突破性感染

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突破性感染(英語:breakthrough infection)是指接种疫苗完成后,接种者感染疫苗所应免疫的疾病的现象。出现突破性感染的原因是疫苗没能让接种者与对应病原体产生免疫流行性腮腺炎[1]水痘[2]流感[3]SARS-CoV-2[4]等病原体对应的疫苗均曾出现突破性感染的情况。突破性感染的具体症状取决于病毒本身的情况。通常,突破性感染患者的症状要比普通感染患者的要轻一些[5]

突破性感染发生的原因包括疫苗储存或施打不当,病毒突变,以及抗体遮断英语Blocking antibody。由于这些原因,一种疫苗的效力很少能达到100%。常见的流感疫苗大约能为58%的接种者提供免疫[6];约有2%接种麻疹疫苗的儿童无法获得免疫效果。然而如果群体免疫已经产生,也能防止免疫获得不充分的接种者感染疾病[7]。换句话说,群体免疫可以降低人群中突破性感染的发生概率。[8]

2021年4月,美国疾控中心报告称,美国7500万COVID-19疫苗完全接种者中共发现5814例COVID-19突破性感染病例,包含74例死亡病例。[9][10][11][12][13][14]

突破性感染案例[编辑]

水痘[编辑]

水痘疫苗预防水痘的有效率约为85%。[15]发生突破性感染的病例中,75%感染者的症状较未接种疫苗的感染者更轻微[5],例如低烧及少于50个水泡;而未接种疫苗的患者通常有39 °C(102 °F)的高烧以及200-500个水疱。[5][16] 未接种疫苗者的感染时间亦长于突破性感染患者。[5]

大部分水痘的突破性感染病例是由于未能有效接种疫苗。[15] 因此,有人提议儿童接种者在第一针接种后一年内接种第二针水痘疫苗。[15]

腮腺炎[编辑]

腮腺炎疫苗是麻腮风三联疫苗(MMR)的成分之一[17],有效率约为88%。[18]突破性感染患者中的严重病例较未接种疫苗的患者更少[19],包括无菌性脑膜炎脑炎[19]

腮腺炎突破性感染的原因尚未查明。病毒基因的变化(抗原漂移)被认为是主要诱因[19];也有理论认为记忆T细胞在突破性感染中起一定作用。[19]

乙型肝炎[编辑]

乙型肝炎的突破性感染主要由于乙型肝炎病毒(HBV)突变引起的表面蛋白构象改变,以至于不能被乙肝疫苗诱导生成的抗体识别。[20][21][22]该现象又被称为“免疫逃逸”。乙肝突破性感染亦有可能是由于疫苗接种不及时,免疫抑制,以及母婴传播。[21]乙型肝炎的突破性感染病例可能为无症状感染。[20]

COVID-19[编辑]

2021年4月,研究人员报告在417名COVID-19疫苗接种者中,有两名女性出现了突破性感染,并确认了变异的病毒。[23][24]

参考资料[编辑]

  1. ^ Factsheet for health professionals. ecdc.europa.eu. [2017-02-24]. (原始内容存档于2017-02-24) (英语). 
  2. ^ Clinical Overview | Varicella | CDC. www.cdc.gov. [2017-02-24] (英语). 
  3. ^ Health Professionals | Seasonal Influenza (Flu). www.cdc.gov. [2017-02-24] (英语). 
  4. ^ 白宫:美国一半成年人口已完成新冠疫苗接种. news.sina.com.cn. 澎湃新闻. 2021-05-26 [2021-06-11]. 
  5. ^ 5.0 5.1 5.2 5.3 Chickenpox (Varicella). Center for Disease Control and Prevention. 2016-07-01. 
  6. ^ Osterholm, Michael T; Kelley, Nicholas S; Sommer, Alfred; Belongia, Edward A. Efficacy and effectiveness of influenza vaccines: a systematic review and meta-analysis. The Lancet Infectious Diseases. 2012, 12 (1): 36–44. PMID 22032844. doi:10.1016/s1473-3099(11)70295-x. 
  7. ^ Fine, P.; Eames, K.; Heymann, D. L. "Herd Immunity": A Rough Guide. Clinical Infectious Diseases. 2011-04-01, 52 (7): 911–916. ISSN 1058-4838. PMID 21427399. doi:10.1093/cid/cir007可免费使用 (英语). 
  8. ^ Owen, Judith; Punt, Jenni; Stranford, Sharon. Kuby Immunology 7th. New York City, New York: W.H. Freeman and Company. 2013: 576–578. ISBN 978-14292-1919-8. 
  9. ^ Gilbert, Ben; Brubeck, Hilary. CDC: 5,800 COVID-19 infections, 74 deaths in the more than 75 million fully vaccinated people. Business Insider. 15 April 2021 [18 April 2021]. 
  10. ^ Krieger, Lisa M. COVID vaccines: The mystery of “breakthrough” infections after shots - CDC reports 5,800 COVID-19 infections, 74 deaths in fully vaccinated people. The Mercury News. 15 April 2021 [18 April 2021]. 
  11. ^ Tinker, Ben; Fox, Maggie. CDC reports 5,800 COVID-19 infections, 74 deaths in fully vaccinated people. Orange County Register英语Orange County Register. 15 April 2021 [18 April 2021]. 
  12. ^ Masson, Gabrielle. 5,800 COVID-19 infections detected among 77 million fully vaccinated people: CDC. Beckers Hospital Review. 15 April 2021 [18 April 2021]. 
  13. ^ May, Brandon. COVID-19 Infection After Vaccine is Rare But Possible, CDC Says. BioSpace. 15 April 2021 [18 April 2021]. 
  14. ^ Whelan, Robbie. CDC Identifies Small Group of Covid-19 Infections Among Fully Vaccinated Patients - Incidence is rare, occurring in only 0.008% of cases and in line with expectations. The Wall Street Journal. 15 April 2021 [18 April 2021]. 
  15. ^ 15.0 15.1 15.2 Papaloukas, Orestis; Giannouli, Georgia; Papaevangelou, Vassiliki. Successes and challenges in varicella vaccine. Therapeutic Advances in Vaccines. 2014-03-01, 2 (2): 39–55. ISSN 2051-0136. PMC 3991154. PMID 24757524. doi:10.1177/2051013613515621. 
  16. ^ Varicella | Epidemiology of Vaccine Preventable Diseases | CDC. www.cdc.gov. [2017-02-17] (英语). 
  17. ^ Factsheet for health professionals. ecdc.europa.eu. [2017-02-17]. (原始内容存档于2017-02-24) (英语). 
  18. ^ Cases and Outbreaks | CDC. www.cdc.gov. [2017-02-17] (英语). 
  19. ^ 19.0 19.1 19.2 19.3 Latner, Donald R.; Hickman, Carole J. Remembering Mumps. PLOS Pathogens. 2015-05-07, 11 (5): e1004791. ISSN 1553-7374. PMC 4423963. PMID 25951183. doi:10.1371/journal.ppat.1004791. 
  20. ^ 20.0 20.1 Seed, Clive R.; Jones, Ngaire T.; Pickworth, Anne M.; Graham, Wendy R. Two cases of asymptomatic HBV "vaccine breakthrough" infection detected in blood donors screened for HBV DNA. Medical Journal of Australia. 2012-01-01, 196 (10). ISSN 0025-729X. 
  21. ^ 21.0 21.1 Chang, Mei-Hwei. Breakthrough HBV infection in vaccinated children in Taiwan: surveillance for HBV mutants. Antiviral Therapy. 2010, 15 (3 Part B): 463–469. PMID 20516566. doi:10.3851/imp1555 (英语). 
  22. ^ Coleman, Paul F. Detecting Hepatitis B Surface Antigen Mutants. Emerging Infectious Diseases. 2017-02-17, 12 (2): 198–203. ISSN 1080-6040. PMC 3293431. PMID 16494742. doi:10.3201/eid1203.050038. 
  23. ^ Howard, Jacqueline. Only 2 'breakthrough' infections among hundreds of fully vaccinated people, new study finds. CNN. [11 May 2021]. 
  24. ^ Hacisuleyman, Ezgi; Hale, Caryn; Saito, Yuhki; Blachere, Nathalie E.; Bergh, Marissa; Conlon, Erin G.; Schaefer-Babajew, Dennis J.; DaSilva, Justin; Muecksch, Frauke; Gaebler, Christian; Lifton, Richard; Nussenzweig, Michel C.; Hatziioannou, Theodora; Bieniasz, Paul D.; Darnell, Robert B. Vaccine Breakthrough Infections with SARS-CoV-2 Variants. New England Journal of Medicine. 21 April 2021 [10 May 2021]. doi:10.1056/NEJMoa2105000可免费使用 (英语).