Concerns about SARS-CoV-2 evolution should not hold back efforts to expand vaccination.
Concerns about SARS-CoV-2 evolution should not hold back efforts to expand vaccination.
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DOI：
10.1038/s41577-021-00544-9
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发表时间：
2021-05
期刊：
影响因子：
--
通讯作者：
Lipsitch M
中科院分区：
文献类型：
--
作者：
Cobey S;Larremore DB;Grad YH;Lipsitch M
在疫苗供应有限的情况下，扩大接种某些疫苗的人数，如将接种剂量减半或增加接种间隔，与将可用疫苗剂量集中在一部分人群相比，可以减少疾病和死亡率。这种剂量节省策略的必然结果是接种疫苗的个体可能具有较少的保护性免疫力。人们担心，扩大对SARS-CoV-2部分免疫的人群比例可能会增加对疫苗逃逸变体的选择，最终破坏疫苗的有效性。我们认为，尽管这是可能的，但初步证据表明，这种策略应该减缓病毒从疫苗或自然诱导的免疫中逃逸的速度。只要疫苗接种提供了一定的保护，防止逃逸变异，相应的降低流行率和发病率应降低新的变异产生的速度和适应的速度。由于在典型的感染过程中，几乎没有证据表明SARS-CoV-2的有效免疫选择，这些群体水平的影响可能主导疫苗诱导的进化。在这一观点中，Cobey、Larremore、格拉德和Lipsitch认为，COVID-19疫苗的剂量节省方案可以降低疾病的发病率、流行率和负担，并解释了为什么他们认为这种策略也会减缓病毒从疫苗或自然诱导的免疫中逃逸的速度。
When vaccines are in limited supply, expanding the number of people who receive some vaccine, such as by halving doses or increasing the interval between doses, can reduce disease and mortality compared with concentrating available vaccine doses in a subset of the population. A corollary of such dose-sparing strategies is that the vaccinated individuals may have less protective immunity. Concerns have been raised that expanding the fraction of the population with partial immunity to SARS-CoV-2 could increase selection for vaccine-escape variants, ultimately undermining vaccine effectiveness. We argue that, although this is possible, preliminary evidence instead suggests such strategies should slow the rate of viral escape from vaccine or naturally induced immunity. As long as vaccination provides some protection against escape variants, the corresponding reduction in prevalence and incidence should reduce the rate at which new variants are generated and the speed of adaptation. Because there is little evidence of efficient immune selection of SARS-CoV-2 during typical infections, these population-level effects are likely to dominate vaccine-induced evolution. In this Perspective, Cobey, Larremore, Grad and Lipsitch argue that dose-sparing regimens of COVID-19 vaccines can reduce disease incidence, prevalence and burden and explain why they think that such strategies would also slow the rate of viral escape from vaccine or naturally induced immunity.
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影响因子：
5.4
作者：
Li F;Zhang Y;Shi P;Cao L;Su L;Zhang Y;Peng K;Lu R;Tan W;Shen J
通讯作者：
Shen J
影响因子：
9.4
作者：
Addetia A;Crawford KHD;Dingens A;Zhu H;Roychoudhury P;Huang ML;Jerome KR;Bloom JD;Greninger AL
通讯作者：
Greninger AL
DOI：
10.1093/cid/cix468
发表时间：
2017-10-15
期刊：
Clinical infectious diseases : an official publication of the Infectious Diseases Society of America
影响因子：
--
作者：
Arriola C;Garg S;Anderson EJ;Ryan PA;George A;Zansky SM;Bennett N;Reingold A;Bargsten M;Miller L;Yousey-Hindes K;Tatham L;Bohm SR;Lynfield R;Thomas A;Lindegren ML;Schaffner W;Fry AM;Chaves SS
通讯作者：
Chaves SS
DOI：
10.1056/nejmoa2029849
发表时间：
2021-01-21
期刊：
The New England journal of medicine
影响因子：
--
作者：
Chen P;Nirula A;Heller B;Gottlieb RL;Boscia J;Morris J;Huhn G;Cardona J;Mocherla B;Stosor V;Shawa I;Adams AC;Van Naarden J;Custer KL;Shen L;Durante M;Oakley G;Schade AE;Sabo J;Patel DR;Klekotka P;Skovronsky DM;BLAZE-1 Investigators
通讯作者：
BLAZE-1 Investigators
影响因子：
82.9
作者：
Adam, Dillon C.;Wu, Peng;Cowling, Benjamin J.
通讯作者：
Cowling, Benjamin J.