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1.
Expert Rev Gastroenterol Hepatol ; 15(11): 1281-1294, 2021 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-34654347

RESUMO

INTRODUCTION: Human gut microbiota plays a crucial role in providing protective responses against pathogens, particularly by regulating immune system homeostasis. There is a reciprocal interaction between the gut and lung microbiota, called the gut-lung axis (GLA). Any alteration in the gut microbiota or their metabolites can cause immune dysregulation, which can impair the antiviral activity of the immune system against respiratory viruses such as severe acute respiratory syndrome coronavirus (SARS-CoV) and SARS-CoV-2. AREAS COVERED: This narrative review mainly outlines emerging data on the mechanisms underlying the interactions between the immune system and intestinal microbial dysbiosis, which is caused by an imbalance in the levels of essential metabolites. The authors will also discuss the role of probiotics in restoring the balance of the gut microbiota and modulation of cytokine storm. EXPERT OPINION: Microbiota-derived signals regulate the immune system and protect different tissues during severe viral respiratory infections. The GLA's equilibration could help manage the mortality and morbidity rates associated with SARS-CoV-2 infection.


Assuntos
COVID-19/imunologia , Disbiose/imunologia , Microbioma Gastrointestinal/imunologia , Sistema Imunitário/imunologia , Pneumonia Viral/imunologia , Humanos , SARS-CoV-2
2.
Front Immunol ; 12: 727941, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34504501

RESUMO

Influenza A virus infection is usually associated with acute lung injury, which is typically characterized by tracheal mucosal barrier damage and an interleukin 17A (IL-17A)-mediated inflammatory response in lung tissues. Although targeting IL-17A has been proven to be beneficial for attenuating inflammation around lung cells, it still has a limited effect on pulmonary tissue recovery after influenza A virus infection. In this research, interleukin 22 (IL-22), a cytokine involved in the repair of the pulmonary mucosal barrier, was fused to the C-terminus of the anti-IL-17A antibody vunakizumab to endow the antibody with a tissue recovery function. The vunakizumab-IL22 (vmab-IL-22) fusion protein exhibits favorable stability and retains the biological activities of both the anti-IL-17A antibody and IL-22 in vitro. Mice infected with lethal H1N1 influenza A virus and treated with vmab-mIL22 showed attenuation of lung index scores and edema when compared to those of mice treated with saline or vmab or mIL22 alone. Our results also illustrate that vmab-mIL22 triggers the upregulation of MUC2 and ZO1, as well as the modulation of cytokines such as IL-1ß, HMGB1 and IL-10, indicating the recovery of pulmonary goblet cells and the suppression of excessive inflammation in mice after influenza A virus infection. Moreover, transcriptome profiling analysis suggest the downregulation of fibrosis-related genes and signaling pathways, including genes related to focal adhesion, the inflammatory response pathway, the TGF-ß signaling pathway and lung fibrosis upon vmab-mIL22 treatment, which indicates that the probable mechanism of vmab-mIL22 in ameliorating H1N1 influenza A-induced lung injury. Our results reveal that the bifunctional fusion protein vmab-mIL22 can trigger potent therapeutic effects in H1N1-infected mice by enhancing lung tissue recovery and inhibiting pulmonary inflammation, which highlights a potential approach for treating influenza A virus infection by targeting IL-17A and IL-22 simultaneously.


Assuntos
Lesão Pulmonar Aguda/tratamento farmacológico , Anticorpos Monoclonais/imunologia , Antivirais/uso terapêutico , Vírus da Influenza A Subtipo H1N1 , Interleucina-17/imunologia , Interleucinas/imunologia , Infecções por Orthomyxoviridae/tratamento farmacológico , Pneumonia Viral/tratamento farmacológico , Proteínas Recombinantes de Fusão/uso terapêutico , Lesão Pulmonar Aguda/genética , Lesão Pulmonar Aguda/imunologia , Lesão Pulmonar Aguda/patologia , Animais , Anticorpos Monoclonais/genética , Antivirais/farmacologia , Células CHO , Cricetulus , Células HT29 , Células Hep G2 , Humanos , Interleucinas/genética , Pulmão/efeitos dos fármacos , Pulmão/imunologia , Pulmão/patologia , Masculino , Camundongos Endogâmicos BALB C , Infecções por Orthomyxoviridae/genética , Infecções por Orthomyxoviridae/imunologia , Infecções por Orthomyxoviridae/patologia , Pneumonia Viral/genética , Pneumonia Viral/imunologia , Pneumonia Viral/patologia , Proteínas Recombinantes de Fusão/farmacologia , Transcriptoma/efeitos dos fármacos
3.
Cell Rep ; 37(1): 109798, 2021 10 05.
Artigo em Inglês | MEDLINE | ID: mdl-34587481

RESUMO

Despite the worldwide effect of the coronavirus disease 2019 (COVID-19) pandemic, the underlying mechanisms of fatal viral pneumonia remain elusive. Here, we show that critical COVID-19 is associated with enhanced eosinophil-mediated inflammation when compared to non-critical cases. In addition, we confirm increased T helper (Th)2-biased adaptive immune responses, accompanying overt complement activation, in the critical group. Moreover, enhanced antibody responses and complement activation are associated with disease pathogenesis as evidenced by formation of immune complexes and membrane attack complexes in airways and vasculature of lung biopsies from six fatal cases, as well as by enhanced hallmark gene set signatures of Fcγ receptor (FcγR) signaling and complement activation in myeloid cells of respiratory specimens from critical COVID-19 patients. These results suggest that SARS-CoV-2 infection may drive specific innate immune responses, including eosinophil-mediated inflammation, and subsequent pulmonary pathogenesis via enhanced Th2-biased immune responses, which might be crucial drivers of critical disease in COVID-19 patients.


Assuntos
Anticorpos Antivirais/imunologia , COVID-19/imunologia , Proteínas do Sistema Complemento/imunologia , Eosinófilos/imunologia , Inflamação/imunologia , Pneumonia Viral/imunologia , SARS-CoV-2/imunologia , Imunidade Adaptativa , Adulto , Idoso , Idoso de 80 Anos ou mais , Complexo Antígeno-Anticorpo/metabolismo , COVID-19/metabolismo , COVID-19/virologia , Ativação do Complemento , Complexo de Ataque à Membrana do Sistema Complemento/metabolismo , Eosinófilos/virologia , Feminino , Humanos , Inflamação/metabolismo , Inflamação/virologia , Lesão Pulmonar/imunologia , Lesão Pulmonar/patologia , Lesão Pulmonar/virologia , Masculino , Pessoa de Meia-Idade , Pneumonia Viral/metabolismo , Receptores de IgG/imunologia , Receptores de IgG/metabolismo , Índice de Gravidade de Doença , Transdução de Sinais , Células Th2/imunologia , Carga Viral , Adulto Jovem
4.
J Immunol ; 207(5): 1229-1238, 2021 09 01.
Artigo em Inglês | MEDLINE | ID: mdl-34348975

RESUMO

Infection with severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) or seasonal influenza may lead to respiratory failure requiring intubation and mechanical ventilation. The pathophysiology of this respiratory failure is attributed to local immune dysregulation, but how the immune response to viral infection in the lower airways of the human lung differs between individuals with respiratory failure and those without is not well understood. We used quantitative multiparameter flow cytometry and multiplex cytokine assays to evaluate matched blood and bronchoalveolar lavage (BAL) samples from control human subjects, subjects with symptomatic seasonal influenza who did not have respiratory failure, and subjects with severe seasonal influenza or SARS-CoV-2 infection with respiratory failure. We find that severe cases are associated with an influx of nonclassical monocytes, activated T cells, and plasmablast B cells into the lower airways. Cytokine concentrations were not elevated in the lower airways of moderate influenza patients compared with controls; however, 28 of 35 measured cytokines were significantly elevated in severe influenza, severe SARS-CoV-2 infection, or both. We noted the largest elevations in IL-6, IP-10, MCP-1, and IL-8. IL-1 family cytokines and RANTES were higher in severe influenza infection than severe SARS-CoV-2 infection. Interestingly, only the concentration of IP-10-correlated between blood and BAL during severe infection. Our results demonstrate inflammatory immune dysregulation in the lower airways during severe viral pneumonia that is distinct from lower airway responses seen in human patients with symptomatic, but not severe, illness and suggest that measurement of blood IP-10 concentration may predict this unique dysregulation.


Assuntos
COVID-19/imunologia , Vírus da Influenza A/fisiologia , Pneumonia Viral/imunologia , Sistema Respiratório/imunologia , SARS-CoV-2/fisiologia , Adulto , Idoso , Proteínas Sanguíneas/metabolismo , Líquido da Lavagem Broncoalveolar/imunologia , COVID-19/diagnóstico , Quimiocina CXCL10/metabolismo , Estudos de Coortes , Feminino , Humanos , Mediadores da Inflamação/metabolismo , Influenza Humana/imunologia , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Insuficiência Respiratória , Índice de Gravidade de Doença
5.
World J Pediatr ; 17(4): 375-384, 2021 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-34341947

RESUMO

BACKGROUND: Severe cases of coronavirus disease 2019 (COVID-19) among pediatric patients are more common in children less than 1 year of age. Our aim is to address the underlying role of immunity and inflammation conditions among different age groups of pediatric patients. METHODS: We recruited pediatric patients confirmed of moderate COVID-19 symptoms, admitted to Wuhan Children's Hospital from January 28th to April 1st in 2020. Patients were divided into four age groups (≤ 1, 1-6, 7-10, and 11-15 years). Demographic information, clinical characteristics, laboratory results of lymphocyte subsets test, immune and inflammation related markers were all evaluated. RESULTS: Analysis included 217/241 (90.0%) of patients with moderate clinical stage disease. Average recovery time of children more than 6 years old was significantly shorter than of children younger than 6 years (P = 0.001). Reduced neutrophils and increased lymphocytes were significantly most observed among patients under 1 year old (P < 0.01). CD19+ B cells were the only significantly elevated immune cells, especially among patients under 1 year old (cell proportion: n = 12, 30.0%, P < 0.001; cell count: n = 13, 32.5%, P < 0.001). While, low levels of immune related makers, such as immunoglobulin (Ig) G (P < 0.001), IgA (P < 0.001), IgM (P < 0.001) and serum complement C3c (P < 0.001), were also mostly found among patients under 1 year old, together with elevated levels of inflammation related markers, such as tumor necrosis factor γ (P = 0.007), interleukin (IL)-10 (P = 0.011), IL-6 (P = 0.008), lactate dehydrogenase (P < 0.001), and procalcitonin (P = 0.007). CONCLUSION: The higher rate of severe cases and long course of COVID-19 among children under 1 year old may be due to the lower production of antibodies and serum complements of in this age group.


Assuntos
COVID-19/imunologia , Pneumonia Viral/imunologia , SARS-CoV-2/imunologia , Síndrome de Resposta Inflamatória Sistêmica/imunologia , Adolescente , Biomarcadores/sangue , COVID-19/epidemiologia , Criança , Pré-Escolar , China/epidemiologia , Citocinas/imunologia , Feminino , Hospitais Pediátricos , Humanos , Lactente , Subpopulações de Linfócitos , Masculino , Pandemias , Pneumonia Viral/epidemiologia , Pneumonia Viral/virologia , Índice de Gravidade de Doença , Síndrome de Resposta Inflamatória Sistêmica/epidemiologia
6.
Biomed Res Int ; 2021: 9987931, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34423043

RESUMO

Objective: Respiratory failure is the leading cause of mortality in COVID-19 patients, characterized by a generalized disbalance of inflammation. The aim of this study was to investigate the relationship between immune-inflammatory index and mortality in PSI IV-V patients with COVID-19. Methods: We retrospectively reviewed the medical records of COVID-19 patients from Feb. to Apr. 2020 in the Zhongfa Xincheng Branch of Tongji Hospital, Wuhan, China. Patients who presented high severity of COVID-19-related pneumonia were enrolled for further analysis according to the Pneumonia Severity Index (PSI) tool. Results: A total of 101 patients diagnosed with COVID-19 were identified at initial research. The survival analysis revealed that mortality of the PSI IV-V cohort was significantly higher than the PSI I-III group (p = 0.0003). The overall mortality in PSI IV-V patients was 32.1% (9/28). The fatal cases of the PSI IV-V group had a higher level of procalcitonin (p = 0.022) and neutrophil-to-lymphocyte ratio (p = 0.033) compared with the survivors. Procalcitonin was the most sensitive predictor of mortality for the severe COVID-19 population with area under receiver operating characteristic curve of 0.78, higher than the neutrophil-to-lymphocyte ratio (0.75) and total lymphocyte (0.68) and neutrophil (0.67) counts. Conclusion: Procalcitonin and neutrophil-to-lymphocyte ratio may potentially be effective predictors for mortality in PSI IV-V patients with COVID-19. Increased procalcitonin and neutrophil-to-lymphocyte ratio were associated with greater risk of mortality.


Assuntos
COVID-19/imunologia , COVID-19/fisiopatologia , Pandemias , SARS-CoV-2 , Idoso , Idoso de 80 Anos ou mais , Biomarcadores/sangue , COVID-19/mortalidade , China/epidemiologia , Estudos de Coortes , Feminino , Humanos , Inflamação/imunologia , Inflamação/fisiopatologia , Linfócitos/imunologia , Masculino , Pessoa de Meia-Idade , Neutrófilos/imunologia , Pneumonia Viral/imunologia , Pneumonia Viral/mortalidade , Pneumonia Viral/fisiopatologia , Pró-Calcitonina/sangue , Prognóstico , Estudos Retrospectivos , Fatores de Risco , Índice de Gravidade de Doença , Análise de Sobrevida
7.
FASEB J ; 35(9): e21801, 2021 09.
Artigo em Inglês | MEDLINE | ID: mdl-34365657

RESUMO

The spike protein of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) plays a crucial role in mediating viral entry into host cells. However, whether it contributes to pulmonary hyperinflammation in patients with coronavirus disease 2019 is not well known. In this study, we developed a spike protein-pseudotyped (Spp) lentivirus with the proper tropism of the SARS-CoV-2 spike protein on the surface and determined the distribution of the Spp lentivirus in wild-type C57BL/6J male mice that received an intravenous injection of the virus. Lentiviruses with vesicular stomatitis virus glycoprotein (VSV-G) or with a deletion of the receptor-binding domain (RBD) in the spike protein [Spp (∆RBD)] were used as controls. Two hours postinfection (hpi), there were 27-75 times more viral burden from Spp lentivirus in the lungs than in other organs; there were also about 3-5 times more viral burden from Spp lentivirus than from VSV-G lentivirus in the lungs, liver, kidney, and spleen. Deletion of RBD diminished viral loads in the lungs but not in the heart. Acute pneumonia was observed in animals 24 hpi. Spp lentivirus was mainly found in SPC+ and LDLR+ pneumocytes and macrophages in the lungs. IL6, IL10, CD80, and PPAR-γ were quickly upregulated in response to infection in the lungs as well as in macrophage-like RAW264.7 cells. Furthermore, forced expression of the spike protein in RAW264.7 cells significantly increased the mRNA levels of the same panel of inflammatory factors. Our results demonstrated that the spike protein of SARS-CoV-2 confers the main point of viral entry into the lungs and can induce cellular pathology. Our data also indicate that an alternative ACE2-independent viral entry pathway may be recruited in the heart and aorta.


Assuntos
Macrófagos/imunologia , Pneumonia Viral/imunologia , Pneumonia Viral/patologia , Glicoproteína da Espícula de Coronavírus/imunologia , Doença Aguda , Células Epiteliais Alveolares/virologia , Animais , Antígeno B7-1 , Linhagem Celular , Mediadores da Inflamação , Interleucina-10 , Interleucina-6 , Lentivirus/genética , Lentivirus/isolamento & purificação , Lentivirus/metabolismo , Pulmão/imunologia , Pulmão/patologia , Pulmão/virologia , Macrófagos/virologia , Masculino , Glicoproteínas de Membrana , Camundongos , Camundongos Endogâmicos C57BL , PPAR gama , Células RAW 264.7 , Glicoproteína da Espícula de Coronavírus/química , Glicoproteína da Espícula de Coronavírus/genética , Glicoproteína da Espícula de Coronavírus/metabolismo , Proteínas do Envelope Viral
8.
J Clin Invest ; 131(14)2021 07 15.
Artigo em Inglês | MEDLINE | ID: mdl-34263736

RESUMO

The coronavirus disease 2019 (COVID-19) pandemic is among the most important public health crises of our generation. Despite the promise of prevention offered by effective vaccines, patients with severe COVID-19 will continue to populate hospitals and intensive care units for the foreseeable future. The most common clinical presentation of severe COVID-19 is hypoxemia and respiratory failure, typical of the acute respiratory distress syndrome (ARDS). Whether the clinical features and pathobiology of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pneumonia differ from those of pneumonia secondary to other pathogens is unclear. This uncertainty has created variability in the application of historically proven therapies for ARDS to patients with COVID-19. We review the available literature and find many similarities between patients with ARDS from pneumonia attributable to SARS-CoV-2 versus other respiratory pathogens. A notable exception is the long duration of illness among patients with COVID-19, which could result from its unique pathobiology. Available data support the use of care pathways and therapies proven effective for patients with ARDS, while pointing to unique features that might be therapeutically targeted for patients with severe SARS-CoV-2 pneumonia.


Assuntos
COVID-19/etiologia , Pneumonia Viral/etiologia , Síndrome do Desconforto Respiratório/etiologia , SARS-CoV-2 , Enzima de Conversão de Angiotensina 2/fisiologia , Autopsia , COVID-19/epidemiologia , COVID-19/patologia , Citocinas/biossíntese , Humanos , Pulmão/imunologia , Pulmão/patologia , Pulmão/virologia , Macrófagos Alveolares/imunologia , Macrófagos Alveolares/virologia , Modelos Biológicos , Pandemias , Pneumonia Viral/imunologia , Pneumonia Viral/patologia , Receptores Virais/fisiologia , Síndrome do Desconforto Respiratório/imunologia , Síndrome do Desconforto Respiratório/patologia , SARS-CoV-2/imunologia , SARS-CoV-2/patogenicidade , SARS-CoV-2/fisiologia , Índice de Gravidade de Doença
9.
Toxicol Appl Pharmacol ; 426: 115645, 2021 09 01.
Artigo em Inglês | MEDLINE | ID: mdl-34271066

RESUMO

Elevated ambient temperatures and extreme weather events have increased the incidence of wildfires world-wide resulting in increased wood smoke particle (WSP). Epidemiologic data suggests that WSP exposure associates with exacerbations of respiratory diseases, and with increased respiratory viral infections. To assess the impact of WSP exposure on host response to viral pneumonia, we performed WSP exposures in rodents followed by infection with mouse adapted influenza (HINI-PR8). C57BL/6 male mice aged 6-8 weeks were challenged with WSP or PBS by oropharyngeal aspiration in acute (single dose) or sub-acute exposures (day 1, 3, 5, 7 and 10). Additional groups underwent sub-acute exposure followed by infection by influenza or heat-inactivated (HI) virus. Following exposures/infection, bronchoalveolar lavage (BAL) was performed to assess for total cell counts/differentials, total protein, protein carbonyls and hyaluronan. Lung tissue was assessed for viral counts by real time PCR. When compared to PBS, acute WSP exposure associated with an increase in airspace macrophages. Alternatively, sub-acute exposure resulted in a dose dependent increase in airspace neutrophils. Sub-acute WSP exposure followed by influenza infection was associated with improved respiratory viral outcomes including reduced weight loss and increased blood oxygen saturation, and decreased protein carbonyls and viral titers. Flow cytometry demonstrated dynamic changes in pulmonary macrophage and T cell subsets based on challenge with WSP and influenza. This data suggests that sub-acute WSP exposure can improve host response to acute influenza infection.


Assuntos
Vírus da Influenza A Subtipo H1N1 , Infecções por Orthomyxoviridae , Pneumonia Viral , Fumaça , Incêndios Florestais , Administração por Inalação , Animais , Vírus da Influenza A Subtipo H1N1/fisiologia , Pulmão/imunologia , Pulmão/metabolismo , Pulmão/virologia , Macrófagos/imunologia , Masculino , Camundongos , Camundongos Endogâmicos C57BL , Infecções por Orthomyxoviridae/imunologia , Infecções por Orthomyxoviridae/metabolismo , Infecções por Orthomyxoviridae/virologia , Pneumonia Viral/imunologia , Pneumonia Viral/metabolismo , Pneumonia Viral/virologia , Índice de Gravidade de Doença , Transcriptoma , Replicação Viral , Madeira
10.
Recurso na Internet em Português | LIS - Localizador de Informação em Saúde | ID: lis-48256

RESUMO

O estudo liderado pela pesquisadora do Instituto de Ciências Biológicas da UFJF, Rossana Melo, foi selecionado entre sete projetos brasileiros que serão financiados pelo Fundo de Pesquisa Lemann Harvard Brazil 2021. O objetivo da proposta contemplada é investigar os papéis desempenhados pelos eosinófilos no combate à infecção causada pela Covid-19 no corpo humano. Os eosinófilos são um tipo de leucócito, células responsáveis pela defesa do sistema imunológico humano que agem diretamente contra os mais diversos agentes infecciosos. Como os processos agressivos da doença provocada pela Covid-19 ainda são desconhecidos pela ciência, a pesquisa explora se os eosinófilos têm papel principal no combate à replicação do vírus no corpo.


Assuntos
Infecções por Coronavirus/imunologia , Pneumonia Viral/imunologia , Eosinófilos/imunologia , Pesquisa em Sistemas de Saúde Pública
11.
Medicine (Baltimore) ; 100(25): e26446, 2021 Jun 25.
Artigo em Inglês | MEDLINE | ID: mdl-34160438

RESUMO

RATIONALE: Viruses are the most common pathogens that can cause infection-related non-recurrent death after transplantation, occurring mostly from the early stages of hematopoietic stem cell transplantation (HSCT) to within 1 year after transplantation. Human coronavirus (HCoV)-NL63 is a coronavirus that could cause mortality among patients with underlying disease complications. Serological tests are of limited diagnostic value in immunocompromised hosts and cases of latent infection reactivation. In contrast, macro-genomic high-throughput (DNA and RNA) sequencing allows for rapid and accurate diagnosis of infecting pathogens for targeted treatment. PATIENT CONCERNS: In this report, we describe a patient who exhibited acute B-lymphocytic leukemia and developed complicated pulmonary HCoV-NL63 infection after a second allogeneic HSCT (allo-HSCT). Six months after the second allo-HSCT, he developed sudden-onset hyperthermia and cough with decreased oxygen saturation. Chest computed tomography (CT) suggested bilateral multiple rounded ground-glass opacities with the pulmonary lobules as units. DIAGNOSES: HCoV-NL63 was detected by metagenomic next-generation sequencing (NGS), and HCoV-NL63 viral pneumonia was diagnosed. INTERVENTIONS: The treatment was mainly based on the use of antiviral therapy, hormone administration, and gamma-globulin. OUTCOMES: After the therapy, the body temperature returned to normal, the chest CT findings had improved on review, and the viral copy number eventually became negative. LESSONS: The latest NGS is an effective method for early infection diagnosis. The HCoV-NL63 virus can cause inflammatory factor storm and alter the neutrophil-to-lymphocyte ratio (NLR). This case suggests that the patient's NLR and cytokine levels could be monitored during the clinical treatment to assess the disease and its treatment outcome in a timely manner.


Assuntos
Infecções por Coronavirus/diagnóstico , Coronavirus Humano NL63/isolamento & purificação , Transplante de Células-Tronco Hematopoéticas/efeitos adversos , Leucemia de Células B/terapia , Pneumonia Viral/diagnóstico , Antivirais/administração & dosagem , Infecções por Coronavirus/tratamento farmacológico , Infecções por Coronavirus/imunologia , Infecções por Coronavirus/virologia , Coronavirus Humano NL63/genética , Coronavirus Humano NL63/imunologia , Quimioterapia Combinada/métodos , Sequenciamento de Nucleotídeos em Larga Escala , Humanos , Hospedeiro Imunocomprometido , Leucemia de Células B/imunologia , Pulmão/diagnóstico por imagem , Masculino , Metagenômica , Pneumonia Viral/tratamento farmacológico , Pneumonia Viral/imunologia , Pneumonia Viral/virologia , Tomografia Computadorizada por Raios X , Transplante Homólogo/efeitos adversos , Adulto Jovem , gama-Globulinas/administração & dosagem
13.
MEDICC Rev ; 23(2): 42, 2021 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-33974614

RESUMO

INTRODUCTION: Advanced age and chronic disease comorbidities are indicators of poor prognosis in COVID-19 clinical progression. Fatal outcomes in patients with these characteristics are due to a dysfunctional immune response. Understanding COVID-19's immunopathogenesis helps in designing strategies to prevent and mitigate complications during treatment. OBJECTIVE: Describe the main immunopathogenic alterations of COVID-19 in patients of advanced age or with chronic non-communicable diseases. DATA ACQUISITION: We carried out a bibliographic search of primary references in PubMed, Elsevier, Science Direct and SciELO. A total of 270 articles met our initial search criteria. Duplicate articles or those unrelated to at least one chronic comorbidity, senescence or inflammation and those that studied only patient clinical characteristics, laboratory tests or treatments were excluded. Finally, our selection included 124 articles for analysis: 10 meta-analyses, 24 original research articles, 67 review articles, 9 editorials, 9 comments, 3 books and 2 websites. DEVELOPMENT: Hypertension and diabetes mellitus are the most common comorbidities in COVID-19 patients. Risk of developing severe manifestations of the disease, including death, is increased in senescent and obese patients and those with cardiovascular disease, cancer or chronic obstructive pulmonary disease. Low-grade chronic inflammation is characteristic of all these conditions, reflected in a pro-inflammatory state, endothelial dysfunction, and changes to innate immunity; mainly of the monocyte-macrophage system with changes in polarization, inflammation, cytotoxicity and altered antigenic presentation. In the case of SARS-CoV-2 infection, mechanisms involved in acute inflammation overlap with the patient's pro-inflammatory state, causing immune system dysfunction. SARS-CoV-2 infection amplifies already-existing alterations, causing failures in the immune system's control mechanisms. The resulting cytokine storm causes an uncontrolled systemic inflammatory response marked by high serum levels of inflammatory biomarkers and a pro-inflammatory cytokine profile with decompensation of underlying diseases. In asthma, chronic eosinophilic inflammation protects against infection by producing a reduced interferon-mediated response and a reduced number of ACE2 receptors. CONCLUSIONS: Low-grade chronic inflammation present in advanced age and chronic diseases-but not in bronchial asthma-produces a pro-inflammatory state that triggers a dysregulated immune response, favoring development of severe forms of COVID-19 and increasing lethality.


Assuntos
COVID-19/imunologia , Inflamação/imunologia , Pneumonia Viral/imunologia , Fatores Etários , COVID-19/patologia , Doença Crônica , Comorbidade , Síndrome da Liberação de Citocina/imunologia , Síndrome da Liberação de Citocina/patologia , Humanos , Inflamação/patologia , Pneumonia Viral/patologia , Fatores de Risco , SARS-CoV-2
14.
J Evid Based Med ; 14(2): 123-138, 2021 May.
Artigo em Inglês | MEDLINE | ID: mdl-34003571

RESUMO

Exposure to air pollutants has been associated with respiratory viral infections. Epidemiological studies have shown that air pollution exposure is related to increased cases of SARS-COV-2 infection and COVID-19-associated mortality. In addition, the changes of meteorological parameters have also been implicated in the occurrence and development of COVID-19. However, the molecular mechanisms by which pollutant exposure and changes of meteorological parameters affects COVID-19 remains unknown. This review summarizes the biology of COVID-19 and the route of viral transmission, and elaborates on the relationship between air pollution and climate indicators and COVID-19. Finally, we envisaged the potential roles of air pollution and meteorological parameters in COVID-19.


Assuntos
Poluentes Atmosféricos/efeitos adversos , Poluição do Ar/efeitos adversos , COVID-19/imunologia , Pneumonia Viral/imunologia , Tempo (Meteorologia) , COVID-19/epidemiologia , Humanos , Pandemias , Material Particulado/efeitos adversos , Pneumonia Viral/epidemiologia , Fatores de Risco , SARS-CoV-2
15.
Curr Opin Microbiol ; 62: 21-27, 2021 08.
Artigo em Inglês | MEDLINE | ID: mdl-34034082

RESUMO

The occurrence of invasive pulmonary aspergillosis (IPA) in critically ill patients with viral pneumonitis has increasingly been reported in recent years. Influenza-associated pulmonary aspergillosis (IAPA) and COVID-19-associated pulmonary aspergillosis (CAPA) are the two most common forms of this fungal infection. These diseases cause high mortality in patients, most of whom were previously immunocompetent. The pathogenesis of IAPA and CAPA is still not fully understood, but involves viral, fungal and host factors. In this article, we discuss several aspects regarding IAPA and CAPA, including their possible pathogenesis, the use of immunotherapy, and future challenges.


Assuntos
COVID-19/complicações , Influenza Humana/complicações , Aspergilose Pulmonar Invasiva/etiologia , Pneumonia Viral/complicações , COVID-19/imunologia , Estado Terminal , Humanos , Imunoterapia , Influenza Humana/imunologia , Aspergilose Pulmonar Invasiva/imunologia , Aspergilose Pulmonar Invasiva/patologia , Aspergilose Pulmonar Invasiva/terapia , Pneumonia Viral/imunologia
17.
Multimedia | Recursos Multimídia | ID: multimedia-8841

RESUMO

O Governador João Doria anunciou nesta quarta-feira (28) que o Instituto Butantan começou a produzir hoje o primeiro lote de 18 milhões de doses da Butanvac, primeira vacina nacional contra o coronavírus. Este será o primeiro imunizante do tipo fabricado integralmente no país, sem a necessidade de importação da matéria-prima, como ocorre atualmente. “Nesta primeira etapa, o Butantan vai produzir 18 milhões de doses da vacina pronta para o uso já na primeira quinzena de junho, assim que o processo de aprovação da Anvisa for concluído. Essa produção vai alcançar 40 milhões de doses. Mas a capacidade de produção da fábrica do Butantan seguramente é para 100 milhões de doses até o final deste ano. No ritmo que o Butantan tem trabalhado, se houver velocidade na aprovação da Anvisa, ainda neste ano o Butantan poderá produzir até 150 milhões de doses da Butanvac”, afirmou Doria. O primeiro lote de 520 mil ovos chegou ao complexo fabril do Butantan e imediatamente foi enviado às incubadoras para transferência e inoculação do vírus. A partir da próxima semana, após período de incubação em ambiente isolado, estão previstas as etapas de colheita do líquido alantóico, clarificação, concentração, purificação e inativação do vírus para a obtenção do IFA (Insumo Farmacêutico Ativo). As fases seguintes, com cronograma ainda a definir, serão o envase e o processo de inspeção de qualidade. Outros cinco lotes com mesma quantidade de ovos do primeiro deverão chegar ao Instituto Butantan até a próxima semana para os processos de produção da matéria-prima, totalizando cerca de 6 milhões de doses em IFA até o dia 18 de maio. A tecnologia para obtenção do IFA da Butanvac, largamente dominada pelo Butantan, já está disponível na fábrica de vacinas contra a gripe do instituto, e usa o cultivo de cepas em ovos de galinha, que gera doses de vacinas inativadas, feitas com fragmentos de vírus mortos. A Butanvac utiliza o vírus da Doença de Newcastle geneticamente modificado, desenvolvido por cientistas norte-americanos na Icahn School of Medicine at Mount Sinai, em Nova Iorque (EUA). O vetor viral contém a proteína Spike do coronavírus de forma íntegra. O desenvolvimento complementar da vacina será com tecnologia do Butantan, incluindo a multiplicação do vírus, condições de cultivo, ingredientes, adaptação dos ovos, conservação, purificação, inativação do vírus, escalonamento de doses e outras etapas. A Doença de Newcastle é uma infecção que afeta aves e, por isso, o vírus se desenvolve bem em ovos embrionados, permitindo eficiência produtiva num processo similar ao utilizado na vacina de Influenza. O vírus da doença de Newcastle não causa sintomas em seres humanos, constituindo-se como alternativa muito segura na produção. Ele é inativado para a formulação da vacina, facilitando sua estabilidade e deixando o imunizante ainda mais seguro. A iniciativa do novo imunizante faz parte de um consórcio internacional do qual o Instituto Butantan é o principal produtor, responsável por 85% da capacidade total, e tem o compromisso de fornecer essa vacina ao Brasil e aos países de baixa e média renda. O Instituto Butantan enviou na última sexta-feira (23) à Anvisa o protocolo de estudo clínico da Butanvac. Assim que autorizados pelo órgão regulador nacional, os estudos de fase 1 e 2 em humanos começarão imediatamente, com 1,8 mil voluntários. A fase 3, com maior escala de participantes, deverá incluir 9 mil pessoas. Em 26 de março o Butantan já havia encaminhado para a Anvisa o Dossiê de Desenvolvimento Clínico de Medicamento, contendo informações sobre a nova vacina. Desde então, técnicos do instituto e do órgão regulador vêm mantendo estreito contato. Os estudos da Butanvac deverão ser conduzidos em um processo muito rápido, a partir de comparativo de respostas vacinais em relação a ensaios clínicos já realizados. Por isso o Butantan espera ter em breve a autorização para os testes. Os ensaios clínicos da nova vacina deverão durar cerca de 20 semanas. Serão feitos com voluntários adultos a partir de 18 anos de idade. Tanto quem já tomou a vacina quanto quem já teve COVID-19 poderão ser incluídos nos testes. A produção-piloto do composto da vacina já foi finalizada para aplicação em voluntários humanos durante os testes.


Assuntos
Betacoronavirus/imunologia , Infecções por Coronavirus/imunologia , Pneumonia Viral/imunologia , Vacinas Virais/provisão & distribuição , Pandemias/prevenção & controle , Programas de Imunização/organização & administração , Institutos Governamentais de Pesquisa , Número de Leitos em Hospital/estatística & dados numéricos , Unidades de Terapia Intensiva/estatística & dados numéricos , Monitoramento Epidemiológico , Sistemas Locais de Saúde/organização & administração , Quarentena/organização & administração , Comércio/organização & administração , Isolamento Social
18.
Multimedia | Recursos Multimídia | ID: multimedia-8785

RESUMO

0:00:34 CL Hello, good day and welcome to... wherever you are listening to us today from [sic]. It's Monday 19th April 2021. My name is Christian Lindmeier and I'm welcoming you to today's global COVID-19 press conference. The press conference today is on COVID updates with a special focus on the linkages between the climate and the COVID-19 crisis and the role of youth in the response ahead of Earth Day, which is 22nd April, and the first Global Youth Summit organised as part of the global youth mobilisation, which is 23rd to 25th April. Today's press conference will include three special guests and I'm happy to welcome Greta Thunberg, Climate and Environmental Activist, Elahi Rawshan from Bangladesh, volunteer in the International Federation of the Red Cross and Red Crescent Society, supporting young people in Bangladesh, and Daisy Moran from the USA, Global Youth Mobilisation Youth Board Member and World YMCA Representative. Welcome to the three of you. We will have simultaneous interpretation as usual provided in the six official UN languages, Arabic, Chinese, French, English, Spanish and Russian, plus Portuguese and Hindi. Now let me introduce the participants here in the room. Present in the room are Dr Tedros Adhanom Ghebreyesus, WHO Director-General, Dr Maria Van Kerkhove, Technical Lead on COVID-19, Dr Bruce Aylward, Special Advisor to the Director-General and the Lead on the ACT Accelerator. We have Mr Anil Suni, Chief Executive Officer from the WHO Foundation and we have Dr Maria Nera, Director for Health and Environment. We also have joining us remotely today Dr Mike Ryan, Executive Director for the Health Emergencies Programme of WHO, and Dr Mariangela Simao, Assistant Director-General for Access to Medicines and Health Products. With this let me hand over to the Director-General for the introductory remarks. Dr Tedros, the floor is yours. Thank you. Thank you, Christian. Good morning, good afternoon and good evening. Last week new cases of COVID-19 increased for the eighth week in a row with more than 5.2 million cases reported, the most in a single week so far. Deaths rose for the fifth straight week and more than three million deaths have now been reported to WHO. It took nine months to reach one million deaths, four months to reach two million and three months to reach three million deaths. Big numbers can make us numb but each one of these deaths is a tragedy for families, communities and nations. Infections and hospitalisations among people aged 25 to 59 are increasing at an alarming rate, possibly as a result of highly transmissible variants and increased social mixing among younger adults. 00:04:28 Today the emergency committee gave me its advice on vaccines, variants, international travel and other issues. Its full statement is available on our website. We have the tools to bring this pandemic under control in a matter of months if we apply them consistently and equitably. On Friday WHO issued an expression of interest for establishing a COVID-19 technology transfer hub for MRNA vaccines to increase production of those vaccines in low and middle-income countries. We're calling for the original manufacturers of MRNA vaccines to contribute their technology and know-how and for manufacturers in low and middle-income countries to express interest in receiving that technology. We have seen incredible innovation in science. Now we need innovation to ensure as many people as possible benefit from that science. The pandemic will recede but we will still be left with all the other challenges that we had before including the climate crisis. 00:05:58 This week marks Earth Day on 22nd April, a reminder that human health depends on the health of the planet that sustains us. COVID-19 has now killed more than three million people. Air pollution kills more than double that number, seven million people every single year. Despite temporary improvements in air quality last year as a result of so-called lock-downs by September air pollution had returned to pre-pandemic levels. Globally CO2 emissions only decreased by less than 6% last year but by December they had rebounded to their previous levels. The health argument for climate action is crystal-clear. The same unsustainable choices that are killing our planet are killing people. There is no vaccine for climate change but we do have solutions. Last year WHO published our manifesto for a healthy and green recovery, calling on all governments to protect nature, support clean energy sources, develop sustainable food systems and healthier cities and reduce polluting activities. 00:07:36 Together the six prescriptions of the WHO manifesto can not only restore resilient economies; they are a linchpin and essential prerequisite for healthy societies. At the COP26 climate conference in Glasgow this year WHO will deliver a special report with recommendations on how to maximise the health benefits of tackling climate change while avoiding the worst health impacts of the climate crisis. WHO is also spearheading an initiative on promoting climate-resistant health systems in collaboration with the Government of the United Kingdom. Today it's my honour to welcome someone who needs no introduction. Over the past few years Greta Thunberg has become the powerful voice of a young generation demanding climate action. Greta's mobilisation of communities, particularly young people, has been truly inspirational and has brought into sharp focus the impact of the climate crisis on people's lives and the urgent need for transformative action. The awareness she has raised on the links between climate, the environment and health has supported WHO's agenda in these areas, demonstrated the threats all of us face and the role young people can play in building a more sustainable, safer, healthier world. 00:09:33 More recently she has become a powerful advocate for vaccine equity. Tack så mycket, Greta. Today Greta has announced a donation of €100,000 from the Greta Thunberg Foundation to the WHO Foundation in support of COVAX to provide vaccines to people in need. Greta, thank you, tack så mycket for your superb advocacy for climate action and now for vaccine equity. Your contribution makes you the youngest person to contribute to COVAX. Welcome and you have the floor. GT Thank you so much for having me. It is an honour to participate in this event and I will talk briefly now. Science shows that in the future we will most likely experience more frequent and more devastating pandemics unless we drastically change our ways and the way we treat nature. Today up to 75% of all emerging diseases come from animals and as we are cutting down forests and destroying habitats we are creating the ideal conditions for diseases to spill over from one animal to another and then to us. 00:11:08 We can no longer separate the health crisis from the ecological crisis and we cannot separate the ecological crisis from the climate crisis. It's all interlinked in many ways. During this pandemic we have seen what we can achieve when we put resources into science. Vaccines were developed in record time but so far on average one in four people in high-income countries have received a coronavirus vaccine compared with just one in over 500 in low and middle-income countries. The international community, governments and vaccine developers must step up their game and address the tragedy that is vaccine inequity. We have the tools we need to correct this great imbalance that exists around the world today in the fight against COVID-19. Just as with the climate crisis those who are the most vulnerable need to be prioritised and global problems require global solutions. It is completely unethical that high-income countries are now vaccinating young and healthy people if that happens at the expense of people in risk groups and on the front lines in low and middle-income countries. This is a moral test. We talk today about showing solidarity and yet vaccine nationalism is what's running the vaccine distribution. It is only when it really comes down to it that we show our true face and that is why I and many others are supporting WHO, GAVI and all involved in the COVAX initiative, which I believe offers the best path forward to ensure a more equitable global vaccine distribution and a way out of this pandemic. Thank you. 00:13:04 TAG Thank you. Thank you so much, Greta, and thank you for your generosity in donating to the WHO Foundation in support of COVAX. These funds will help us save lives. Around the world young people have been affected by the pandemic in many ways from disruptions in education, loss of employment opportunities, mental health challenges and increased domestic and gender-based violence. WHO is committed to ensuring that the global recovery from COVID-19 includes the voices, energy and ideas of young people. To do that we have partnered with an alliance of the six largest youth development organisations in the world to form the Global Youth Mobilisation, to empower young people to respond to the challenges created by the pandemic in their local communities. 00:14:08 The Global Youth Mobilisation has established a grant mechanism with funds from the Solidarity Response Fund to support innovative local solutions to address the impact of the COVID-19 pandemic. From today young people around the world will be able to apply for grants of between 500 and US$5,000 through the Global Youth Mobilisation. These local solutions will be judged and decided on by young people for young people. To mark the starting point for young people to get involved in the Global Youth Mobilisation a Global Youth Summit will be held virtually from this Friday to Sunday, 23rd to 25th April. Over three days thousands of young people, leaders, policymakers and change-makers will come together in one space to discuss the issues facing young people across the world. On behalf of the Big Six youth organisations, the United Nations Foundation and WHO I invite everyone to join us at the Global Youth Summit. Today I'm delighted to be joined by representatives from two of the Big Six organisations. First it's my honour to welcome Elahi Rawshan, a volunteer with the International Federation of the Red Cross and Red Crescent Societies in Bangladesh. Elahi, thank you for joining us today. You have the floor. 00:16:05 ER Thank you, Dr Tedros, for inviting me here today. I'm really honoured to be here. My name is Elahi Rawshan. I'm a Red Cross/Red Crescent youth volunteer living in Bangladesh. There are about three million young people around the world how have been taking action to respond to the COVID-19 pandemic, driving the response efforts and supporting their local communities. I'd like to share with you my story to help explain why recognising, championing and investing in young people through the Global Youth Mobilisation is important. I led the very first disinfection team of Bangladesh Red Crescent Society in different hospitals for two consecutive months. At the beginning of the pandemic here the hospitals needed more supporting hands and we wanted to make sure the hospital environment was safe for everyone and we did to a great extent. One day when the very first COVID patient died in a hospital and everyone was so frightened to go near him, even his own son was reluctant to take his father's body. We went in, we disinfected the room and made sure the body was safe for carrying. 00:17:31 Another day I carried a critical COVID patient on a wheelchair and put an oxygen mask on her when there was no-one around for the support of that person. But I was not the only one; there are thousands of young people in Bangladesh fighting this battle in many different forms. About 4,500 young volunteers of the Red Crescent Society are supporting the vaccination programme every day in Bangladesh. It's mostly the young people here who are making a difference and again it's the young people here who are mostly infected by the pandemic. Many of my friends, colleagues from the different youth organisations and networks have lost their jobs. Almost everyone here is suffering from mental health issues. The data shows that from March 2020 to February 2021 more than 14,000 have committed suicide, which is 45% higher than the previous year and the majority of them are young people. 00:18:44 My dear friends, I have seen localised action making a positive impact on people's lives during this pandemic. I have been trying to collaborate with the Red Crescent Society with my workplace [unclear] who have been offering an online skills programme for the young people. Now as both parties have agreed the Red Crescent youth volunteers will receive a three-month online skills training on different trades like graphics designing, web development, etc. I believe drives like this will help young people individually and at the same time will contribute to the national economy. There are plenty of organisations and individuals out there who are making many more new initiatives to combat this COVID crisis and I would like to invite them all to collaborate with the Global Youth Mobilisation and it will support, promote and invest in your initiatives for improving more lives and communities. Thank you. TAG Thank you. Thank you so much, Elahi. Next it's my pleasure to introduce Daisy Moran, a representative of the World YMCA and a board member of the Global Youth Mobilisation. Daisy, thank you for joining us and you have the floor. 00:20:16 DM Thank you for giving me this opportunity, Dr Tedros, and greetings to you all. I'm Daisy Moran, proud to be with the YMCA in Illinois, USA and proud to be one of the six youth board representatives of the Global Youth Mobilisation. Here's what youth mobilisation has meant for me as the COVID pandemic has significantly increased the inequities in all of our societies. As a young leader I saw a need in my community to offer relief to essential workers who are undocumented immigrants. Through collaboration with fellow young change-makers and organisations we were able to disburse almost $17,000 in relief funds for 38 families. This is just one of thousands of stories that illustrate the simple and powerful fact; when given access and opportunities young people can make a significant difference. In the YMCA and right across the Big Six youth organisations young people have stepped up during the pandemic by delivering supplies to vulnerable people, looking after each other's mental health, making masks, helping share vital public information and now actively facilitating the COVID vaccine campaign. 00:21:35 As the global pandemic enters the recovery and relief period it is crystal-clear that young people are disproportionately impacted by the immediate and long-term implications of disruption in education, employment opportunities, physical and mental health/well-being, to name a few. These two reasons - young people bearing the brunt of the impact of COVID and young people offering so many of the solutions - are what has inspired the Big Six organisations, the World Health Organization and the United Nations Foundation to support young people around the would in delivering and developing youth-led community solutions through the Global Youth mobilisation. I am so excited and I want young people all over the world to be excited and get involved. They can start by attending the Global Youth Summit, which will be held virtually from 23rd to 25th April. At the summit they will hear about the role of young people in the immediate and long-term COVID recovery. It's a great forum where we can share our thoughts, passions, ideas that will influence policies and decisions that impact all of our lives. 00:22:47 This is a critical time for my generation, for our generation to bring policymakers, change-makers, advocate together to address the major challenges confronting young people by solutions and put them into action in our communities. No matter how big or how small I encourage you to have the confidence to apply for funding. If you have an idea to a challenge created by the pandemic you can apply for funding from $500 to $5,000. It is young people like you and me who will evaluate and agree who gets support for these local solutions. So please visit our website, www.globalyouthmobilisation.org We are the movement by youth, for youth and young people really are the answer. We are not the challenge. We are truly being the change that we want to see in the world. Thank you. TAG Thank you. Thank you so much, Daisy - by youth, for youth - and thank you to both of you for your leadership and vision. I look forward to joining both of you at the World Youth Summit and I look forward to seeing what ideas we can help take forward through the Global Youth Mobilisation. This is a reminder that although we're all living through a dark time there are also many reasons for hope and optimism about the future. Christian, back to you. 00:24:24 CL Thank you very much, all, and thank you very much, Dr Tedros. We will start the round of questions and answers. To remind you, if you want to get into the queue for questions please press the raise your hand icon on your screen. We'll start with the first question from Carlos from El Mundo. Carlos, please unmute yourself. CA Hi. CL Go ahead, please. CA It's a question specifically for Greta. Isn't there a risk that the COP26 will lose its momentum? What should we change in the next three months for example to turn the tide and to put the two goals of climate change and vaccination equality on the same level? CL Thank you very much, Carlos. Yes, Greta Thunberg, please. 00:25:27 GT Of course there's a risk that COP will lose momentum but the most important thing is that everyone is safe and of course safety and health come first in these kinds of situations. Of course there's not just one thing that needs to change in order to break this trend that we are seeing now, there's not just one single thing that we can do to - so-called - solve the climate crisis and the vaccine inequity crisis. Of course it's a bit more complicated than that and I think I may not be the best person to answer that. I think there are lots of experts who are more suited for that question but we do need to change our mindsets, we do need to think globally and not only think about ourselves. That's what these crises come down to, that we only think about ourselves, that we don't think about others. They come down to the way we treat others, the way we treat other human beings, the way we treat other animals and nature itself so we need to change our mindsets, if you want one single thing; it's more complicated than but just one thing. CL Thank you very much, Greta. I'll ask Dr Maria Neira from WHO to add, possibly. 00:26:56 MN Thank you, Christian, and thank you very much, Greta. It's really a pleasure to have you with us. You are an inspiration. You have been driving an incredible movement and many people are behind so certainly the COP26 has to be something very successful. In response to your question, Carlos - hola - I think what will change the mindset and what might have an incredible impact is what the Director-General was saying at the beginning, the health argument of climate change. If we are able to explain to people that climate change is about our health, it is affecting our health and if we stop burning fossil fuels the benefits will be enormous in terms of reducing the process of climate change but as well on reducing air pollution. Air pollution, as mentioned again by the Director-General, is responsible for more than seven million premature deaths every year due to exposure to air pollution and in addition to that it creates an environment that makes our health more vulnerable and creates the perfect conditions for more emerging infectious diseases to occur. 00:28:12 So I think we have a perfect case here for creating more action at the COP26, giving the health benefits that can be obtained in an incredible way. If we tackle the causes of air pollution, if we tackle the causes of climate change that will be an enormous health agenda and talking about health is what can make this change that we all need in terms of ambition to go for more at [?] the COP and in convincing people. If we tell people that this is connected to human health I think this will be the final argument that will create much more motivation and engagement and probably a stronger movement to put political pressure on those who will take decisions and hopefully going for much more. Thank you. CL Thank you very much. This was Dr Maria Neira, Director for Environment, Climate Change and Health. The next question goes to Shoko Koyama from NHK. Shoko, please unmute yourself. SH Hello. Can you hear me? CL Go ahead, please. SH Thank you for taking my question. Regarding COVAX, UNICEF is trying to buy one billion syringes by the end of this year in order to distribute to countries together with vaccines. 00:29:37 One billion syringes in addition to the six to 800 million syringes they procure annually seems to be a large quantity. Is COVAX able to procure this huge number of syringes by the end of this year and what challenges are there regarding the procurement of syringes? Thank you. CL Thank you very much, Shoko. I'll give it to Dr Bruce Aylward. BA Thank you very much, Shoko, for the question and thanks for highlighting that it takes more to get the world vaccinated than simply to make and procure the vaccines because there are all the additional pieces that have to go into this including additional supplies like not just syringes, which you mentioned, but also the vaccination cold chains and other supplies that are necessary to keep them in the right conditions before we get them to the actual people who need to be vaccinated. 00:30:38 In terms of the syringes, just like the cold chain equipment the COVAX facility began working with countries way back in October or even earlier last year to look at what numbers of syringes would be required and to start working with manufactures to ensure that pipeline would be there. You might remember some months ago the Director-General invited Henrietta Fore, who is the Executive Director of UNICEF, to join one of these press conferences and at that time she explained what they were already doing to try and make sure that the necessary syringes would be in place. This will continue to be a challenge, just like all of the supplies necessary to get the world vaccinated, these extraordinary numbers but for the moment the pipelines are there and the producers are doing their part. But it all comes back again also to the COVAX facility having the resources it needs so that it can put the contracts in place up-front to make sure the supplies are there, not just the supplies in terms of the vaccines but, exactly as you highlight, the syringes and the other supplies including, as I mentioned, the cold chain equipment and sometimes very specialised cold chain equipment to get these products to people. 00:31:57 CL Thank you very much, Dr Aylward. We'll move on to Robin Mia from AFP. Robin, please unmute yourself. RO Thank you. A question for Greta, if I may. If vaccine inequity carries on and young people start being offered a vaccine in wealthy countries whilst at the same time elderly and wealthy people remain completely unprotected in poor countries, would you advocate a vaccine strike amongst younger people in rich countries until their governments start sharing more vaccines? Thank you. CL Thank you very much, Robin. Of course, Greta, the floor is yours. GT We must not forget that this is not a problem that is caused by individuals. This is a problem that needs to be addressed by the international community, governments and the vaccine developers. It is wrong; if we should start focusing on individuals and urging individuals not to take the vaccine that would send a very wrong message. 00:33:00 Of course everyone who is offered a vaccine should take it but we need to see the bigger picture here and be able to focus on several things at once. So no, I would not advocate for people not to take the vaccine. CL Thank you so much for that. We'll move to Jamil Chad from O Estado de Sao Paulo. Jamil, please unmute yourself. Jamil, do you hear us? Please unmute yourself. JA Can you hear me, Christian? CL Please go ahead. JA Can you hear me? CL Yes. JA Thank you. This is Jamil Chad, a journalist from Brazil. Ms Greta Thunberg, my question is about vaccines but also on climate change. What is your message to President Bolsonaro at this time when both the pandemic is hitting Brazil hard but also climate change is an issue? You'll note very well what is the position of President Bolsonaro. What is the message you can send him today? Thank you. CL Thank you so much, Jamil. Over to Greta. 00:34:24 GT Of course I don't think we should be focusing on talking about individuals since this is a much larger problem but of course Jair Bolsonaro has a huge responsibility both when it comes to the climate, environment and of course we can see the response that Brazil has had during the corona pandemic. I can only speak for myself but I can safely say that he has failed to take the responsibility that is necessary in order to safeguard present and future living conditions for humanity. CL Thank you very much, Greta. We'll move on to Navas Shah from Xinhua. Navas, please unmute yourself. Navas Shah, do you hear us? Please unmute yourself. It looks as if we're not getting to you so we will continue with Gunila Van Hal from Svenska Dagbladet. Gunila, please unmute yourself. GU Can you hear me? CL Wonderful. Go ahead. GU Thanks for taking my question. It is to Greta Thunberg and I'd like to know your view on the proposal from WHO and many governments, among those your own, the Swedish Government, that richer countries should donate remaining vaccine doses to poorer countries once their own risk groups have been vaccinated and before they vaccinate the rest of the population. 00:36:06 What do you think about this and what do you respond to people questioning this, saying, why should we sacrifice our own populations in order to save the world? Thank you. CL Thank you, Gunila. Over to Greta, please. GT I think that is a very reasonable thing to do. We need to protect and prioritise the most vulnerable people in risk groups and working on the front lines, no matter which countries they come from; at least that's my opinion. Of course I understand that people will be frustrated by that. Of course I also want to return to everyday life and everyone I know wants to do that as well but we need to act in solidarity and we need to use common sense when it comes to these issues. As I said, the only sensible thing to do, the only morally right thing to do is to prioritise the people who are the most vulnerable no matter whether they live in a high-income country or a low-income country. 00:37:23 CL Thank you very much, Ms Thunberg. We'll move ahead to Jamie Keaton from AP. Jamie, please unmute yourself. JM Thank you, Christian. My question is both for Ms Thunberg and Ms Moran. What is your message to young people who have become a major driver of COVID-19 infection? We heard the Director-General, Dr Tedros, just mention that increased social mixing among younger adults is possibly one of the reasons for the increase in infections and hospitalisations among people aged 25 to 59. If I could just sneak in a another question to Ms Thunberg, ahead of President Biden's climate summit what do you hope it will achieve? Thank you. CL No small questions today. Thank you very much, Jamie. Let's move to Greta Thunberg first and then on. Thank you. GT Yes, of course it's absolutely crucial that everyone takes our personal responsibility in this crisis. We young people may be the ones who are in general least affected by the virus in a direct way but of course, as I said, we need to act in solidarity with the people in risk groups. 00:38:57 Of course many young people fail to draw that connection maybe; of course not everyone but of course there will always be some. My message to those is that during crises like these we need to take a few steps back and act for the greater good of society and in order to protect our fellow citizens and of course especially people in risk groups because that is the thing you do during crises; you step up for one another. My hopes for the Biden summit; I hope that we will soon in one way or another start treating this crisis like a crisis - the climate crisis, that is - because if we are to be blunt, we can have as many summits as we want, we can have as many meetings and conferences as we want and make nice speeches and nice pledges like next year or 2050 and so on. But as long as those things contain so many loopholes as they do and as long as we are not actually treating the crisis as a crisis of course we won't be able to achieve any major changes. As I mentioned earlier, we need to change our mindsets and we need to change or view of the world. We cannot try to solve this crisis with the same approach that got us into it in the first place so we need to start treating the crisis like a crisis. 00:40:40 Without an increased level of awareness among people in general of course there will be no pressure on world leaders to actually start making the changes that are necessary to safeguard humanity so my hope is that we will start treating the crisis like a crisis. CL Thank you so much, Greta. Let me first give the floor to Daisy Moran from the global youth organisation [unclear]. Daisy. DM Thank you and thank you for your question. I believe my generation, our generation that we are representing is a generation of allyship because we understand our privilege and how to use our privileges to uplift those in the most vulnerable situations. The Global Youth Summit is a platform and a forum for all of youth and stakeholders and supporters to come together to really listen to what are the policy changes that need to be made so that we can have more equitable societies and systems in place. So I hope that you can join us this weekend while we discuss the important issues and challenges facing our generation and how our youth leaders are in a position to create the most innovative solutions to tackle these big issues. Thank you. 00:41:59 CL Thanks so much, Daisy. Now we'll move to Dr Maria Van Kerkhove. MK Thanks, Christian. Those were excellent answers but I did want to clarify something here with regard to increased transmission. We are seeing increased rates of infection across all age groups. Last week there were 5.2 million cases reported to WHO globally, the largest in a single week since this pandemic began, 16 months into the pandemic. That is the largest increase in a week that we have seen to date. We've seen an increase across all age groups. We need to take the blame away and in the question it was meant to blame and we can't do that. Everyone has a role to play in this pandemic. We all have a role to play in keeping ourselves and our loved ones safe. What we are seeing is a slight age shift in some countries driven by social mixing and social mixing doesn't necessarily mean going out and having a party. It means individuals who have to leave their home to go to work, it means individuals have to feed their families and if you increase social mixing for a variety of reasons, whether this is for work or for religious reasons or indeed socialising itself the virus will take advantage of that. 00:43:18 If you add on top of it these variants of concern, variants that are circulating around the world, particularly the B117 variant which is circulating in a large number of countries across the globe that have increased transmissibility; if you add variants that have increased transmissibility with increased mixing this virus will take off and case numbers will increase. In a number of countries we've seen a very, very steep incline due to this. In addition to that we are seeing some countries not able to implement the public health and social measures that are needed to allow for physical distancing and in many parts of the world physical distancing is really not possible but in other parts of the world it is. So we need to do what we can to avoid those crowded settings, avoid those settings where social mixing - particularly indoor, crowded settings where there's poor ventilation, where the virus really likes to spread efficiently between individuals. 00:44:18 We need governments to enable people to carry out those measures; very easy for us to say stay home if you can but we need governments to support individuals to work from home, to stay home if necessary so that we can reduce the possibility for the virus to spread. All of us really have a role to play. Youth, young people, children, young adults are showing us ways in which to be innovative, to remain socially connected yet physically distant. I think what we are seeing with the youth and this youth mobilisation is really energetic. There's a spirit, there's an energy here that is holding leaders accountable and saying, help us help the situation and I'm really inspired to see that. I was really happy to hear the by youth, for youth as you pointed out and showing us that young people, young adults, children can make a significant difference every day. So please let's stop the blame in terms of who is spreading. All of us have a role to play, all of us need to be supported in taking those individual-level measures as well as measures at the family, at the community, at the sub-national, at the international level. 00:45:30 CL Thanks so much, Dr Van Kerkhove. We have Dr Mike Ryan, WHO Health Emergencies Executive Director, to add. MR Thanks, Christian. I just want to reflect on one thing that Daisy said. She said youths are not the problem, youths are the solution and I fundamentally believe in that and thank you, Daisy, for saying that and the energy from everyone today is fantastic. Reflecting on something that Greta said, she spoke about mindset and mindset is everything and Tedros reminds of that every day, I think; it's one of his most common pronouncements about mindset and it doesn't matter what problem you're trying to solve. There's no amount of announcement, there's no amount of recommendations, there's no amount of anything that changes anything until we change our mindset and that can be the mindset about protecting ourselves and our families from COVID and taking precautions. It can be the mindset on government's response to COVID. It can be the mindset driving climate action and reducing climate change. 00:46:37 So I think really we all need to reflect on that. It is our mindsets that drive our behaviour, both positive and negative and they're having a huge impact on the planet and obviously our behaviour's having a huge impact on the trajectory of this pandemic. Thank you. CL Thank you very much, Dr Ryan. The next question in line comes from Isabel Sacco from EFE. Isabel, please unmute yourself. IS Good afternoon, thank you, Christian. I would like to know if you can give us an overview of the proportion of the people under 40 years old who are in ICUs globally or by region. Connected to that, what do we know about mortality among babies? I saw figures from Brazil that indicate that 1,300 babies have died there from COVID. Thank you. CL Thank you very much, Isabel; very detailed questions. Let me give to Dr Maria Van Kerkhove first. MK Thanks for these very important questions. I cannot give you a specific answer of the proportion of those under 40 in ICU but what I can say is that there is an increasing number of hospitalisations among younger individuals and this is driven by what I answered in the last part of the question. 00:48:01 When you have increased transmissibility across all age groups you will see increased rates of hospitalisation, you will see an increased proportion of ICU and you will see increases in death. We are seeing unfortunately a little bit of a shift in the age structure in terms of the median age of individuals who are infected but that is driven by changes in social mixing patterns. If you remember, last spring, in the northern hemisphere's spring we saw a similar situation where as societies were opening up across Europe for example there was an age shift in the median age; it went from an older age group to a slightly younger age group. Again this is driven by people who are leaving their homes to go back to work and if there is the virus that is spreading, if you have virus variants this is a dangerous combination. We are seeing increases in hospitalisation among younger age groups and increased ICU and increased deaths. 00:48:55 With regard to children I did see that report that you mentioned about Brazil. Overall if we look at infection among children, if we look at severity among children still around the world there is a lower proportion of children that experience disease, that experience severe disease and some children do die. If there is a lot of virus that is circulating, if you have millions of cases being reported - and you know so far we've had 140 million cases reported worldwide - we will see deaths in all age groups. With regard to the youngest children, overall they tend to be more mild but again this is not universal. We do see that children, particularly children with underlying conditions but children in general, have died from COVID. So everyone is at risk from this virus. People are at risk of getting infected, at risk of getting severe disease so we do need to do what we can where we can as much as we can to first and foremost prevent infections but also making sure that we use the systems that are in place to get tested, to be able to carry out the public health actions that do prevent the spread from an adult to a child, from a child to an adult; everything that we can to really prevent that level of infection and care for as many people as we can, getting them early into that clinical care pathway to receive the care based on the symptoms that they have. 00:50:28 CL Thank you so much. The next question goes to Akwazi Sarpong from BBC News Africa. Akwazi, please unmute yourself. Akwazi, do you hear us? Yes, please go ahead. AK [Inaudible]. CL Akwazi, the sound is really bad. Please try one more time. AK Yes, [inaudible] in Ghana so [inaudible]. I have two questions. I would like [sound slip] many young people living with disability, particularly visual impairment, have been affected by this virus in Africa and at the global level. The second question is, what programmes are in place to support families with children and young persons with disability and special needs to help us combat this? Thank you. CL Thank you very much, Akwazi; very important questions. I'll hand to Dr Van Kerkhove for a start. 00:51:35 MK I can start. In fact we have departments that are working particularly on persons with disabilities to ensure that persons with disabilities, who are disproportionately affected by COVID-19 in a variety of ways, whether this is about getting the right care, receiving information appropriately so that they know how to keep themselves safe, making sure that they have the ability to receive the materials they need, testing, etc. We have some guidance that is coming out, I hope, today - it was approved yesterday - looking specifically at the more than one billion people worldwide who are living with disabilities, making sure that they have access to vaccination for example. We have seen some innovation in terms of personal protective equipment; if you've noticed, some of the masks for example will have a clear panel so that you can see lips moving for people who have a hearing impairment so there are a number of innovations that are coming online to support individuals with disabilities but also families with disabilities as well because even individuals with disabilities; their caretakers have to be able to care for them. So we need to make sure that those caregivers are protected against the virus as well so there're a number of activities that are underway to ensure those living with disabilities as well as those caring for those with disabilities have the appropriate care and information that they need. 00:53:05 CL Thank you very much, Dr Van Kerkhove. The next question goes to Priti Padnaik from Geneva Health Files. Priti, please unmute yourself. No, Priti lowered her hand apparently in the meantime or we don't find you any more. The next question goes to John Zaracostas from The Lancet. John, please unmute yourself. JO Good afternoon. Can you hear me there? CL Very well. Go ahead. JO I was wondering if you could give me up-to-date estimates on how many vaccine facilities worldwide with excess capacity could be enabled to produce vaccines and secondly, if possible, if Dr Tedros could give us his perspective on what's going on in his homeland where right now they're facing an existential threat. CL Thank you very much. We'll take the first question and I guess we'll see if Mariangela Simao is online... or then... SS I could start. CL Dr Swaminathan; exactly. Please go ahead. SS Thank you. Thank you very much, John, for that question. This is exactly the work that we've started now as part of the COVID vaccine manufacturing taskforce with our COVAX partners, CEPI, GAVI, UNICEF as well as the private sector and regional bodies like the African Union but also other regional organisations. The idea really is to take a short-to-medium-term and a longer-term approach. The short-term and the immediate need is to increase vaccine supplies within the next weeks and months and that can be done by unblocking roadblocks and obstacles that have been identified by the manufacturers and by working with suppliers of those critical ingredients and raw materials so that we can link suppliers and manufacturers as well as work with member states to make sure that export bans and things like that don't interfere with the process of vaccine manufacturing. That's our immediate short-term priority which hopefully will be able to put more doses for COVAX in the coming weeks. The second, more medium-term, is to look at fill and finish capacity to link... 00:55:43 We know that there's a lot of unused fill and finish capacity globally and therefore we need manufacturers who have the capacity to make bulk product and link them with these existing fill and finish capacities in facilities around the world. CEPI already has done a mapping of that and it exists. Then the third, more medium to longer-term, is really to develop new facilities that would build on existing facilities, particularly in low and middle-income countries and get technology transfer, encourage companies. As the DG mentioned, the WHO put out a call on Friday both for owners of technology, particularly MRNA technology to begin with, to come forward to work with us to share that technology, share the know-how and experience with recipient companies that will be selected according to a set of criteria that we are developing. 00:56:40 This will ensure not only supplies for this pandemic - though it may take a few months to get up and running if we start with existing facilities with some expertise - but also will help the future regional health security of regions which currently do not have any manufacturing capacity. This obviously can be extended to vaccines for many other infectious diseases. So that's what the taskforce is looking at and over the coming days we will provide much more detail. Thank you. CL Thank you so much, Dr Swaminathan. I'm calling on Dr Mike Ryan to take the other part. MR Thank you, John; important question. The situation in Tigray in Ethiopia remains very, very dire at the moment. The situation is not improving. We have unpredictable access, increasing humanitarian needs, increasing sexual violence. The response has been hindered by armed clashes throughout the region and many areas are still not receiving food or other assistance. We've got 4.5 million people affected by this crisis. 2.5 million of them have no access to services whatsoever. Half a million people have no access to food. We have a million internally displaced people in 178 sites scattered across the region being served by IOM and UNHCR. 00:58:18 We've had over 800 cases of sexual and gender-based violence reported from just five hospitals alone; that many cases. We've over 62,000 refugees who have crossed into Sudan. That safety valve is very, very difficult to manage and very difficult for us to have access from that side and to support people in the affected area. So, as I said, unpredictable access, displacement, tremendous humanitarian needs but we have 20 health partners working with us who are operational on the ground but they're only accessing about half of the... where aid is concerned. When we look at health facilities, we've done a health facilities survey throughout the region in 264 health facilities. As of now only 72 of those facilities are operational and 40 of those are only partially accessible. 19 hospitals have been completely damaged or destroyed; 15 more with major damage. There're inadequate supply chains across the board. 00:59:23 So the situation in Tigray could not be more dire, the people there could not be in more need of support and help. The situation is deteriorating. The situation is very much a massive concern on a purely humanitarian basis here. There is a health crisis on top of a humanitarian crisis. We're very concerned about malnutrition, about malaria, about cholera, measles, COVID-19 - positivity rates have been rising - and other diseases like meningitis and other diseases that will exploit malnutrition, they will exploit stress and they will exploit all of what's happening in that population. We have resumed surveillance activities but only covering about 30% of the population and again severe, acute malnutrition is a major, major issue. It is very hard to overstate the extent of the humanitarian crisis and the health crisis currently unfolding in Tigray and the WHO and the other UN agencies and NGOs are calling for unfettered humanitarian access and for military conflict and those perpetrating the conflict to remove themselves from civilian areas and those who should not be there should not be there. Thank you. CL Thank you very much. This was Dr Mike Ryan, Executive Director for WHO's Health Emergencies Programme and Dr Bruce Aylward wanted to come in too. 01:00:51 BA Thanks, Christian. I just want to come back to the important point you raised, John, about how much capacity is unused around the world right now because there was huge attention last week at the conference of the African Union on the consultation that was called by the World Trade Organization to try to expand vaccine production globally. But we need to remember that the challenge is how we're actually using the doses that are being made because last week while those conferences were taking place 100 million more doses of vaccine were administered around the world. The issue, John, is where they're being administered because 1% of that 100 million went to low-income countries so 99 million doses of vaccine last week went into high, upper-middle-income and some low-middle-income countries but only 1% of that went to the lowest-income countries. 01:01:48 So every time we bring new capacities online, when we bring new deals online, etc, that you're hearing about we need to ask the question of where those doses are going because those doses are not going to the places that have got the least vaccine today. So we need to be careful in thinking that we can simply build additional capacity because that capacity is still going to the wrong places, quite frankly. While we are giving great attention to how we expand capacity it's going to take weeks and months for that to come online and in the meantime we've got to take some urgent and important decisions about how we are going to use the vaccines that exist today because if we have a lot more weeks where 100, 99% of the vaccine goes to a set of countries that already have most of the vaccine we are not going to get out of this crisis as rapidly and efficiently and with the least lives lost possible. CL Thank you very much for all your answers. With this we're coming to the end of our question-and-answer session. I was very glad to have you all online today and our special guests and I will ask our special guests to start the closing round and we'll go in reverse order. We'll start with Daisy Moran, the Global Youth Mobilisation, Youth [Unclear] and Worldwide YMCA representative. Daisy, please go ahead. 01:03:20 DM Thank you for the opportunity once again and as a reminder, please join us this weekend on April 23rd to 25th to have your voice heard. You have the solutions; please come to the table. We want you to be involved in your local communities and we have the funds to support you. With any questions please visit our website at www.youthglobalmobilisation.org Thank you. CL Fantastic. Thanks so much. Now we go to Elahi Rawshan, volunteer from the International Federation of the Red Cross and Red Crescent Societies, supporting young people in Bangladesh. Elahi, please go ahead. ER Thank you. I would like to thank everyone for inviting me here and I would like to echo the last voice; young people are the solution and I would like to invite all the localised solutions to collaborate with the Global Youth Mobilisation, who have been supporting these local actions and promoting them. 01:04:22 So I would also like to invite everyone to join the Global Youth Summit coming up this week from 23rd to 25th. Thank you once again. CL Thank you so much, Elahi, to you. Last but not least we go to Greta Thunberg, Climate and Environmental Activist. Greta, the floor is yours. GT To be honest I don't really have anything more to add. Just take care, everyone. But also while we have media here, I really urge you to really bring awareness to this issue of vaccine inequity because you have the power to raise awareness about this. When we talk about countries like, for example, the UK and the US - just as a few examples - that they are mass-vaccinating large groups of their populations, even healthier young people, we see it from a different perspective, that we don't always see it from our Western, privileged point of view but rather that we think globally and we need to prioritise those most vulnerable first. Thank you. Take care, everyone. CL Thank you so much, Greta, for these words. Yes, there's hardly anything to add; I agree. From my side let me thank everyone and remind you that the sound files of this press briefing will be shared right afterwards today and the transcript will be available as of tomorrow. Dr Tedros. TAG Thank you. Thank you, Christian. I would like to thank our guests today, Greta, Elahi and Daisy. You have been wonderful. Thank you so much indeed. I would also like to join you in inviting everybody to join on the 23rd to 25th the Global Youth Summit, from Friday to Sunday so I look forward to seeing you there. I would also like to thank our media colleagues who have joined and see you in our upcoming presser. That will be on Friday. Thank you so much. 01:06:54


Assuntos
Infecções por Coronavirus/epidemiologia , Pneumonia Viral/epidemiologia , Pandemias/prevenção & controle , Monitoramento Epidemiológico , América/epidemiologia , Quarentena/organização & administração , Isolamento Social , Desenvolvimento Ecológico , Betacoronavirus/imunologia , Vacinas Virais/provisão & distribuição , Acesso a Medicamentos Essenciais e Tecnologias em Saúde , Infecções por Coronavirus/imunologia , Pneumonia Viral/imunologia , Mudança Climática , Doações , Equidade em Saúde , Participação Social , Betacoronavirus/genética , Infecções por Coronavirus/genética , Pneumonia Viral/genética , Mutação/genética , DNA Viral/genética , Sistemas de Saúde/organização & administração , Saúde da Pessoa com Deficiência
19.
Multimedia | Recursos Multimídia | ID: multimedia-8783

RESUMO

How much protection does the current batch of COVID-19 vaccines provide us? Would you need a booster shot for new variants? What does science and evidence tell us about mass gatherings and the spread of COVID-19? WHO’s Chief Scientist Dr Soumya Swaminathan explains in Science in 5 this week.


Assuntos
Betacoronavirus/genética , Betacoronavirus/imunologia , Pandemias/prevenção & controle , Infecções por Coronavirus/imunologia , Pneumonia Viral/imunologia , Infecções por Coronavirus/genética , Pneumonia Viral/genética , Potência de Vacina , Vacinas Virais/imunologia , Mutação/genética , DNA Viral/genética , Comunicação em Saúde
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