Sebenzisa ulwazi kunye neenkonzo zeQela le-NEJM ukulungiselela ukuba ngugqirha, ukuqokelela ulwazi, ukukhokela umbutho wezempilo kunye nokukhuthaza uphuhliso lwakho lomsebenzi.
Lixesha lokuba sitshintshe indlela esijonga ngayo ubuntununtunu bovavanyo lwe-Covid-19.I-US Food and Drug Administration (i-FDA) kunye noluntu lwenzululwazi okwangoku lujolise ngokukodwa ekubhaqweni kobuntununtunu, obulinganisa ukukwazi kwendlela enye yokufumanisa iiproteni zentsholongwane okanye iimolekyuli ze-RNA.Okubaluleke kakhulu, lo mlinganiselo awuwuhoyi umxholo wendlela yokusebenzisa uvavanyo.Nangona kunjalo, xa kufikwa kuvavanyo olubanzi olufunwa yi-United States kakhulu, umxholo ubalulekile.Umbuzo ongundoqo ayingowokuba ilungile kangakanani iamolekyuli inokufunyanwa kwisampulu enye, kodwa ngaba usulelo lunokubonwa ngokufanelekileyo kubemi ngokuphinda lusebenzise uvavanyo olunikiweyo njengenxalenye yesicwangciso-qhinga sokubhaqa?Uvakalelo lwesicwangciso sovavanyo.
Iinkqubo zovavanyo eziqhelekileyo zinokusebenza njengohlobo lwesihluzi se-Covid-19 ngokuchonga, ukubahlukanisa kunye nokuhluza abantu abosulelekileyo ngoku (kubandakanya abantu abangenazimpawu).Ukulinganisa ubuntununtunu besicwangciso sovavanyo okanye isihluzi sifuna ukuba sithathele ingqalelo uvavanyo kumxholo: ubuninzi bokusetyenziswa, ngubani osetyenziswayo, xa usebenza ngexesha losulelo, kunye nokuba luyasebenza na.Iziphumo ziya kubuyiselwa kwangethuba ukuthintela ukusasazeka.1-3
Umzila wosulelo lomntu (umgca oluhlaza) uboniswa kumxholo weenkqubo ezimbini zokucupha (izangqa) ezinobuntununtunu obuhlukeneyo bokuhlalutya.Iimvavanyo zobuntununtunu ezisezantsi ziyenziwa rhoqo, ngelixa uvavanyo oluphezulu lovakalelo lunqabile.Zombini izikimu zovavanyo zinokubona usulelo (isangqa se-orenji), kodwa ngaphandle kobuntununtunu bohlalutyo olusezantsi, luvavanyo lwe-frequency ephezulu kuphela olunokuthi lubhaqe ngaphakathi kwefestile yosasazo (ithunzi), elenza libe sisiXhobo esisebenzayo sokucoca.I-polymerase chain reaction (PCR) ifestile yokufumanisa (eluhlaza) ngaphambi kokuba ukutheleleka kufutshane kakhulu, kunye nefestile ehambelanayo (emfusa) enokuthi ibonwe yi-PCR emva kokuba usuleleko lude kakhulu.
Ukucinga ngemiphumo yokusetyenziswa ngokuphindaphindiweyo yingcamango eyaziwayo kwiiklinikhi kunye nee-arhente ezilawulayo;iyabhengezwa nanini na silinganisa ukusebenza kwesicwangciso sonyango kunedosi enye.Ngophuhliso olukhawulezileyo okanye ukuzinziswa kwamatyala e-Covid-19 kwihlabathi liphela, kufuneka sitshintshe ngokukhawuleza ingqalelo yethu ukusuka kwingqwalasela encinci ukuya kubuntununtunu bovavanyo (umda osezantsi wokukwazi ukubona ngokuchanekileyo ukugcwala kweemolekyuli ezincinci kwisampulu. ) kunye novavanyo Inkqubo inxulumene nobuntununtunu bokubona usulelo (abantu abosulelekileyo bayaqonda ukuba kunokwenzeka ukuba basuleleke kwangethuba ukuze bahluzwe ngaphandle kwabemi kunye nokuthintela ukusasazeka kwabanye).Uvavanyo lwendawo yokukhathalela, olufikelelekayo ngokwaneleyo kwaye lunokusetyenziswa rhoqo, lunovakalelo oluphezulu lokubona usulelo oluthatha inyathelo kwangethuba ngaphandle kokufikelela kumda wohlalutyo lovavanyo lokuqala (jonga umfanekiso).
Uvavanyo esiludingayo lwahluke kakhulu kuvavanyo lwezonyango olusetyenziswayo ngoku, kwaye kufuneka luvavanywe ngokwahlukileyo.Uvavanyo lweklinikhi lwenzelwe abantu abaneempawu, aludingi ixabiso eliphantsi, kwaye lufuna uvakalelo oluphezulu lohlalutyo.Ngethuba nje kukho ithuba lokuvavanya, ukuxilongwa okucacileyo kweklinikhi kunokubuyiselwa.Ngokwahlukileyo koko, iimvavanyo kwiinkqubo zokucupha ezisebenzayo zokunciphisa ukuxhaphaka kweentsholongwane zokuphefumla kubemi kufuneka zibuyise iziphumo ngokukhawuleza ukunqanda usulelo lwe-asymptomatic, kwaye kufuneka zingabizi ngokwaneleyo kwaye kube lula ukwenza ukuvumela uvavanyo rhoqo- kaninzi ngeveki.Ukusasazeka kwe-SARS-CoV-2 kubonakala kwenzeka kwiintsuku ezimbalwa emva kokuba sesichengeni, xa umthamo wentsholongwane egazini ufikelela kwincopho yawo.I-4 Eli nqaku ngexesha linyusa ukubaluleka kovavanyo oluphezulu, kuba uvavanyo kufuneka lusetyenziswe ekuqaleni kosulelo ukuthintela ukusasazeka okuqhubekayo kunye nokunciphisa ukubaluleka kokufikelela kumda ophantsi kakhulu wemolekyuli wovavanyo oluqhelekileyo.
Ngokwemigaqo emininzi, uvavanyo olusemgangathweni lwekliniki yepolymerase chain reaction (PCR) luyasilela xa lusetyenziswa kwiiprothokholi zokucupha.Emva kokuqokelelwa, iisampulu ze-PCR zikholisa ukuthuthwa zisiwe kwilabhoratri esembindini ebunjwe ziingcali, eyonyusa iindleko, icuthe amaza, kwaye inokulibazisa iziphumo ngosuku olunye ukuya kwezimbini.Iindleko kunye nomzamo ofunekayo wokuvavanya kusetyenziswa uvavanyo oluqhelekileyo kuthetha ukuba uninzi lwabantu e-US abakaze bavavanywe, kwaye ixesha elifutshane lokuguqula lithetha ukuba nokuba iindlela zangoku zokuhlola zinokubona abantu abosulelekileyo, basenokusasaza usulelo kangangeentsuku ezininzi.Ngaphambili, oku kwanciphisa impembelelo yokuvalelwa yedwa kunye nokulandelwa koqhagamshelwano.
Amaziko oLawulo noThintelo lweZifo (CDC) aqikelela ukuba ngoJuni 2020, inani lamatyala afunyenwe e-Covid-19 eUnited States liya kuliphinda ka-10 inani labantu abafunyenweyo.5 Ngamanye amazwi, ngaphandle kokubekwa esweni, izikimu zovavanyo zanamhlanje zinokubona kuphela ubuntununtunu be-10% kakhulu kwaye azinakusetyenziswa njengesihluzo se-Covid.
Ukongeza, emva kwenqanaba elidluliselwayo, umsila omde we-RNA-positive uchazwe ngokucacileyo, oku kuthetha ukuba, ukuba akunjalo, abantu abaninzi basebenzisa uvakalelo oluphezulu lokuhlalutya ukufumanisa usulelo ngexesha lokujongwa, kodwa abasasuleli ngexesha lokufunyanwa. .Ukufunyanwa (jonga umfanekiso).2 Ngapha koko, uphononongo lwakutsha nje olwenziwe yiNew York Times lufumanise ukuba eMassachusetts naseNew York, ngaphezulu kwe-50% yosulelo olufunyenwe ngocupho olusekwe kwi-PCR lunomyinge womjikelo we-PCR phakathi kweminyaka engama-30 ukuya kuma-30., Ibonisa ukuba inani lentsholongwane egazini lisezantsi.Nangona amanani aphantsi anokubonisa usulelo kwangoko okanye kade, ixesha elide lemisila ene-RNA ebonisa ukuba uninzi lwabantu abosulelekileyo bachongiwe emva kwexesha losulelo.Ibalulekile kuqoqosho, ikwathetha ukuba nangona bephumelele inqanaba losulelo, amawakawaka abantu asavalelwe yedwa kangangeentsuku ezili-10 emva kovavanyo lwe-RNA-positive.
Ukuze siwuyekise ngempumelelo lo bhubhani we-Covid filter, kufuneka siyivavanye ukuze sifumane isisombululo esibamba uninzi losulelo kodwa sisosulela.Namhlanje, olu vavanyo lukhona ngohlobo lovavanyo lwe-antigen oluhamba ngokukhawuleza olusecaleni, kwaye iimvavanyo ezikhawulezayo zokuqukuqela ezisecaleni ezisekwe kwitekhnoloji yokuhlela imfuza yeCRISPR sele iza kuvela.Uvavanyo olunjalo lutshiphu kakhulu (<5 USD), amashumi ezigidi okanye ngaphezulu kovavanyo lunokwenziwa veki nganye, kwaye lunokwenziwa ekhaya, luvula umnyango kwisisombululo esisebenzayo sokucoca iCovid.Uvavanyo lwe-antigen lwe-lateral flow aluna nyathelo lokukhulisa, ngoko ke umda wokufumanisa i-100 okanye i-1000 amaxesha ovavanyo lwe-benchmark, kodwa ukuba injongo kukuchonga abantu abasasaza intsholongwane ngoku, oku akunamsebenzi.I-SARS-CoV-2 yintsholongwane enokukhula ngokukhawuleza emzimbeni.Ke ngoko, xa i-benchmark ye-PCR isiphumo sovavanyo silungile, intsholongwane iya kukhula ngokukhawuleza.Ngelo xesha, kunokuthatha iiyure endaweni yeentsuku ukuba intsholongwane ikhule kwaye ifikelele kumda wokubona uvavanyo olukhawulezayo nolukhawulezayo olukhoyo ngoku.Emva koko, xa abantu befumana iziphumo ezilungileyo kuzo zombini iimvavanyo, banokulindeleka ukuba bosuleleke (jonga umfanekiso).
Sikholelwa ukuba iinkqubo zovavanyo lokucupha ezinokuqhawula amakhonkco osulelo ngokwaneleyo ukuze kuncitshiswe usulelo loluntu kufuneka zongezelele endaweni yovavanyo lwethu lwangoku lwezonyango.Isicwangciso esicingayo sinokuthatha ithuba kwezi mvavanyo zimbini, kusetyenziswa iimvavanyo ezinkulu, rhoqo, eziphantsi kunye nezikhawulezayo zokunciphisa ukuqhambuka, i-1-3 isebenzisa uvavanyo lwesibini olukhawulezayo lweeprotheni ezahlukeneyo okanye ukusebenzisa i-benchmark yovavanyo lwe-PCR ukuqinisekisa iziphumo ezilungileyo.Iphulo lokwazisa uluntu kufuneka ligqithise naluphi na uhlobo lovavanyo olubi olungathethi mpilo, ukuze kukhuthazwe ukuqhubeka komgama ekuhlaleni kunye nokunxitywa kwemaski.
I-FDA ye-Abbott BinaxNOW i-Emergency Use Authorization (EUA) ngasekupheleni kuka-Agasti linyathelo eliya kwicala elifanelekileyo.Luvavanyo lokuqala olukhawulezayo, olungenaso isixhobo se-antigen ukufumana i-EUA.Inkqubo yokuvunywa igxininisa uvakalelo oluphezulu lovavanyo, olunokugqiba ukuba abantu banokusasaza nini usulelo, ngaloo ndlela benciphisa umda ofunekayo wokufumanisa ngemiyalelo emibini yobukhulu ukusuka kwi-benchmark ye-PCR.Olu vavanyo lukhawulezayo ngoku kufuneka luphuhliswe kwaye luvunywe ukuba lusetyenziswe ekhaya ukuze kuphunyezwe inkqubo yovavanyo yoluntu ngokubanzi ye-SARS-CoV-2.
Okwangoku, akukho ndlela ye-FDA yokuvavanya kunye nokwamkelwa kovavanyo lokusetyenziswa kwisicwangciso sonyango, hayi njengovavanyo olunye, kwaye akukho mandla empilo yoluntu ekunciphiseni usulelo loluntu.Ii-arhente ezilawulayo zisagxile kuphela kwiimvavanyo zokuxilongwa kweklinikhi, kodwa ukuba injongo yazo echaziweyo kukunciphisa ukuxhaphaka koluntu lwentsholongwane, izikhombisi ezitsha zinokusetyenziswa kwiimvavanyo zokuvavanya ngokusekelwe kwisakhelo se-epidemiological.Kule ndlela yokuvunywa, ukurhweba phakathi kokuphindaphindiweyo, umda wokufumanisa kunye nexesha lokuguqula kunokulindelwa kwaye kuvavanywe ngokufanelekileyo.1-3
Ukuze soyise i-Covid-19, sikholelwa ukuba i-FDA, iCDC, amaZiko ezeMpilo eSizwe kunye nezinye ii-arhente kufuneka zikhuthaze ukuvavanywa okucwangcisiweyo kovavanyo kumxholo weenkqubo zovavanyo ezicwangcisiweyo zokufumanisa ukuba yeyiphi inkqubo yovavanyo enokubonelela ngeyona filter ilungileyo ye-Covid.Rhoqo ukusebenzisa iimvavanyo ezingabizi kakhulu, ezilula, nezikhawulezayo zinokufikelela le njongo, nokuba uvakalelo lwabo lohlalutyo lungaphantsi kakhulu kunolo lovavanyo lwebenchmark.1 Iskimu esinjalo sinako ukusinceda ukuba sithintele ukukhula kwe-Covid.
I-Boston Harvard Chenchen School of Public Health (MJM);kunye neYunivesithi yaseColorado Boulder (RP, DBL).
1. I-Larremore DB, iWilder B, i-Lester E, njl. Kuphononongo lwe-COVID-19, ubuntununtunu bovavanyo bukwisibini kuphela kumaxesha kunye nexesha lokuguqula izinto.NgoSeptemba 8, 2020 (https://www.medrxiv.org/content/10.1101/2020.06.22.20136309v2).Ukuprintwa kwangaphambili.
2. UPaltiel AD, uZheng A, uWalensky RP.Vavanya isicwangciso se-SARS-CoV-2 sokuhlola ukuvumela ukuvulwa ngokukhuselekileyo kweekhampasi zaseyunivesithi eMelika.JAMA Cyber Vula ngo-2020;3(7): e2016818-e2016818.
3. Chin ET, Huynh BQ, Chapman LAC, Murrill M, Basu S, Lo NC.Ukuphindaphindwa kovavanyo lwesiqhelo lwe-COVID-19 kwiindawo ezinomngcipheko ophezulu ukunciphisa ukuqhambuka kwendawo yokusebenza.NgoSeptemba 9, 2020 (https://www.medrxiv.org/content/10.1101/2020.04.30.20087015v4).Ukuprintwa kwangaphambili.
4. He X, Lau EHY, Wu P, njl. Amandla exesha lokuchithwa kwentsholongwane kunye nomthamo wosulelo lwe-COVID-19.UNat Med 2020;26:672-675.
5. Amaziko oLawulo lweSifo kunye noThintelo.Ushicilelo lwengxelo ehlaziyiweyo yomnxeba ye-CDC nge-COVID-19.NgoJuni 25, 2020 (https://www.cdc.gov/media/releases/2020/t0625-COVID-19-update.html).
Umzila wosulelo lomntu (umgca oluhlaza) uboniswa kumxholo weenkqubo ezimbini zokucupha (izangqa) ezinobuntununtunu obuhlukeneyo bokuhlalutya.Iimvavanyo zobuntununtunu ezisezantsi ziyenziwa rhoqo, ngelixa uvavanyo oluphezulu lovakalelo lunqabile.Zombini izikimu zovavanyo zinokubona usulelo (isangqa se-orenji), kodwa ngaphandle kobuntununtunu bohlalutyo olusezantsi, luvavanyo lwe-frequency ephezulu kuphela olunokuthi lubhaqe ngaphakathi kwefestile yosasazo (ithunzi), elenza libe sisiXhobo esisebenzayo sokucoca.I-polymerase chain reaction (PCR) ifestile yokufumanisa (eluhlaza) ngaphambi kokuba ukutheleleka kufutshane kakhulu, kunye nefestile ehambelanayo (emfusa) enokuthi ibonwe yi-PCR emva kokuba usuleleko lude kakhulu.
Ixesha lokuposa: Mar-11-2021