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Mwaka wega wega denda refuruwenza rinokonzera pakati pe290,000 ne650,000 kufa kwezvirwere zvekufema pasi rose gore rega rega. Nyika iri kusangana nedenda refuruwenza munguva ino yechando mushure mekupera kwedenda reCOVID-19. Influenza vaccine ndiyo inonyanya kushanda nzira yekudzivirira furuwenza, asi tsika dzechivanhu furuwenza yakavakirwa pahuku embryo tsika ine zvimwe zvinokanganisa, senge immunogenic variation, kuganhurwa kwekugadzira uye zvichingodaro.

Kuuya kwe recombinant HA protein gene engineering furuwenza vaccine inogona kugadzirisa hurema hwechinyakare huku embryo vaccine. Parizvino, American Advisory Committee on Immunisation Practices (ACIP) inokurudzira mushonga wepamusoro-dose recombinant furuwenza yevakuru ≥65 yemakore. Zvisinei, kuvanhu vari pasi pemakore makumi matanhatu nemashanu ekuberekwa, ACIP haikurudziri chero zera rekudzivirira furuwenza sechinhu chakakosha nekuda kwekushaikwa kwekuenzanisa kwemusoro kune-musoro pakati pemhando dzakasiyana dzejekiseni.

The quadrivalent recombinant hemagglutinin (HA) genetically engineered furue vaccine (RIV4) yakatenderwa kutengeswa munyika dzakati wandei kubvira 2016 uye pari zvino ndiyo yakajairika recombinant yekudzivirira furuwenza iri kushandiswa. RIV4 inogadzirwa uchishandisa recombinant protein tekinoroji papuratifomu, iyo inogona kukurira kushomeka kwechinyakare inactivated kugadzirwa kwejekiseni inogumira nekupihwa kwehuku embryo. Zvakare, iyi puratifomu ine ipfupi yekugadzira kutenderera, inonyanya kubatsira kutsiva panguva yeanomirira vaccine strains, uye inogona kudzivirira shanduko dzekuchinja dzinogona kuitika mukugadzirwa kwehutachiwana hwehutachiwana hunogona kukanganisa kudzivirira kweakapera vaccine. Karen Midthun, aive director weCenter for Biologics Ongororo uye Tsvagiridzo kuUS Food and Drug Administration (FDA), akataura kuti "kuuya kwemishonga yefuruwenza inomiririra kufambira mberi kwehunyanzvi mukugadzirwa kwejekiseni refuruwenza ... Pamusoro pezvo, RIV4 ine hemagglutinin protein yakapetwa katatu pane yakajairwa dosi yefuruwenza vaccine, ine simba rekudzivirira muviri [2]. Zvidzidzo zvavepo zvakaratidza kuti RIV4 inodzivirira kupfuura iyo yakajairwa-dose yekudzivirira furuwenza muvakuru vakuru, uye humbowo hwakakwana hunodiwa kuenzanisa vaviri muvanhu vadiki.

Musi waZvita 14, 2023, New England Journal of Medicine (NEJM) yakaburitsa Chidzidzo chakaitwa naAmber Hsiao et al., Kaiser Permanente Vaccine Study Center, KPNC Health System, Oakland, USA. Chidzidzo ichi chidzidzo chepasi rose chakashandisa nzira yakasarudzika yehuwandu yekuongorora kudzivirira kweRIV4 maringe nequadrivalent standard-dose inactivated influenza vaccine (SD-IIV4) muvanhu vari pasi pemakore makumi matanhatu neshanu mumwaka miviri yefuruwenza kubva 2018 kusvika 2020.

Zvichienderana nenzvimbo yebasa uye saizi yenzvimbo yezvivakwa zveKPNC, vakapihwa zvisina tsarukano kuboka A kana Boka B (Mufananidzo 1), uko boka A rakagamuchira RIV4 muvhiki rekutanga, Boka B rakawana SD-IIV4 musvondo rekutanga, uyezve nzvimbo yega yega yakagamuchira majekiseni maviri aya pavhiki kusvika pakupera kwemwaka wefuruwenza. Mhedzisiro yekutanga yechidzidzo yaive PCR-yakasimbiswa nyaya dzefuruwenza, uye magumo ekupedzisira aisanganisira furuwenza A, furuwenza B, uye zvipatara zvine chekuita nefuruwenza. Vanachiremba panzvimbo yega yega vanoita bvunzo dzefuruwenza PCR pakuda kwavo, zvichibva pakuratidzwa kwekiriniki kwemurwere, uye vanowana kuongororwa kwevarwere vepachipatara nevekunze, kuongororwa murabhoritari, uye ruzivo rwekudzivirira kuburikidza nemagetsi zvinyorwa zvekurapa.

Chidzidzo ichi chaisanganisira vanhu vakuru vane makore 18 kusvika kumakore 64, vane makore 50 kusvika 64 vari veboka rezera rekutanga rinoongororwa. Mhedzisiro yacho yakaratidza kuti hukama hwekudzivirira (rVE) hweRIV4 ichienzaniswa neSD-IIV4 inopesana nePCR-yakasimbiswa furuwenza yaive 15.3% (95% CI, 5.9-23.8) muvanhu vane makore makumi mashanu kusvika makumi matanhatu nemana. Kudzivirirwa kunopesana nefuruwenza A yaive 15.7% (95% CI, 6.0-24.5). Hapana mhedzisiro yakakosha yekudzivirira yakaratidzwa pafuruwenza B kana kuchipatara zvine chekuita nefuruwenza. Mukuwedzera, kuongorora kwekuongorora kwakaratidza kuti muvanhu vane makore 18-49 makore, zvose zvefuruwenza (rVE, 10.8%; 95% CI, 6.6-14.7) kana furuwenza A (rVE, 10.2%; 95% CI, 1.4-18.2), RIV4-18.2 yakaratidza kudzivirira zviri nani kupfuura RIV4.

Yakapfuura isina kurongeka, yakapetwa kaviri-mapofu, yakanaka-inodzorwa inoshanda yekiriniki kuyedza yakaratidza kuti RIV4 yaive nedziviriro iri nani pane SD-IIV4 muvanhu 50 makore uye kupfuura (rVE, 30%; 95% CI, 10 ~ 47) [3]. Chidzidzo ichi chinoratidza zvakare kuburikidza nehukuru-chaiyo-chaiyo data yepasirese kuti majekiseni efuruwenza anopa dziviriro iri nani pane echinyakare isingashandiswe majekiseni, uye inozadzisa humbowo hwekuti RIV4 inopawo dziviriro iri nani muvanhu vadiki. Chidzidzo ichi chakaongorora chiitiko chechirwere chekufema syncytial virus (RSV) mumapoka maviri (RSV utachiona hunofanirwa kuenzaniswa mumapoka maviri nekuti jekiseni yefuruwenza haidziviriri utachiona hweRSV), isingabatanidzi zvimwe zvinovhiringidza, uye yakasimbisa kusimba kwemhedzisiro kuburikidza nekuongorora kwakawanda kwekunzwa.

Boka risingaverengeki dhizaini nzira yakagamuchirwa muchidzidzo chino, kunyanya kubaiwa kwejekiseni rekuyedza uye jekiseni rekudzora pasvondo rega rega, rinogadzirisa zvirinani zvinhu zvinovhiringa pakati pemapoka maviri aya. Nekudaro, nekuda kwekuoma kwedhizaini, izvo zvinodiwa pakuitwa kwekutsvaga zvakakwirira. Muchidzidzo ichi, kusakwana kwejekiseni refuruwenza recombinant kwakakonzera kuti vanhu vakawanda vaifanira kunge vakagamuchira RIV4 vachiwana SD-IIV4, zvichikonzera mutsauko mukuru pahuwandu hwevatori vechikamu pakati pemapoka maviri aya uye njodzi inogona kuitika yekurerekera divi rimwe chete. Pamusoro pezvo, chidzidzo ichi chakatanga kurongwa kuti chiitwe kubva muna 2018 kusvika 2021, uye kubuda kweCCIDID-19 nekudzivirira kwayo nekudzora matanho kwakanganisa kudzidza uye kusimba kwedenda refuruwenza, kusanganisira kupfupikiswa kwemwaka wefuruwenza wa2019-2020 uye kusavapo kwemwaka wefuruwenza wa2019-2020. Dhata kubva mumwaka miviri chete "yakashata" yefuruwenza kubva 2018 kusvika 2020 iripo, saka tsvakiridzo yakawanda inodiwa kuti uone kana zvakawanikwa izvi zvakabata mumwaka wakawanda, madhiri anotenderera akasiyana uye zvikamu zvekudzivirira.

Zvese mune zvese, chidzidzo ichi chinoratidzazve kugona kwejekiseni remajenetiki rakagadzirwazve rinoshandiswa mumunda wemishonga yekudzivirira furuwenza, uye zvakare inoisa hwaro hwakasimba hwehunyanzvi hwetsvakiridzo yeramangwana nekuvandudzwa kwemishonga yefuruwenza. Iyo recombinant genetic engineering vaccine tekinoroji papuratifomu haitsamiri pahuku embryos, uye ine zvakanakira zvepfupi kugadzirwa kutenderera uye yakakwirira kugadzirwa kugadzikana. Zvisinei, kana zvichienzaniswa nemishonga yefuruwenza yagara isingashandiswi, haina pundutso inokosha mukudzivirira, uye zvakaoma kugadzirisa kudzivirirwa kwekudzivirira kwezvirwere kunokonzerwa nehutachiona hwefuruwenza hwakanyanya kubva kune chikonzero. Zvakafanana nemajekiseni efuruwenza echinyakare, kufanotaura kwekutambudzika uye kutsiva antigen kunodiwa gore rega rega.

Pamberi pezvakasiyana-siyana zvefuruwenza, tinofanira kuramba tichicherechedza kugadzirwa kwemishonga yekudzivirira furuwenza mune ramangwana. Kuvandudzwa kwemushonga wepasi rose wekudzivirira furuwenza kunofanira kuwedzera zvishoma nezvishoma chiyero chekudzivirira kubva kuhutachiwana hwehutachiwana, uye pakupedzisira kuwana dziviriro inoshanda kubva kune ese madhiri mumakore akasiyana. Nokudaro, tinofanira kuramba tichikurudzira kugadzirwa kwehupamhi hwehutachiona hwehutachiona hunobva paHA protein mune ramangwana, tarisa ku NA, imwe puroteni yepamusoro yehutachiona hwefuruwenza, sechinhu chinokosha chekudzivirira, uye kutarisa nzira dzekudzivirira tekinoroji yekufema iyo inonyanya kubatsira mukukonzera mhinduro dzakawanda dzekudzivirira dzinosanganisira masero emunharaunda (zvakadai semushonga wemhuno wepoda, inhalable, inhalable). Ramba uchisimudzira tsvakiridzo yeMRNA vaccines, vaccine yevatakuri, maadjuvants matsva uye mamwe mapuratifomu ehunyanzvi, uye ziva kuvandudzwa kwemishonga yekudzivirira furuwenza "inopindura kune shanduko dzese pasina shanduko"