生物与医学2021jamanetwork.com
感染与接种疫苗后针对 SARS-CoV-2 变异株的中和抗体
Neutralizing antibodies against SARS-CoV-2 variants after infection, vaccination
进阶 · 约 20 分钟读完前置知识：免疫学基础、病毒变异与中和抗体、疫苗学基础
导读
这篇发表于 JAMA 的研究评估感染 SARS-CoV-2 和/或接种疫苗后，血清中对不同变异株的中和抗体反应。它属于体外中和试验层面的免疫学分析，关注变异株是否降低抗体中和能力，以及感染诱导免疫与疫苗诱导免疫的差异，而非直接证明临床保护效力。
HN 关注点：标题是否把体外中和结果夸大为“疫苗对变异株有效”，以及变异株逃逸、突破感染和真实世界数据缺乏等焦点。
HN 评论精选
这几条评论里：质疑 1 补充 3
质疑批评标题夸大原文，强调只是体外、部分疫苗和部分变异株的结果，并举阿斯利康对南非变异株失效的反例。
当前 HN 标题偏离原文，具有误导性。“Vaccines Are Effective Against Covid Variants”是一个错误断言。原文只说体外实验显示某些疫苗对某些变异株有效；并非所有疫苗、所有变异株，也没有人体试验。反例是某些疫苗似乎对某些变异株无效，例如阿斯利康对 B.1.351（南非）。预印本结论称：两剂 ChAdOx1-nCoV19 对 B.1.351 引起的轻中度 Covid-19 未显示保护，但对重症的疫苗有效性尚未确定。CDC 也表示部分变异株会出现“中和作用中度下降”。
idoubtit查看英文原文
The current HN title deviates from the original title in a way that is misleading. "Vaccines Are Effective Against Covid Variants" is a wrong affirmation. The original article only states that in vitro experiments show that some vaccines are effective against some variants. Not all vaccines, not all variants, and no test on human beings. A counter point is that some vaccines seem to be ineffective agains some variants. For instance AstraZeneca against B.A.351 (South-Africa). From a preprint: "Conclusions A two-dose regimen of ChAdOx1-nCoV19 did not show protection against mild-moderate Covid-19 due to B.1.351 variant, however, VE against severe Covid-19 is undetermined." https://www.medrxiv.org/content/10.1101/2021.02.10.21251247v1 The US CDC does state that, according to current publications, some variants present a "moderate reduction on neutralization". Their page about "Variants of Interest" and "Variants of Concern" mentions many scientific papers. https://www.cdc.gov/coronavirus/2019-ncov/cases-updates/variant-surveillance/variant-info.html
补充呼吁按接种状态采集真实世界突破感染和住院数据，认为已有足够接种人群可供分析。
我们从 12 月就开始接种。现在应该已有统计证据说明接种者是否、以及多大程度上仍会感染新冠和变异株。为什么还听到流行病学家对此一无所知？例如所有接受新冠检测或因新冠住院的人，都应被问是否接种、何时接种、接种了哪种疫苗。美国已有 7000 万人接种，现在应该有很多数据。
WalterBright查看英文原文
We've been vaccinating people since December. There ought to be statistical evidence now of whether and how much vaccinated people still get sick from Covid and its variants. Why do we still hear that epidemiologists have no idea about this? For example, everyone being tested for covid or being admitted to the hospital for covid, should be asked if they've been vaccinated, when, and which vaccination. 70 million people in the US have received vaccinations. There ought to be plenty of data by now.
补充个人低风险不等于群体安全；巴西的教训显示放松防护会导致变异株传播和医疗系统崩溃。
对于以“自己不属于高风险群体”为由不保护自己的人，请从巴西吸取教训。不属于高风险群体并不能让你避免传染其他高风险群体成员。巴西基本就是这样：非高风险人群在总统本人鼓励下聚集，感染人数飙升，出现影响年轻人的变异株，卫生系统因重症人数过多、ICU 不足而崩溃。
marcodiego查看英文原文
For people arguing that not being part of a risk group is a reason not to protect yourself, please take a lesson from brazil. Being part of a 'high risk group' does not saves you from infecting other people who are part of such groups. That's basically what happened in brazil: people who were not part of risk groups crowded, encouraged by the president himself[0][1][2]. The number of infected poeple soared and variants that affect younger people appeared[3][4]. The health system has now collapsed because there is not enough ICU for such a high number of ill people[5][6]. [0] https://www.em.com.br/app/noticia/politica/2021/02/26/interna_politica,1241415/ignorando-a-covid-19-bolsonaro-esteve-em-7-aglomeracoes-em-4-dias.shtml [1] https://noticias.uol.com.br/politica/ultimas-noticias/2021/02/19/bolsonaro-volta-a-provocar-aglomeracao-em-visita-ao-nordeste.htm [2] https://cultura.uol.com.br/noticias/15258_bolsonaro-mergulha-na-praia-grande-e-causa-aglomeracao-com-banhistas.html [3] https://www.cartacapital.com.br/saude/segunda-onda-de-covid-19-no-brasil-ataca-cada-vez-mais-jovens/ [4] https://www.brasildefato.com.br/2021/03/19/tres-novas-cepas-identificadas-no-brasil-sao-mais-potentes-e-transmissiveis [5] https://www.cnnbrasil.com.br/saude/2021/03/19/17-estados-e-o-df-estao-em-colapso-na-saude-mt-ms-rs-e-rr-nao-tem-mais-leitos [6] https://www.cnnbrasil.com.br/saude/2021/03/19/em-meio-ao-colapso-do-sistema-de-saude-faltam-medicos-intensivistas-nas-utis
补充补充新冠死亡率估计数据：非机构化患者约 0.26%，并按年龄分层。
2021 年 1 月发表在《Annals of Internal Medicine》的一项研究估算，非机构化患者的死亡率为 0.26%，并给出了年龄分层数据。
mcwone查看英文原文
A January 2021 study in the annals of internal medicine estimating the death rates of non institutionalized patients of .26 percent with age breakdowns . https://www.acpjournals.org/doi/10.7326/M20-5352?utm_source=24-scientists-determine-death-rate-covid-19-general-population&utm_medium=email&utm_content=published+in+the+Annals+of+Internal+Medicine&utm_campaign=ag&#t1-M205352
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