生物与医学2021medrxiv.org
比较 SARS-CoV-2 自然免疫与疫苗诱导免疫
Comparing SARS-CoV-2 natural immunity to vaccine-induced immunity
入门 · 约 45 分钟读完前置知识：流行病学基础概念、疫苗免疫原理
导读
这篇以色列的预印本研究比较了新冠自然感染免疫与 BNT162b2 两剂疫苗诱导免疫对 Delta 变异的保护效果，结论是自然免疫在预防感染、有症状疾病和住院方面提供更持久更强的保护。研究基于大规模以色列人群数据，但尚未经过同行评审。
HN 关注点：疫苗与自然免疫哪个保护力更强是当时 HN 上激烈争论的话题，这篇直接比较两者的大规模研究引发了对'已感染者是否还需要打疫苗'的讨论。
HN 评论精选
这几条评论里：质疑 2 补充 2
质疑提醒这是未经同行评审的预印本，结论可能变化
读这篇时要注意：这是一篇预印本（未经同行评审），而且引用的其他文献也是预印本。这是初步工作，在正式发表前结论可能会变。
tynpeddler查看英文原文
One thing to keep in mind when reading through this, it's a pre-print (not peer reviewed) that's citing other pre-prints like https://www.medrxiv.org/content/10.1101/2021.07.29.21261317v1.full.pdf. It's preliminary work and may change before final publication.
补充从数据看两种免疫都极强地防再感染，住院率极低、零死亡
撇开疫苗与自然免疫之争，有几点值得注意：第一，即使感染率最高的组，在所有模型中感染率也低于 1.5%——无论免疫来自疫苗还是自然感染，都能极大程度防止再感染（当然有很多变量，比如接种疫苗后行为是否更谨慎等）。第二，据我统计所有模型合计约 10.6 万–15.2 万受试者，其中仅 34 例住院、零死亡，住院率 ≤0.032%，相当可观。第三，所有模型中除免疫类型外，影响再感染的只有社会经济地位和 60 岁以上年龄，合并症似乎不影响再感染几率（但可能影响严重程度）。
sfteus查看英文原文
Couple things of note, outside of the vaccinated vs natural infection debate: First, even group with the largest infection rate was still under 1.5% in all applicable models. Whether immunity is achieved via vaccine or natural immunity, it appears that it will overwhelmingly prevent you from being re-infected. There's obviously a ton of variables here (are vaccinated individuals being overly cautious or reckless after vaccination, are natural infections more likely to receive repeat exposures to build immunity, etc). Second, by my count there were a total of ~106k-152k subjects observed in that study across all groups and models (not sure if there is overlap between models). Across all subjects, only 34 hospitalizations were reported, and there were no recorded deaths. A hospitalization rate of <= 0.032% is pretty damn impressive. Zero deaths is phenomenal. Finally, across all models the only factors outside of immunity type affecting reinfection were socio-economic status and age > 60. Comorbidities don't appear to affect the chance of reinfection, though I'm sure a breakthrough infection/re-infection would still likely be more severe in cases with co-morbidities.
质疑质疑：研究结论是否支持'感染过就不必打疫苗'的立场
论文说自然免疫比两剂疫苗对 Delta 的保护更持久更强。那些因为已经感染过而拒绝打疫苗的人，现在是不是有道理了？
samename查看英文原文
> This study demonstrated that natural immunity confers longer lasting and stronger protection against infection, symptomatic disease and hospitalization caused by the Delta variant of SARS-CoV-2, compared to the BNT162b2 two-dose vaccine-induced immunity. Do the people who are refusing a vaccine because they were already infected have a good point now?
补充提出'疫苗+自然感染'组合免疫的设想及其风险
我在想，接种疫苗后故意感染真实病毒是否有益？缺点是有重症风险且需要隔离到病毒清除，但好处是获得的自然免疫可能对未来可能逃逸疫苗的变异株有效。
devit查看英文原文
I wonder if after being vaccinated it might be beneficial to intentionally get infected with the actual virus? The downside is of course the risk of severe illness and having to quarantine until the virus is cleared, but the upside is that the resulting natural immunity might be effective against a possible future vaccine escaping variant.
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从这篇论文所有 HN 讨论帖的全部评论里整理出来的链接。
历次讨论
- 2021Hacker News 讨论帖187 分 · 249 评
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