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2.
Emerg Microbes Infect ; 10(1): 1931-1946, 2021 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-34538222

RESUMEN

Identification of relevant epitopes is crucial for the development of subunit peptide vaccines inducing neutralizing and cellular immunity against SARS-CoV-2. Our aim was the characterization of epitopes in the receptor-binding domain (RBD) of SARS-CoV-2 spike (S) protein to generate a peptide vaccine. Epitope mapping using a panel of 10 amino acid overlapped 15-mer peptides covering region 401-515 from RBD did not identify linear epitopes when tested with sera from infected individuals or from RBD-immunized mice. However, immunization of mice with these 15-mer peptides identified four peptides located at region 446-480 that induced antibodies recognizing the peptides and RBD/S1 proteins. Immunization with peptide 446-480 from S protein formulated with Freund's adjuvant or with CpG oligodeoxinucleotide/Alum induced polyepitopic antibody responses in BALB/c and C56BL/6J mice, recognizing RBD (titres of 3 × 104-3 × 105, depending on the adjuvant) and displaying neutralizing capacity (80-95% inhibition capacity; p < 0.05) against SARS-CoV-2. Murine CD4 and CD8T-cell epitopes were identified in region 446-480 and vaccination experiments using HLA transgenic mice suggested the presence of multiple human T-cell epitopes. Antibodies induced by peptide 446-480 showed broad recognition of S proteins and S-derived peptides belonging to SARS-CoV-2 variants of concern. Importantly, vaccination with peptide 446-480 or with a cyclic version of peptide 446-488 containing a disulphide bridge between cysteines 480 and 488, protected humanized K18-hACE2 mice from a lethal dose of SARS-CoV-2 (62.5 and 75% of protection; p < 0.01 and p < 0.001, respectively). This region could be the basis for a peptide vaccine or other vaccine platforms against Covid-19.


Asunto(s)
Anticuerpos Neutralizantes/inmunología , Vacunas contra la COVID-19/inmunología , COVID-19/prevención & control , Inmunidad Celular , Inmunidad Humoral , SARS-CoV-2/inmunología , Adyuvantes Inmunológicos/administración & dosificación , Animales , Anticuerpos Neutralizantes/sangre , Linfocitos T CD4-Positivos/inmunología , Linfocitos T CD8-positivos/inmunología , COVID-19/inmunología , Vacunas contra la COVID-19/normas , Reacciones Cruzadas/inmunología , Mapeo Epitopo , Epítopos de Linfocito B , Epítopos de Linfocito T/inmunología , Humanos , Inmunización , Ratones , Ratones Endogámicos BALB C , Ratones Endogámicos C57BL , Ratones Transgénicos , SARS-CoV-2/genética , Glicoproteína de la Espiga del Coronavirus/genética , Glicoproteína de la Espiga del Coronavirus/inmunología , Vacunas de Subunidad/inmunología , Vacunas Sintéticas/inmunología
3.
Pharmaceut Med ; 35(4): 203-213, 2021 07.
Artículo en Inglés | MEDLINE | ID: mdl-34453703

RESUMEN

The Emergency Use Authorization (EUA) originated in 2004 because of the need for emergency medical countermeasures (MCMs) against potential bioterrorist attacks. The EUA also proved useful in dealing with subsequent pandemics and has emerged as a critical regulatory pathway for therapeutics and vaccines throughout the Coronavirus Disease 2019 (COVID-19) pandemic. With the EUA process in the USA, we witnessed emergency authorizations, their expansions, as well as withdrawal of previously authorized products, which exemplifies the dynamic nature of scientific review of EUA products. EUAs proved vital for the first group of COVID-19 vaccines, including the temporary pause of one vaccine while emergency safety issues were evaluated. Although this review on the EUA is primarily focused on the USA, distinctions were made with other jurisdictions such as Europe and Canada with respect to the emergency authorizations of the vaccines. Finally, we discuss some important differences following EUA and formal new drug/vaccine application (NDA/BLA) approvals.


Asunto(s)
Antivirales/normas , Vacunas contra la COVID-19/normas , COVID-19/prevención & control , Aprobación de Drogas/legislación & jurisprudencia , Urgencias Médicas/historia , Antivirales/administración & dosificación , Antivirales/efectos adversos , Bioterrorismo/historia , Bioterrorismo/prevención & control , COVID-19/tratamiento farmacológico , COVID-19/epidemiología , Vacunas contra la COVID-19/administración & dosificación , Vacunas contra la COVID-19/efectos adversos , Canadá/epidemiología , Defensa Civil/historia , Aprobación de Drogas/historia , Urgencias Médicas/epidemiología , Europa (Continente)/epidemiología , Historia del Siglo XXI , Humanos , Pandemias/prevención & control , Estados Unidos/epidemiología
7.
Endocrinol Metab (Seoul) ; 36(4): 757-765, 2021 08.
Artículo en Inglés | MEDLINE | ID: mdl-34399446

RESUMEN

Since the first outbreak of coronavirus disease 2019 (COVID-19), ongoing efforts have been made to discover an efficacious vaccine against COVID-19 to combat the pandemic. In most countries, both mRNA and DNA vaccines have been administered, and their side effects have also been reported. The clinical course of COVID-19 and the effects of vaccination against COVID-19 are both influenced by patients' health status and involve a systemic physiological response. In view of the systemic function of endocrine hormones, endocrine disorders themselves and the therapeutics used to treat them can influence the outcomes of vaccination for COVID-19. However, there are very limited data to support the development of clinical guidelines for patients with specific medical backgrounds based on large clinical trials. In the current severe circumstances of the COVID-19 pandemic, position statements made by clinical specialists are essential to provide appropriate recommendations based on both medical evidence and clinical experiences. As endocrinologists, we would like to present the medical background of COVID-19 vaccination, as well as precautions to prevent the side effects of COVID-19 vaccination in patients with specific endocrine disorders, including adrenal insufficiency, diabetes mellitus, osteoporosis, autoimmune thyroid disease, hypogonadism, and pituitary disorders.


Asunto(s)
Vacunas contra la COVID-19/normas , COVID-19/prevención & control , Enfermedades del Sistema Endocrino , Endocrinólogos/normas , Sociedades Médicas/normas , Vacunación/normas , COVID-19/epidemiología , COVID-19/inmunología , Vacunas contra la COVID-19/administración & dosificación , Vacunas contra la COVID-19/efectos adversos , Enfermedades del Sistema Endocrino/epidemiología , Enfermedades del Sistema Endocrino/inmunología , Humanos , Guías de Práctica Clínica como Asunto/normas , República de Corea/epidemiología
8.
Emerg Microbes Infect ; 10(1): 1751-1759, 2021 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-34396940

RESUMEN

The effectiveness of inactivated SARS-CoV-2 vaccines against the Delta variant, which has been associated with greater transmissibility and virulence, remains unclear. We conducted a test-negative case-control study to explore the vaccine effectiveness (VE) in real-world settings. We recruited participants aged 18-59 years who consisted of SARS-CoV-2 test-positive cases (n = 74) and test-negative controls (n = 292) during the outbreak of the Delta variant in May 2021 in Guangzhou city, China. Vaccination status was compared to estimate The VE of SARS-CoV-2 inactivated vaccines. A single dose of inactivated SARS-CoV-2 vaccine yielded the VE of only 13.8%. After adjusting for age and sex, the overall VE for two-dose vaccination was 59.0% (95% confidence interval: 16.0% to 81.6%) against coronavirus disease 2019 (COVID-19) and 70.2% (95% confidence interval: 29.6-89.3%) against moderate COVID-19 and 100% against severe COVID-19 which might be overestimated due to the small sample size. The VE of two-dose vaccination against COVID-19 reached 72.5% among participants aged 40-59 years, and was higher in females than in males against COVID-19 and moderate diseases. While single dose vaccination was not sufficiently protective, the two-dose dosing scheme of the inactivated vaccines was effective against the Delta variant infection in real-world settings, with the estimated efficacy exceeding the World Health Organization minimal threshold of 50%.


Asunto(s)
Vacunas contra la COVID-19/normas , COVID-19/prevención & control , SARS-CoV-2/genética , Adolescente , Adulto , Distribución por Edad , COVID-19/clasificación , Vacunas contra la COVID-19/administración & dosificación , Estudios de Casos y Controles , China , Brotes de Enfermedades , Femenino , Variación Genética , Humanos , Masculino , Persona de Mediana Edad , Vacunas de Productos Inactivados/administración & dosificación , Vacunas de Productos Inactivados/normas , Adulto Joven
9.
Endeavour ; 45(3): 100779, 2021 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-34352721

RESUMEN

Animals, especially mammals, have played a critical role in the COVID-19 pandemic. The COVID-19 virus originated in animals, and the virus can jump back and forth between humans and animals. Moreover, animals have been central to the development of the various vaccines against the virus now employed around the world, continuing a long history. The interrelationships between animals and humans in both disease transmission and its prevention call for an interdisciplinary approach to medicine.


Asunto(s)
Vacunas contra la COVID-19/normas , COVID-19/prevención & control , COVID-19/transmisión , Comunicación Interdisciplinaria , SARS-CoV-2/aislamiento & purificación , Animales , Susceptibilidad a Enfermedades , Humanos , Investigación Interdisciplinaria
10.
PLoS One ; 16(7): e0254734, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-34270597

RESUMEN

As the COVID-19 pandemic drags into its second year, there is hope on the horizon, in the form of SARS-CoV-2 vaccines which promise disease suppression and a return to pre-pandemic normalcy. In this study we critically examine the basis for that hope, using an epidemiological modeling framework to establish the link between vaccine characteristics and effectiveness in bringing an end to this unprecedented public health crisis. Our findings suggest that a return to pre-pandemic social and economic conditions without fully suppressing SARS-CoV-2 will lead to extensive viral spread, resulting in a high disease burden even in the presence of vaccines that reduce risk of infection and mortality. Our modeling points to the feasibility of complete SARS-CoV-2 suppression with high population-level compliance and vaccines that are highly effective at reducing SARS-CoV-2 infection. Notably, vaccine-mediated reduction of transmission is critical for viral suppression, and in order for partially-effective vaccines to play a positive role in SARS-CoV-2 suppression, complementary biomedical interventions and public health measures must be deployed simultaneously.


Asunto(s)
COVID-19/prevención & control , Vacunación/estadística & datos numéricos , Factores de Edad , Número Básico de Reproducción , COVID-19/epidemiología , COVID-19/transmisión , Vacunas contra la COVID-19/administración & dosificación , Vacunas contra la COVID-19/inmunología , Vacunas contra la COVID-19/normas , Estudios de Factibilidad , Humanos , Inmunidad Colectiva , Inmunogenicidad Vacunal , Modelos Estadísticos , Mortalidad/tendencias , SARS-CoV-2/inmunología , SARS-CoV-2/fisiología , Vacunación/normas
11.
Ann Glob Health ; 87(1): 71, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-34327118

RESUMEN

Despite the pandemic, 34,154 migrants, refugees or asylum-seekers landed in Sicily (Italy) in 2020, representing the main point of entry by sea into Europe. The SARS-CoV-2 surveillance program among migrants arriving to Sicily via the Mediterranean Sea, made by the combination of clinical examination and molecular testing, has been integrated by full-genome sequencing strains using the NGS technology from the last week of February. To date, more than one hundred full-genome strains have been sequenced and 8 different lineages have been identified mostly belonging to the lineages B.1.1.7 and B.1.525. As global access to COVID-19 vaccines should be ensured, the need to provide more detailed information to inform policies and to drive the possible re-engineering of vaccines needed to deal with the challenge of new and future variants should be highlighted.


Asunto(s)
COVID-19 , Genoma Viral , SARS-CoV-2 , Migrantes/estadística & datos numéricos , COVID-19/diagnóstico , COVID-19/epidemiología , COVID-19/prevención & control , Vacunas contra la COVID-19/clasificación , Vacunas contra la COVID-19/normas , Humanos , Técnicas de Diagnóstico Molecular/métodos , Técnicas de Diagnóstico Molecular/estadística & datos numéricos , SARS-CoV-2/genética , SARS-CoV-2/aislamiento & purificación , Sicilia/epidemiología
12.
Cell Host Microbe ; 29(7): 1036-1039, 2021 07 14.
Artículo en Inglés | MEDLINE | ID: mdl-34265241

RESUMEN

Global vaccine inequity is prolonging the COVID-19 pandemic. Here, we outline the scope and impact of inequitable vaccine distribution and identify challenges in vaccine development, manufacturing, and distribution as well as potential solutions to address this crisis.


Asunto(s)
Vacunas contra la COVID-19/provisión & distribución , COVID-19/prevención & control , Pandemias/prevención & control , Investigación Biomédica , Vacunas contra la COVID-19/normas , China , Humanos , Instalaciones Industriales y de Fabricación , SARS-CoV-2 , Estados Unidos , United States Food and Drug Administration , Vacunación
13.
JMIR Public Health Surveill ; 7(9): e30010, 2021 09 17.
Artículo en Inglés | MEDLINE | ID: mdl-34265740

RESUMEN

BACKGROUND: On March 11, 2020, the World Health Organization declared SARS-CoV-2, causing COVID-19, as a pandemic. The UK mass vaccination program commenced on December 8, 2020, vaccinating groups of the population deemed to be most vulnerable to severe COVID-19 infection. OBJECTIVE: This study aims to assess the early vaccine administration coverage and outcome data across an integrated care system in North West London, leveraging a unique population-level care data set. Vaccine effectiveness of a single dose of the Oxford/AstraZeneca and Pfizer/BioNTech vaccines were compared. METHODS: A retrospective cohort study identified 2,183,939 individuals eligible for COVID-19 vaccination between December 8, 2020, and February 24, 2021, within a primary, secondary, and community care integrated care data set. These data were used to assess vaccination hesitancy across ethnicity, gender, and socioeconomic deprivation measures (Pearson product-moment correlations); investigate COVID-19 transmission related to vaccination hubs; and assess the early effectiveness of COVID-19 vaccination (after a single dose) using time-to-event analyses with multivariable Cox regression analysis to investigate if vaccination independently predicted positive SARS-CoV-2 in those vaccinated compared to those unvaccinated. RESULTS: In this study, 5.88% (24,332/413,919) of individuals declined and did not receive a vaccination. Black or Black British individuals had the highest rate of declining a vaccine at 16.14% (4337/26,870). There was a strong negative association between socioeconomic deprivation and rate of declining vaccination (r=-0.94; P=.002) with 13.5% (1980/14,571) of individuals declining vaccination in the most deprived areas compared to 0.98% (869/9609) in the least. In the first 6 days after vaccination, 344 of 389,587 (0.09%) individuals tested positive for SARS-CoV-2. The rate increased to 0.13% (525/389,243) between days 7 and 13, before then gradually falling week on week. At 28 days post vaccination, there was a 74% (hazard ratio 0.26, 95% CI 0.19-0.35) and 78% (hazard ratio 0.22, 95% CI 0.18-0.27) reduction in risk of testing positive for SARS-CoV-2 for individuals that received the Oxford/AstraZeneca and Pfizer/BioNTech vaccines, respectively, when compared with unvaccinated individuals. A very low proportion of hospital admissions were seen in vaccinated individuals who tested positive for SARS-CoV-2 (288/389,587, 0.07% of all patients vaccinated) providing evidence for vaccination effectiveness after a single dose. CONCLUSIONS: There was no definitive evidence to suggest COVID-19 was transmitted as a result of vaccination hubs during the vaccine administration rollout in North West London, and the risk of contracting COVID-19 or becoming hospitalized after vaccination has been demonstrated to be low in the vaccinated population. This study provides further evidence that a single dose of either the Pfizer/BioNTech vaccine or the Oxford/AstraZeneca vaccine is effective at reducing the risk of testing positive for COVID-19 up to 60 days across all age groups, ethnic groups, and risk categories in an urban UK population.


Asunto(s)
Movimiento Anti-Vacunación/estadística & datos numéricos , Vacunas contra la COVID-19/normas , Programas de Inmunización/normas , Movimiento Anti-Vacunación/psicología , COVID-19/prevención & control , Vacunas contra la COVID-19/uso terapéutico , Estudios de Cohortes , Hospitalización/estadística & datos numéricos , Humanos , Programas de Inmunización/estadística & datos numéricos , Londres , Estudios Retrospectivos
14.
Arthritis Rheumatol ; 73(8): e30-e45, 2021 08.
Artículo en Inglés | MEDLINE | ID: mdl-34128356

RESUMEN

OBJECTIVE: To provide guidance to rheumatology providers on the use of coronavirus disease 2019 (COVID-19) vaccines for patients with rheumatic and musculoskeletal diseases (RMDs). METHODS: A task force was assembled that included 9 rheumatologists/immunologists, 2 infectious disease specialists, and 2 public health physicians. After agreeing on scoping questions, an evidence report was created that summarized the published literature and publicly available data regarding COVID-19 vaccine efficacy and safety, as well as literature for other vaccines in RMD patients. Task force members rated their agreement with draft consensus statements on a 9-point numerical scoring system, using a modified Delphi process and the RAND/University of California Los Angeles Appropriateness Method, with refinement and iteration over 2 sessions. Consensus was determined based on the distribution of ratings. RESULTS: Despite a paucity of direct evidence, 74 draft guidance statements were developed by the task force and agreed upon with consensus to provide guidance for use of the COVID-19 vaccines in RMD patients and to offer recommendations regarding the use and timing of immunomodulatory therapies around the time of vaccination. CONCLUSION: These guidance statements, made in the context of limited clinical data, are intended to provide direction to rheumatology health care providers on how to best use COVID-19 vaccines and to facilitate implementation of vaccination strategies for RMD patients.


Asunto(s)
Vacunas contra la COVID-19/normas , COVID-19/prevención & control , Factores Inmunológicos/uso terapéutico , Enfermedades Musculoesqueléticas/tratamiento farmacológico , Guías de Práctica Clínica como Asunto/normas , Enfermedades Reumáticas/tratamiento farmacológico , Reumatología/normas , Academias e Institutos , Comités Consultivos , Consenso , Técnica Delfos , Humanos , Enfermedades Musculoesqueléticas/inmunología , Enfermedades Reumáticas/inmunología , SARS-CoV-2 , Estados Unidos
15.
Proc Natl Acad Sci U S A ; 118(28)2021 07 13.
Artículo en Inglés | MEDLINE | ID: mdl-34162739

RESUMEN

Severe acute respiratory syndrome (SARS) coronavirus 2 (SARS-CoV-2) has emerged as the infectious agent causing the pandemic coronavirus disease 2019 (COVID-19) with dramatic consequences for global human health and economics. Previously, we reached clinical evaluation with our vector vaccine based on modified vaccinia virus Ankara (MVA) against the Middle East respiratory syndrome coronavirus (MERS-CoV), which causes an infection in humans similar to SARS and COVID-19. Here, we describe the construction and preclinical characterization of a recombinant MVA expressing full-length SARS-CoV-2 spike (S) protein (MVA-SARS-2-S). Genetic stability and growth characteristics of MVA-SARS-2-S, plus its robust expression of S protein as antigen, make it a suitable candidate vaccine for industrial-scale production. Vaccinated mice produced S-specific CD8+ T cells and serum antibodies binding to S protein that neutralized SARS-CoV-2. Prime-boost vaccination with MVA-SARS-2-S protected mice sensitized with a human ACE2-expressing adenovirus from SARS-CoV-2 infection. MVA-SARS-2-S is currently being investigated in a phase I clinical trial as aspirant for developing a safe and efficacious vaccine against COVID-19.


Asunto(s)
Anticuerpos Neutralizantes/inmunología , Anticuerpos Antivirales/inmunología , Vacunas contra la COVID-19/inmunología , COVID-19/prevención & control , Glicoproteína de la Espiga del Coronavirus/inmunología , Animales , Vacunas contra la COVID-19/normas , Relación Dosis-Respuesta Inmunológica , Humanos , Ratones , Ratones Endogámicos BALB C , SARS-CoV-2 , Glicoproteína de la Espiga del Coronavirus/genética , Linfocitos T , Vacunación , Virus Vaccinia
16.
Nat Rev Microbiol ; 19(7): 409-424, 2021 07.
Artículo en Inglés | MEDLINE | ID: mdl-34075212

RESUMEN

Although most mutations in the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) genome are expected to be either deleterious and swiftly purged or relatively neutral, a small proportion will affect functional properties and may alter infectivity, disease severity or interactions with host immunity. The emergence of SARS-CoV-2 in late 2019 was followed by a period of relative evolutionary stasis lasting about 11 months. Since late 2020, however, SARS-CoV-2 evolution has been characterized by the emergence of sets of mutations, in the context of 'variants of concern', that impact virus characteristics, including transmissibility and antigenicity, probably in response to the changing immune profile of the human population. There is emerging evidence of reduced neutralization of some SARS-CoV-2 variants by postvaccination serum; however, a greater understanding of correlates of protection is required to evaluate how this may impact vaccine effectiveness. Nonetheless, manufacturers are preparing platforms for a possible update of vaccine sequences, and it is crucial that surveillance of genetic and antigenic changes in the global virus population is done alongside experiments to elucidate the phenotypic impacts of mutations. In this Review, we summarize the literature on mutations of the SARS-CoV-2 spike protein, the primary antigen, focusing on their impacts on antigenicity and contextualizing them in the protein structure, and discuss them in the context of observed mutation frequencies in global sequence datasets.


Asunto(s)
COVID-19/virología , Evasión Inmune , SARS-CoV-2/genética , SARS-CoV-2/inmunología , Glicoproteína de la Espiga del Coronavirus/clasificación , Aminoácidos/química , Aminoácidos/genética , Variación Antigénica/genética , Variación Antigénica/fisiología , COVID-19/inmunología , COVID-19/prevención & control , COVID-19/transmisión , Vacunas contra la COVID-19/inmunología , Vacunas contra la COVID-19/normas , Epítopos/química , Epítopos/genética , Epítopos/inmunología , Humanos , Evasión Inmune/genética , Mutación , Conformación Proteica , SARS-CoV-2/clasificación , Glicoproteína de la Espiga del Coronavirus/química , Glicoproteína de la Espiga del Coronavirus/genética , Glicoproteína de la Espiga del Coronavirus/inmunología
17.
Indian J Med Ethics ; VI(1): 1-5, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-34080997

RESUMEN

The Covid-19 pandemic is raging, taking heavy toll of lives and livelihoods. The need for safe and effective vaccine(s) is urgent. Vaccine research has progressed rapidly and a few vaccine candidates have passed trial Phases 1 and 2, confirming reasonable safety and immunogenicity parameters. They are ready for large scale Phase 3 trials to quantify protective efficacy, if any, and to detect uncommon but serious adverse effects, if any. These developments present unprecedented opportunities and challenges, scientific and ethical. Globally hundreds die every day due to Covid-19, and emergency/compassionate use of vaccine candidates that are ready for Phase 3 trials are likely to save lives. We perceive an ethical imperative to allow such vaccination for those at high risk of death and voluntarily make such informed choice - for them protection delayed will be tantamount to protection denied.


Asunto(s)
Investigación Biomédica/ética , Investigación Biomédica/normas , Vacunas contra la COVID-19/normas , COVID-19/prevención & control , Pandemias/prevención & control , Vacunación/ética , Vacunación/normas , Humanos , India , Guías de Práctica Clínica como Asunto , SARS-CoV-2 , Factores de Tiempo
19.
Eur J Epidemiol ; 36(7): 709-714, 2021 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-34037927

RESUMEN

Vaccine hesitancy is a global health threat which may hinder the widespread acceptance of several COVID-19 vaccines. Following the collection of 2470 responses from an anonymous questionnaire distributed between October and November 2020 across Israel, we analyzed the responses of physicians, life science graduates (biology, virology, chemistry, etc.), and the general public to whether they would obtain a COVID-19 vaccine with particular vaccine characteristics such as vaccine country of origin, technology, side effect profile, efficacy, and other attributes. Physicians and life science graduates were least likely to accept a vaccine based on mRNA technology (30%) while the general population seemed to adopt any vaccine technology if the declared efficacy is above 90% and the country of manufacturing is the USA/UK rather than China or Russia. However, current inoculation rates in Israel far outpace our predicted rate. Our results highlight the importance of tailored vaccine educational campaigns based on population demographic details and specific vaccine concerns.


Asunto(s)
Vacunas contra la COVID-19 , Aceptación de la Atención de Salud/psicología , Negativa a la Vacunación/psicología , Actitud del Personal de Salud , Vacunas contra la COVID-19/efectos adversos , Vacunas contra la COVID-19/genética , Vacunas contra la COVID-19/normas , Certificación , China , Información de Salud al Consumidor , Humanos , Israel , Vacunación Masiva , Aceptación de la Atención de Salud/estadística & datos numéricos , ARN Mensajero , Federación de Rusia , Encuestas y Cuestionarios , Reino Unido , Estados Unidos , Negativa a la Vacunación/estadística & datos numéricos
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