunización/tendencias , Evaluación de Necesidades , Mejoramiento de la Calidad , SARS-CoV-2 , Cobertura de Vacunación/métodos , Cobertura de Vacunación/normasAsunto(s)
Vacunas contra la COVID-19/administración & dosificación , COVID-19/prevención & control , Inmunidad Colectiva/efectos de los fármacos , Pandemias/prevención & control , Vacunación/tendencias , COVID-19/epidemiología , COVID-19/inmunología , Vacunas contra la COVID-19/inmunología , Humanos , Inmunidad Colectiva/inmunologíaRESUMEN
Immunity is a multifaceted phenomenon. For T cell-mediated memory responses to SARS-CoV-2, it is relevant to consider their impact both on COVID-19 disease severity and on viral spread in a population. Here, we reflect on the immunological and epidemiological aspects and implications of pre-existing cross-reactive immune memory to SARS-CoV-2, which largely originates from previous exposure to circulating common cold coronaviruses. We propose four immunological scenarios for the impact of cross-reactive CD4+ memory T cells on COVID-19 severity and viral transmission. For each scenario, we discuss its implications for the dynamics of herd immunity and on projections of the global impact of SARS-CoV-2 on the human population, and assess its plausibility. In sum, we argue that key potential impacts of cross-reactive T cell memory are already incorporated into epidemiological models based on data of transmission dynamics, particularly with regard to their implications for herd immunity. The implications of immunological processes on other aspects of SARS-CoV-2 epidemiology are worthy of future study.
Asunto(s)
Anticuerpos Antivirales/biosíntesis , Betacoronavirus/inmunología , Infecciones por Coronaviridae/prevención & control , Infecciones por Coronavirus/prevención & control , Pandemias/prevención & control , Neumonía Viral/prevención & control , Vacunas Virales/inmunología , Inmunidad Adaptativa/efectos de los fármacos , Betacoronavirus/efectos de los fármacos , Betacoronavirus/patogenicidad , Linfocitos T CD4-Positivos/efectos de los fármacos , Linfocitos T CD4-Positivos/inmunología , Linfocitos T CD4-Positivos/virología , COVID-19 , Vacunas contra la COVID-19 , Coronaviridae/efectos de los fármacos , Coronaviridae/inmunología , Infecciones por Coronaviridae/epidemiología , Infecciones por Coronaviridae/inmunología , Infecciones por Coronaviridae/virología , Infecciones por Coronavirus/epidemiología , Infecciones por Coronavirus/inmunología , Infecciones por Coronavirus/virología , Reacciones Cruzadas , Humanos , Inmunidad Colectiva/efectos de los fármacos , Memoria Inmunológica , Neumonía Viral/epidemiología , Neumonía Viral/inmunología , Neumonía Viral/virología , Rhinovirus/efectos de los fármacos , Rhinovirus/inmunología , SARS-CoV-2 , Vacunas Virales/administración & dosificación , Vacunas Virales/biosíntesisAsunto(s)
Betacoronavirus/patogenicidad , Infecciones por Coronavirus/prevención & control , Industria Farmacéutica/tendencias , Pandemias/prevención & control , Neumonía Viral/prevención & control , Medición de Riesgo , Vacunas Virales/administración & dosificación , Betacoronavirus/efectos de los fármacos , Betacoronavirus/inmunología , COVID-19 , Vacunas contra la COVID-19 , Defensa Civil , Infecciones por Coronavirus/epidemiología , Infecciones por Coronavirus/inmunología , Infecciones por Coronavirus/virología , Industria Farmacéutica/ética , Humanos , Inmunidad Colectiva/efectos de los fármacos , Inmunidad Innata , Inmunogenicidad Vacunal , Seguridad del Paciente , Neumonía Viral/epidemiología , Neumonía Viral/inmunología , Neumonía Viral/virología , SARS-CoV-2 , Índice de Severidad de la Enfermedad , Incertidumbre , Vacunas Virales/biosíntesisRESUMEN
Coronaviruses are single-stranded RNA viruses that cause severe respiratory, enteric, and systemic infections in a vast range of hosts, including man, fish, mammals, and avian. Scientific interest has heightened on coronaviruses after the emergence of the 2019 novel Coronavirus (SARS-CoV-2). This review provides current perspectives on morphology, genetic diversity, transmission characteristics, replication cycle, diagnostic approaches, epidemiological assessment, and prevention strategies against the SARS-CoV-2. Moreover, different potential biotherapeutics such as small drug molecules, different vaccines, and immunotherapies to control severe acute respiratory infections caused by 2019 novel coronavirus (SARS-CoV-2) are repurposed and discussed with different mechanistic approaches. The current growth trends of the SARS-CoV-2/COVID-19 outbreak globally and preventive measures are briefly discussed. Furthermore, the lessons learned from the COVID-19 outbreak, so far, concluding remarks and future directions for controlling for COVID-19, are also recommended for a safer tomorrow.
Asunto(s)
Antivirales/inmunología , COVID-19/inmunología , COVID-19/prevención & control , Inmunoterapia/métodos , SARS-CoV-2/inmunología , Animales , Antivirales/administración & dosificación , COVID-19/genética , Coronavirus/efectos de los fármacos , Coronavirus/genética , Coronavirus/inmunología , Brotes de Enfermedades/prevención & control , Humanos , Inmunidad Colectiva/efectos de los fármacos , Inmunidad Colectiva/inmunología , Inmunoterapia/tendencias , Cuarentena/métodos , Cuarentena/tendencias , Infecciones del Sistema Respiratorio , SARS-CoV-2/efectos de los fármacos , SARS-CoV-2/genéticaRESUMEN
The coronavirus disease 2019 (COVID-19) pandemic caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is the most formidable challenge to humanity in a century. It is widely believed that prepandemic normalcy will never return until a safe and effective vaccine strategy becomes available and a global vaccination programme is implemented successfully. Here, we discuss the immunological principles that need to be taken into consideration in the development of COVID-19 vaccine strategies. On the basis of these principles, we examine the current COVID-19 vaccine candidates, their strengths and potential shortfalls, and make inferences about their chances of success. Finally, we discuss the scientific and practical challenges that will be faced in the process of developing a successful vaccine and the ways in which COVID-19 vaccine strategies may evolve over the next few years.
Asunto(s)
Anticuerpos Antivirales/biosíntesis , Betacoronavirus/inmunología , Infecciones por Coronavirus/prevención & control , Pandemias/prevención & control , Neumonía Viral/prevención & control , Síndrome Respiratorio Agudo Grave/epidemiología , Síndrome Respiratorio Agudo Grave/prevención & control , Vacunas Virales/inmunología , Betacoronavirus/efectos de los fármacos , Betacoronavirus/patogenicidad , COVID-19 , Vacunas contra la COVID-19 , Ensayos Clínicos como Asunto , Infecciones por Coronavirus/epidemiología , Infecciones por Coronavirus/inmunología , Infecciones por Coronavirus/virología , Vectores Genéticos/química , Vectores Genéticos/inmunología , Humanos , Inmunidad Colectiva/efectos de los fármacos , Inmunidad Innata/efectos de los fármacos , Esquemas de Inmunización , Inmunogenicidad Vacunal , Seguridad del Paciente , Neumonía Viral/epidemiología , Neumonía Viral/inmunología , Neumonía Viral/virología , SARS-CoV-2 , Síndrome Respiratorio Agudo Grave/inmunología , Síndrome Respiratorio Agudo Grave/virología , Vacunas Atenuadas , Vacunas de ADN , Vacunas de Subunidad , Vacunas de Partículas Similares a Virus , Vacunas Virales/administración & dosificación , Vacunas Virales/biosíntesisAsunto(s)
Formación de Anticuerpos/efectos de los fármacos , Infecciones por Coronavirus/tratamiento farmacológico , Infecciones por Coronavirus/inmunología , Hidroxicloroquina/efectos adversos , Inmunidad Celular/efectos de los fármacos , Inmunidad Colectiva/efectos de los fármacos , Neumonía Viral/tratamiento farmacológico , Neumonía Viral/inmunología , Antivirales/uso terapéutico , Azitromicina/administración & dosificación , Azitromicina/efectos adversos , Betacoronavirus/efectos de los fármacos , Betacoronavirus/fisiología , COVID-19 , Enfermedades Cardiovasculares/inducido químicamente , Enfermedades Cardiovasculares/epidemiología , Infecciones por Coronavirus/complicaciones , Infecciones por Coronavirus/epidemiología , Quimioterapia Combinada/efectos adversos , Humanos , Hidroxicloroquina/administración & dosificación , Hidroxicloroquina/farmacología , Inmunosupresores/efectos adversos , Inmunosupresores/uso terapéutico , Pandemias , Neumonía Viral/complicaciones , Neumonía Viral/epidemiología , SARS-CoV-2 , Carga Viral/efectos de los fármacos , Vacunas Virales/uso terapéutico , Tratamiento Farmacológico de COVID-19RESUMEN
Diarrhea remains one of the top five causes of disease and death among young children in developing nations. Fortunately, scientists are making progress developing vaccines against enterotoxigenic E. coli (ETEC) and Shigella, two of the leading diarrhea pathogens. As vaccine developers start to consider field efficacy trials of these vaccines, they should be aware of the importance of evaluating not only vaccine direct effects on the immunized, but also the herd effects that vaccination can afford to the unimmunized in a community. In a workshop held at the conference titled "Vaccines against Shigella and ETEC (VASE)", we described to participants what herd effects are and we presented on methods used in cholera and rotavirus studies that could be useful for future ETEC and Shigella vaccine trials conducted in low and middle-income nations. We also presented evidence on the effects of vaccine herd effects for estimates of vaccine cost-effectiveness.
Asunto(s)
Diarrea/prevención & control , Disentería Bacilar/prevención & control , Infecciones por Escherichia coli/prevención & control , Vacunas contra Escherichia coli/biosíntesis , Inmunidad Colectiva/efectos de los fármacos , Vacunas contra la Shigella/biosíntesis , Cólera/epidemiología , Cólera/inmunología , Cólera/microbiología , Cólera/prevención & control , Vacunas contra el Cólera/administración & dosificación , Vacunas contra el Cólera/economía , Ensayos Clínicos como Asunto , Análisis Costo-Beneficio , Diarrea/epidemiología , Diarrea/inmunología , Diarrea/microbiología , Disentería Bacilar/epidemiología , Disentería Bacilar/inmunología , Disentería Bacilar/microbiología , Escherichia coli Enterotoxigénica/efectos de los fármacos , Escherichia coli Enterotoxigénica/inmunología , Escherichia coli Enterotoxigénica/patogenicidad , Infecciones por Escherichia coli/epidemiología , Infecciones por Escherichia coli/inmunología , Infecciones por Escherichia coli/microbiología , Vacunas contra Escherichia coli/administración & dosificación , Vacunas contra Escherichia coli/economía , Sistemas de Información Geográfica/estadística & datos numéricos , Humanos , Inmunización/métodos , Infecciones por Rotavirus/epidemiología , Infecciones por Rotavirus/inmunología , Infecciones por Rotavirus/microbiología , Infecciones por Rotavirus/prevención & control , Vacunas contra Rotavirus/administración & dosificación , Vacunas contra Rotavirus/economía , Shigella/efectos de los fármacos , Shigella/inmunología , Shigella/patogenicidad , Vacunas contra la Shigella/administración & dosificación , Vacunas contra la Shigella/economíaRESUMEN
BACKGROUND: Clinical trials of the 4-valent human papillomavirus (HPV) vaccine demonstrate high efficacy, but surveillance studies are essential to examine the long-term impact of vaccine introduction on HPV prevalence in community settings. The aims of this study were to determine during the 11 years after vaccine introduction the prevalence of (1) vaccine-type HPV in adolescent and young adult women who were vaccinated (to assess vaccine effectiveness) and (2) vaccine-type HPV in women who were unvaccinated (to assess herd protection). METHODS: Young women 13 to 26 years of age were recruited from hospital-based and community health clinics for 4 surveillance studies from 2006 to 2017. We determined the proportion of vaccinated and unvaccinated women who were positive for vaccine-type HPV across the studies, and the odds of positivity for vaccine-type HPV using logistic regression; all analyses were propensity score-adjusted to control for between-wave differences in participant characteristics. RESULTS: Vaccination rates increased from 0% to 84.3% (97% of study participants received the 4-valent vaccine). Among women who were vaccinated, 4-valent vaccine-type HPV detection decreased from 35% to 6.7% (80.9% decline; odds ratio 0.13, 95% confidence interval 0.08 to 0.22). Among women who were unvaccinated, 4-valent vaccine-type HPV detection decreased from 32.4% to 19.4% (40% decline; odds ratio 0.50, 95% confidence interval 0.26 to 0.97). Estimated vaccine effectiveness was 90.6% in wave 3 and 80.1% in wave 4. CONCLUSIONS: In this study in which trends in HPV in a US community >10 years after 4-valent HPV vaccine introduction and after 9-valent vaccine introduction were examined, we found evidence of vaccine effectiveness and herd protection. Further research is needed to examine trends in 9-valent vaccine-type HPV after higher rates of vaccination are achieved.
Asunto(s)
Inmunidad Colectiva/efectos de los fármacos , Infecciones por Papillomavirus/epidemiología , Infecciones por Papillomavirus/prevención & control , Vacunas contra Papillomavirus/uso terapéutico , Vacunación/tendencias , Adolescente , Adulto , Femenino , Humanos , Infecciones por Papillomavirus/diagnóstico , Vacunas contra Papillomavirus/farmacología , Resultado del Tratamiento , Vacunación/métodos , Adulto JovenRESUMEN
BACKGROUND: We assessed the effectiveness and possible impact of introducing rotavirus vaccine into the routine immunization program. METHODS: Two provinces were selected for an observational study, one where vaccine was introduced and another where vaccine was not available. In these areas, two sub-studies were linked. The prospective cohort study enrolled children 2month old and followed them to the age of 18months to detect all diarrhea episodes. The hospital surveillance study enrolled all children up to age 5 hospitalized with diarrhea whose fecal samples were tested for rotavirus. Rates of rotavirus hospitalizations in older children who had not been vaccinated in both settings provided data to determine whether immunization had an indirect herd effect. The key endpoints for the study were both vaccine effectiveness (VE) based upon hospitalized rotavirus diarrhea and herd protection. FINDINGS: From the cohort study, the overall VE for hospitalized rotavirus diarrhea was 88% (95%CI 76-94). Data from hospital surveillance indicated that for 2 consecutive years, the seasonal peak of rotavirus admissions was no longer present in the vaccinated area. Herd protection was observed among older children born before the rotavirus vaccine program was introduced, who experienced a 40-69% reduction in admission for rotavirus. CONCLUSIONS: Rotavirus vaccine was highly effective in preventing diarrheal hospitalizations and in conferring herd protection among older children who had not been vaccinated.
Asunto(s)
Diarrea/prevención & control , Programas de Inmunización/organización & administración , Infecciones por Rotavirus/prevención & control , Vacunas contra Rotavirus/administración & dosificación , Rotavirus/efectos de los fármacos , Vacunación , Preescolar , Diarrea/inmunología , Diarrea/virología , Femenino , Hospitalización/estadística & datos numéricos , Humanos , Inmunidad Colectiva/efectos de los fármacos , Lactante , Masculino , Estudios Prospectivos , Rotavirus/inmunología , Infecciones por Rotavirus/inmunología , Infecciones por Rotavirus/virología , Tailandia , Potencia de la Vacuna , Vacunas AtenuadasRESUMEN
Three years after a 7-valent pneumococcal conjugate vaccine was replaced by a 10-valent pneumococcal conjugate vaccine in the Netherlands, we observed a decrease in incidence of invasive pneumococcal disease caused by Streptococcus pneumoniae serotypes 1, 5, and 7F. Our data do not support or exclude cross-protection against serotype 19A.
Asunto(s)
Infecciones Neumocócicas/epidemiología , Vacunas Neumococicas/uso terapéutico , Humanos , Inmunidad Colectiva/efectos de los fármacos , Incidencia , Países Bajos/epidemiología , Infecciones Neumocócicas/inmunología , Infecciones Neumocócicas/prevención & control , Infecciones Neumocócicas/transmisión , Vacunas Neumococicas/inmunología , Serotipificación , Streptococcus pneumoniae/inmunología , Streptococcus pneumoniae/patogenicidad , Vacunas Conjugadas/inmunología , Vacunas Conjugadas/uso terapéuticoAsunto(s)
Actitud Frente a la Salud , Vacunación Masiva/psicología , Sarampión/prevención & control , Donantes de Sangre/legislación & jurisprudencia , Diagnóstico Precoz , Promoción de la Salud/métodos , Promoción de la Salud/normas , Historia del Siglo XIX , Historia del Siglo XX , Historia del Siglo XXI , Humanos , Inmunidad Colectiva/efectos de los fármacos , Vacunación Masiva/historia , Vacunación Masiva/legislación & jurisprudencia , Sarampión/diagnóstico , Sarampión/epidemiología , Sarampión/historia , Vacuna Antisarampión/historia , Patient Protection and Affordable Care Act , Pediatría/historia , Garantía de la Calidad de Atención de Salud/legislación & jurisprudencia , Contaminación por Humo de Tabaco/legislación & jurisprudencia , Contaminación por Humo de Tabaco/prevención & control , Estados Unidos/epidemiologíaRESUMEN
We demonstrate how direct, indirect, total, and overall effectiveness estimates and absolute benefits of rotavirus vaccines vary through the years following vaccine introduction. Privately insured US children in a large claims database were followed from age 8 months until they 1) experienced a hospitalization for rotavirus or acute gastroenteritis; 2) lost continuous health plan enrollment; 3) turned 20 months of age; or 4) reached the end of the study period. Vaccine effectiveness estimates in preventing rotavirus and acute gastroenteritis hospitalizations were estimated using Cox proportional hazards regression, stratified by calendar year and adjusted for birth month. Incidence rate differences were estimated to determine the absolute number of gastroenteritis hospitalizations prevented in the cohort. Among 905,718 children, 51%, 66%, 80%, and 86% received 1 or more doses of rotavirus vaccine in each year from 2007 to 2010. The direct vaccine effectiveness of 1 or more doses of rotavirus vaccine in preventing rotavirus gastroenteritis hospitalizations ranged from 87% to 92% each year. Accounting for indirect protection increased estimates of vaccine effectiveness by an additional 3%-8% among those vaccinated. Failing to account for population-level vaccine benefits in 2010, when circulation of rotavirus was low, could underestimate the sustained impact of the vaccine program.
Asunto(s)
Gastroenteritis/prevención & control , Hospitalización/tendencias , Inmunidad Colectiva/efectos de los fármacos , Seguro de Salud/estadística & datos numéricos , Infecciones por Rotavirus/prevención & control , Vacunas contra Rotavirus/administración & dosificación , Enfermedad Aguda , Femenino , Gastroenteritis/epidemiología , Gastroenteritis/virología , Humanos , Lactante , Revisión de Utilización de Seguros , Masculino , Modelos de Riesgos Proporcionales , Análisis de Regresión , Infecciones por Rotavirus/epidemiología , Infecciones por Rotavirus/inmunología , Vacunas contra Rotavirus/inmunología , Estados Unidos/epidemiologíaRESUMEN
Rotavirus infection is the most common cause of severe diarrhea disease in infants and young children worldwide and continues to have a major global impact on childhood morbidity and mortality. Vaccination is the only control measure likely to have a significant impact on the incidence of severe dehydrating rotavirus disease. Rotavirus vaccines have reduced the burden of rotavirus disease in the United States. Long-term monitoring will need to continue to assess the effects of rotavirus immunization programs and epidemiologic strain surveillance is necessary to determine whether changes in strain ecology will affect the rotavirus vaccine effectiveness and whether rotaviruses with the ability to evade vaccine immunity emerge.
Asunto(s)
Diarrea/terapia , Infecciones por Rotavirus , Vacunas contra Rotavirus , Rotavirus/inmunología , Preescolar , Contraindicaciones , Diarrea/prevención & control , Diarrea/virología , Humanos , Inmunidad Colectiva/efectos de los fármacos , Lactante , Rotavirus/clasificación , Infecciones por Rotavirus/epidemiología , Infecciones por Rotavirus/prevención & control , Infecciones por Rotavirus/terapia , Vacunas contra Rotavirus/administración & dosificación , Estados Unidos/epidemiologíaRESUMEN
Human papillomavirus (HPV) infection is the world's most common sexually transmitted infection. It is a prerequisite for cervical cancer, the second most common cause of death in cancer among women worldwide, and is also believed to cause other anogenital and head and neck cancers. Vaccines that protect against the most common cancer-causing HPV types have recently become available, and different countries have taken different approaches to implementing vaccination. This paper examines the ethics of alternative HPV vaccination strategies. It devotes particular attention to the major arguments for and against one strategy: voluntary, publicly funded vaccination for all adolescent boys and girls. This approach seems attractive because it would protect more people against cervical cancer and other HPV-related cancers than less inclusive alternatives, without the sacrifice of autonomy that a comparably broad compulsory programme would require. Also, the herd immunity that it would likely generate would protect those who remain unvaccinated, a major advantage from a justice perspective. However, there is a possibility that a HPV vaccination programme targeting all adolescents of both sexes is not considered sufficiently cost-effective. Also, it might pose more difficulties for achieving informed consent than comparable vaccination programmes against other diseases. Ultimately, society's choice of HPV vaccination strategy requires careful consideration not only of the values at stake but also of available and emerging scientific evidence.
Asunto(s)
Programas de Inmunización/ética , Infecciones por Papillomavirus/prevención & control , Vacunas contra Papillomavirus/administración & dosificación , Neoplasias del Cuello Uterino/prevención & control , Adolescente , Comparación Transcultural , Países Desarrollados , Femenino , Humanos , Inmunidad Colectiva/efectos de los fármacos , Programas de Inmunización/organización & administración , Masculino , Justicia Social , Neoplasias del Cuello Uterino/etiología , Neoplasias del Cuello Uterino/virologíaRESUMEN
BACKGROUND: Pneumococcal conjugate vaccines (PCVs) prevent vaccine serotype (VT) invasive disease; nonvaccine serotype (NVT) disease increases modestly. The impact of PCV on nasopharyngeal (NP) colonization is essential to understanding disease effects. METHODS: We conducted a community-randomized controlled trial with catch-up vaccination through age 2 years investigating the effect of 7-valent PCV (PnCRM7) on NP colonization among American Indian infants and their unvaccinated contacts. Infants receiving blinded vaccine at 2, 4, 6, and 12-15 months of age had NP cultures obtained at age 7, 12, and 18 months. Serotype-specific colonization was detected by immunoblot. RESULTS: We enrolled 566 vaccinated and 286 unvaccinated children from 511 households and collected 5157 specimens, of which 3525 (68.4%) had pneumococcus. PnCRM7 vaccinees were less likely to be colonized with VT (odds ratio [OR], 0.40 [95% confidence interval {CI}, 0.23-0.67]) but were more likely to be colonized with NVT pneumococci (OR, 1.67 [95% CI, 1.02-2.78]). PnCRM7 vaccinees were less densely colonized with VT strains than control vaccinees (OR, 0.61 [95% CI, 0.38-0.99]). Day care-attending unvaccinated children in PnCRM7 communities were less likely to have VT colonization than those in control communities (OR, 0.27 [95% CI, 0.07-1.07]). CONCLUSIONS: PnCRM7 reduces the risk of VT acquisition and colonization density but increases the risk of NVT acquisition among vaccinees and their household contacts.