Shandisa ruzivo rweNEJM Boka uye masevhisi kugadzirira kuve chiremba, kuunganidza ruzivo, kutungamira sangano rehutano uye kusimudzira basa rako.
Yave nguva yekuchinja maonero edu ekunzwa kweCovid-19 bvunzo.Iyo US Chikafu neDrug Administration (FDA) uye nharaunda yesainzi parizvino yakatarisana nekutarisa kuona, iyo inoyera kugona kweimwe nzira yekuona yekuona mapuroteni ehutachiona kana mamorekuru eRNA.Zvikuru, chiyero ichi chinofuratira mamiriro ekushandisa bvunzo.Nekudaro, kana zvasvika pakutariswa kwakapararira uko United States inoda zvakanyanya, mamiriro ezvinhu akakosha.Mubvunzo wakakosha hausi kuti yakanaka sei mamorekuru anogona kuonekwa mune imwe sampuli, asi hutachiona hunogona kunyatsoonekwa muhuwandu nekushandisa zvakare bvunzo yakapihwa sechikamu chehurongwa hwese hwekuona?Kunzwa kwechirongwa chekuedza.
Zvirongwa zvekuyedza zvakajairwa zvinogona kuita serudzi rweCovid-19 sefa nekuzivisa, kupatsanura uye kusefa vanhu vane hutachiona parizvino (kusanganisira asymptomatic people).Kuyera kunzwisiswa kwechirongwa chekuyedza kana sefa kunoda kuti titarise bvunzo mumamiriro ezvinhu: kuwanda kwekushandiswa, ndiani anoshandiswa, kana achishanda panguva yehutachiona, uye kuti inoshanda here.Mibairo ichadzoserwa nenguva kudzivirira kupararira.1-3
Nzira yehutachiona hwemunhu (mutsara webhuruu) inoratidzwa mumamiriro ezvirongwa zviviri zvekuongorora (madenderedzwa) ane maonero akasiyana ekuongorora.Low analytical sensitivity assays inowanzoitwa, nepo yakakwirira analytical senitivity assays isingawanzo.Zvose zvirongwa zvekuedza zvinogona kuona hutachiona (orenji denderedzwa), asi zvisinei nekudzika kwayo kwekuongorora kunzwisiswa, chete iyo yepamusoro-frequency bvunzo inogona kuiona mukati meiyo yekuparadzira hwindo (mumvuri), iyo inoita kuti ive inoshanda sefa Chishandiso.Iyo polymerase chain reaction (PCR) yekuona hwindo (yegirini) isati yatapukirwa ipfupi kwazvo, uye hwindo rinoenderana (yepepuru) rinogona kuonekwa nePCR mushure mekutapukirwa rakareba kwazvo.
Kufunga nezvemigumisiro yekudzokorora kushandiswa ipfungwa inozivikanwa kune varapi uye masangano ekutonga;inokumbirwa pese patinoyera kushanda kwechirongwa chekurapa pane kuyera imwe chete.Nekukurumidza kusimudzira kana kudzikamiswa kwemakesi eCovid-19 pasirese, isu tinofanirwa kukurumidza kushandura pfungwa dzedu kubva kune yakamanikana kutarisa kune yekuongorora senitivity yebvunzo (iyo yakaderera muganho wekugona kwayo kuona nemazvo kusangana kwemamorekuru mumuenzaniso. ) uye bvunzo Chirongwa ichi chine chekuita nekunzwa kwekuona hutachiona (vanhu vane hutachiona vanonzwisisa mukana wekutapukirwa nenguva yekuzvisefa kubva muhuwandu uye kudzivirira kupararira kune vamwe).Muedzo wepoint-of-care, uyo wakachipa zvakakwana uye unogona kushandiswa nguva dzose, une kunzwisiswa kwakanyanya kwekuona hutachiona hunotora matanho nenguva pasina kusvika padanho rekuongorora rekutanga bvunzo (ona mufananidzo).
Iwo maedzo atinoda akasiyana zvakanyanya kubva kumakiriniki bvunzo ari kushandiswa parizvino, uye anofanirwa kuongororwa zvakasiyana.Muedzo wekiriniki wakagadzirirwa vanhu vane zviratidzo, haadi mutengo wakaderera, uye unoda yakakwirira analytical sensitivity.Chero bedzi pane mukana wekuedza, chirwere chekiriniki chechokwadi chinogona kudzorerwa.Kusiyana neizvi, bvunzo muzvirongwa zvekutarisa zvinodzikisira kuwanda kwehutachiona hwekufema muhuwandu hunofanirwa kudzorera mhinduro nekukurumidza kudzikamisa kutapurirana kweasymptomatic, uye inofanirwa kunge yakachipa zvakakwana uye iri nyore kuita kuti ibvumidze kuongororwa-kazhinji pasvondo.Kupararira kweSARS-CoV-2 kunoratidzika kunge kuchiitika mazuva mashoma mushure mekufumurwa, kana huwandu hwehutachiona hwasvika pakakwirira.4 Iyi poindi nenguva inowedzera kukosha kweiyo yakakwira yekuyedza frequency, nekuti kuyedzwa kunofanirwa kushandiswa pakutanga kwehutachiona kudzivirira kuenderera mberi kupararira uye kuderedza kukosha kwekuwana iyo yakaderera kwazvo molecular muganho wekuyedzwa kwakajairwa.
Zvinoenderana nemaitiro akati wandei, iyo benchmark yakajairwa yekiriniki polymerase chain reaction (PCR) bvunzo inokundikana kana ichishandiswa mukutarisa mapuroteni.Mushure mekuunganidzwa, PCR samples dzinowanzoda kutakurwa kuenda kurabhoritari yepakati inoumbwa nenyanzvi, iyo inowedzera mitengo, inoderedza kuwanda, uye inogona kunonoka mhedzisiro nezuva rimwe kusvika maviri.Mutengo uye kushanda nesimba kunodiwa kuyedza uchishandisa yakajairwa bvunzo zvinoreva kuti vanhu vazhinji muUS havasati vamboongororwa, uye nguva pfupi yekuchinja inoreva kuti kunyangwe nzira dzazvino dzekutarisa dzichikwanisa kuona vanhu vane hutachiona, vanogona kuparadzira hutachiona kwemazuva akati wandei.Pakutanga, izvi zvakaganhurira kukanganisa kwekuvharirwa uye kuonana nekutevera.
Centers for Disease Control and Prevention (CDC) inofungidzira kuti panosvika Chikumi 2020, huwandu hwenyaya dzeCovid-19 dzakaonekwa muUnited States huchapeta kagumi huwandu hwenyaya dzaonekwa.5 Nemamwe mazwi, kunyangwe ichitariswa, zvirongwa zvekuyedza zvemazuva ano zvinongoona kunzwisiswa kwegumi muzana zvakanyanya uye hazvigone kushandiswa seCovid sefa.
Mukuwedzera, mushure mechikamu chinotapukira, iyo RNA-positive refu muswe inotsanangurwa zvakajeka, zvinoreva kuti, kana isiri yakawanda, vanhu vakawanda vanoshandisa high analytical senitivity kuti vaone utachiona panguva yekuongorora nguva dzose, asi havachatapukirwi panguva yekuonekwa. .Kuonekwa (ona mufananidzo).2 Muchokwadi, ongororo ichangoburwa neThe New York Times yakawana kuti muMassachusetts neNew York, zvinodarika makumi mashanu muzana ezvirwere zvakawanikwa kuburikidza nePCR-based surveillance zvine PCR kutenderera kwepakati pakati pemakumi matatu kusvika makumi matatu., Kuratidza kuti hutachiona hweRNA huwandu hwakaderera.Kunyange hazvo huwandu hwakaderera hunogona kuratidza hutachiona hwekutanga kana kunonoka, kureba kwenguva refu kweRNA-positive miswe inoratidza kuti vanhu vazhinji vane hutachiona vakaonekwa mushure menguva yehutachiona.Zvakakosha kuhupfumi, zvinoreva zvakare kuti kunyangwe vakapfuura danho rekutapurirana, zviuru zvevanhu zvichiri kugariswa kwemazuva gumi mushure mebvunzo dzeRNA-positive.
Kuti tikwanise kumisa denda iri Covid sefa, tinofanirwa kuiyedza kuti igone kugonesa mhinduro inobata hutachiona hwakawanda asi ichiri kutapukira.Nhasi, bvunzo idzi dziripo nenzira yekukurumidza lateral kuyerera antigen bvunzo, uye nekukurumidza lateral kuyerera bvunzo yakavakirwa paCRISPR gene editing tekinoroji yava kuda kuoneka.Maedzo akadai akachipa zvakanyanya (<5 USD), makumi emamiriyoni kana anopfuura ebvunzo anogona kuitwa svondo rega rega, uye anogona kuitwa kumba, achivhura musuwo kune inoshanda Covid yekusefa mhinduro.Iyo lateral inoyerera antigen bvunzo haina nhanho yekusimudzira, saka yekuona kwayo muganhu ka100 kana 1000 nguva yebenchmark test, asi kana chinangwa chiri chekuziva vanhu vari kuparadzira hutachiona izvozvi, izvi hazvina basa.SARS-CoV-2 hutachiona hunogona kukura nekukurumidza mumuviri.Naizvozvo, kana benchmark PCR bvunzo mhedzisiro ikaita, hutachiona huchakura nekukasira.Panguva iyoyo, zvinogona kutora maawa pachinzvimbo chemazuva kuti hutachiona ukure uye husvike pakuonekwa kwekuchipa uye nekukurumidza kuyedza kuripo parizvino.Mushure meizvozvo, kana vanhu vawana mhedzisiro mune zvese bvunzo, vanogona kutarisirwa kutapukira (ona mufananidzo).
Isu tinotenda kuti zvirongwa zvekuongorora zvekuongorora zvinogona kucheka macheni akakwana ekutapurirana kudzikisa kutapurirana kwenharaunda zvinofanirwa kuwedzera kwete kutsiva bvunzo dzekiriniki dzazvino.Zano rekufungidzira rinogona kutora mukana weaya maedzo maviri, uchishandisa yakakura-yakakura, yakajairika, yakachipa uye nekukurumidza bvunzo kuderedza kubuda, 1-3 uchishandisa yechipiri nekukurumidza bvunzo yemapuroteni akasiyana kana kushandisa bhenji PCR bvunzo kuratidza mhedzisiro yakanaka.Mushandirapamwe wekuzivisa veruzhinji unofanirwa zvakare kuendesa chero mhando yemutemo wakashata webvunzo usingareve hutano, kuitira kukurudzira kuenderera mberi kwekudyidzana uye kupfekedzwa kwemasks.
Iyo FDA's Abbott BinaxNOW Emergency Use Authorization (EUA) mukupera kwaNyamavhuvhu inhanho munzira kwayo.Ndiyo yekutanga kukurumidza, chiridzwa-isina antigen bvunzo kuwana EUA.Nzira yekubvumirwa inosimbisa kunzwisiswa kwepamusoro kwekuedzwa, iyo inogona kuona apo vanhu vangangonyanya kuparadzira hutachiona, nokudaro kuderedza muganhu unodiwa wekutsvaga nemirairo miviri yehukuru kubva kuPCR benchmark.Iyi bvunzo dzekukurumidza izvozvi dzinoda kuvandudzwa uye kubvumidzwa kushandiswa pamba kuitira kuti uwane yechokwadi nharaunda-yakawanda yekutarisa chirongwa cheSARS-CoV-2.
Parizvino, hapana nzira yeFDA yekuongorora uye kubvumidza bvunzo kuti ishandiswe muchirongwa chekurapa, kwete seyedzo imwe chete, uye hapana hutano hweveruzhinji hunogona kuderedza kutapurirana kwenharaunda.Masangano anodzora anongotarisa chete pamakiriniki ekuongororwa bvunzo, asi kana chinangwa chavo chakataurwa chiri chekudzikisa kupararira kwehutachiona munharaunda, zviratidzo zvitsva zvinogona kuiswa pabvunzo dzekuongorora zvichienderana neiyo epidemiological framework.Munzira iyi yemvumo, kutengeserana pakati pehuwandu, muganhu wekuona uye nguva yekushandura inogona kutarisirwa uye kuongororwa zvakakodzera.1-3
Kuti tikunde Covid-19, isu tinotenda kuti FDA, CDC, National Institutes of Health nemamwe masangano anofanirwa kukurudzira kuongororwa kwakarongeka kwebvunzo mumamiriro ezvirongwa zvebvunzo zvakarongwa kuti vaone kuti ndeipi chirongwa chebvunzo chinogona kupa yakanakisa Covid sefa.Kazhinji kushandisa zvakachipa, zvakapusa, uye nekukurumidza bvunzo zvinogona kuzadzisa chinangwa ichi, kunyangwe kana ongororo yavo yakadzikira pane iyo yemabhenji bvunzo.1 Chirongwa chakadaro chinogona kutibatsirawo kudzivirira budiriro yeCovid.
Boston Harvard Chenchen School of Public Health (MJM);uye Yunivhesiti yeColorado Boulder (RP, DBL).
1. Larremore DB, Wilder B, Lester E, zvichingodaroGunyana 8, 2020 (https://www.medrxiv.org/content/10.1101/2020.06.22.20136309v2).Preprint.
2. Paltiel AD, Zheng A, Walensky RP.Ongorora iyo SARS-CoV-2 yekuongorora nzira yekubvumidza kuvhurwa kwakachengeteka kwemayunivhesiti emakampasi muUnited States.JAMA Cyber Vhura 2020;3(7): e2016818-e2016818.
3. Chin ET, Huynh BQ, Chapman LAC, Murrill M, Basu S, Lo NC.Kuwanda kwekuyedzwa kwemaitiro eCCIDID-19 munzvimbo dzine njodzi huru kuderedza kubuda kwenzvimbo yebasa.Gunyana 9, 2020 (https://www.medrxiv.org/content/10.1101/2020.04.30.20087015v4).Preprint.
4. Iye X, Lau EHY, Wu P, etc. Nguva yekuchinja kwehutachiona uye COVID-19 kutapurirana simba.Nat Med 2020;26:672-675.
5. Centers for Disease Control and Prevention.Chinyorwa cheCDC yakagadziridzwa muchidimbu parunhare paCOVID-19.Chikumi 25, 2020 (https://www.cdc.gov/media/releases/2020/t0625-COVID-19-update.html).
Nzira yehutachiona hwemunhu (mutsara webhuruu) inoratidzwa mumamiriro ezvirongwa zviviri zvekuongorora (madenderedzwa) ane maonero akasiyana ekuongorora.Low analytical sensitivity assays inowanzoitwa, nepo yakakwirira analytical senitivity assays isingawanzo.Zvose zvirongwa zvekuedza zvinogona kuona hutachiona (orenji denderedzwa), asi zvisinei nekudzika kwayo kwekuongorora kunzwisiswa, chete iyo yepamusoro-frequency bvunzo inogona kuiona mukati meiyo yekuparadzira hwindo (mumvuri), iyo inoita kuti ive inoshanda sefa Chishandiso.Iyo polymerase chain reaction (PCR) yekuona hwindo (yegirini) isati yatapukirwa ipfupi kwazvo, uye hwindo rinoenderana (yepepuru) rinogona kuonekwa nePCR mushure mekutapukirwa rakareba kwazvo.
Nguva yekutumira: Mar-11-2021