Peb suav nrog kev txhaj tshuaj tiv thaiv. Ntu 21. Rotavirus

2024 Tus sau: Seth Attwood | [email protected]. Kawg hloov kho: 2023-12-16 16:06

1. Ua ntej qhov tshwm sim ntawm cov tshuaj tiv thaiv, ob peb tus neeg tau hnov txog tus kab mob rotavirus, txawm tias yuav luag txhua tus menyuam yaus mob nrog nws.

2. CDC Pinkbook

Tus kab mob rotavirus tau tshawb pom hauv xyoo 1973 thiab tau muab lub npe ntawd vim nws zoo li lub log. Tus kab mob no feem ntau ua rau tus kab mob gastroenteritis hauv cov menyuam mos thiab menyuam yaus. Nws kis tau los ntawm txoj kev fecal-qhov ncauj.

Thawj tus kab mob tom qab muaj hnub nyoog 3 hli feem ntau yog qhov hnyav tshaj plaws. Nws tuaj yeem ua asymptomatic, nws tuaj yeem ua rau mob raws plab, lossis nws tuaj yeem ua rau mob plab hnyav nrog kub taub hau thiab ntuav. Cov tsos mob feem ntau daws tau hauv 3-7 hnub. Cov tsos mob zoo sib xws tuaj yeem tshwm sim tsis yog los ntawm rotavirus nkaus xwb, tab sis kuj los ntawm lwm cov kab mob, yog li kev soj ntsuam kuaj yog tsim nyog kom paub meej.

Nyob rau hauv huab cua kub, tus kab mob no tshwm sim nyob rau hauv lub caij nplooj zeeg thiab lub caij ntuj no.

Tam sim no muaj ob hom tshuaj tiv thaiv kab mob hauv qhov ncauj: Rotatec thiab Rotarix. Rotatek muab 3 koob tshuaj (ntawm 2, 4 thiab 6 lub hlis) thiab Rotarix ob koob (ntawm 2 thiab 4 lub hlis). Thawj koob tshuaj yuav tsum tsis txhob muab tom qab 14 lub lis piam, thiab koob tshuaj zaum kawg yuav tsum tsis txhob muab tom qab 8 lub hlis.

Cov tshuaj tiv thaiv yog 74-98% zoo tiv thaiv cov serotypes lawv muaj. Kev tiv thaiv ntev npaum li cas tsis paub.

Txij li tsis tau kawm txog kev ua tau zoo thiab kev nyab xeeb ntawm ntau tshaj ib koob tshuaj, nws tsis pom zoo kom muab tshuaj tiv thaiv rau koj tus menyuam ntxiv yog tias nws nplawm nws los yog nplawm nws.

Hauv kev sim tshuaj, raws plab thiab ntuav feem ntau tau sau tseg hauv cov tshuaj tiv thaiv Rotatek hauv thawj lub lim tiam tom qab txhaj tshuaj ntau dua li hauv pawg placebo. Tsis pub dhau 42 hnub tom qab txhaj tshuaj, cov tshuaj tiv thaiv feem ntau yuav muaj raws plab, ntuav, otitis media, nasopharyngitis, thiab bronchospasm.

Kev txhaj tshuaj Rotarix feem ntau yuav muaj hnoos thiab hnoos hauv qhov ntswg hauv 7 hnub, thiab khaus khaus thiab flatulence ntau dua tuaj yeem tshwm sim hauv ib hlis tom qab txhaj tshuaj, piv nrog cov pab pawg "placebo".

3. Kev kis kab mob rotavirus hauv cov menyuam mos los tiv thaiv kev kis kab mob tom ntej. (Velázquez, 1996, N Engl J Med)

Qhov ua rau mob raws plab hauv thawj tus kab mob rotavirus yog 47%. Nrog rau cov kab mob tom ntej, qhov yuav ua rau raws plab yog txo.

Cov kab mob rotavirus yav dhau los txo qhov kev pheej hmoo ntawm kev mob raws plab los ntawm kev kis kab mob tom ntej los ntawm 77% thiab kev pheej hmoo ntawm mob raws plab los ntawm 87%. Ob / peb kab mob raws plab los ntawm rotavirus txo qhov kev pheej hmoo ntawm kev kis kab mob los ntawm 83% / 92%.

Tus kab mob asymptomatic yav dhau los txo qhov kev pheej hmoo ntawm kev kis kab mob ntxiv los ntawm 38%.

Ob tug kab mob yav dhau los (xws li cov tsos mob lossis asymptomatic) muab 100% tiv thaiv kab mob raws plab.

Lub sij hawm luv luv ntawm kev pub niam mis ua rau muaj kev pheej hmoo ntawm tus kab mob rotavirus.

4. Tib neeg tiv thaiv kab mob rotavirus. (Molyneaux, 1995, J Med Microbiol)

Kev rov kis tus kab mob rotavirus tuaj yeem ua tau, tab sis nws ploj mus nrog cov tsos mob me lossis tsis muaj tsos mob.

Nyob rau hauv tag nrho, muaj 7 pawg neeg ntawm tus kab mob (A-G). Pawg A tau muab faib ua serotypes G1-G14, P1-P11 thiab lwm yam. Cov tib neeg feem ntau kis tau tus kab mob G1-G4 hauv pawg A, thiab tsawg dua hauv pawg B thiab C.

Hauv cov menyuam yug tshiab, tus kab mob feem ntau yog asymptomatic. Tom qab ntawd, lawv tau mob rotavirus tsawg dua thiab mob yooj yim dua li cov neeg uas tsis muaj mob tom qab yug me nyuam. Kev kis mob hauv menyuam mos, txawm tias cov tsos mob lossis asymptomatic, muab kev tiv thaiv rau 2 xyoos. Tom qab ib lub sij hawm thaum yau, cov tsos mob ntawm tus kab mob yog tsawg.

Kev pub niam mis tshwj xeeb hauv thawj xyoo ntawm lub neej txo qis kev pheej hmoo kis mob.

Xyoo 90s, lawv tau pib tsim cov tshuaj tiv thaiv kab mob rotavirus, yog li CDC xav paub tias muaj pes tsawg tus menyuam tuag los ntawm nws. Txhawm rau ua qhov no, lawv tau ua cov kev tshawb fawb hauv qab no:

5. Kev mob raws plab hauv cov menyuam yaus Asmeskas. Lawv puas tiv thaiv tau? (Ho, 1988, JAMA)

Kev tuag los ntawm kev mob raws plab (los ntawm txhua qhov ua rau) suav txog 2% ntawm tag nrho cov kev tuag tom qab yug menyuam. Xyoo 1983, 500 tus menyuam yaus tau tuag vim mob raws plab hauv Tebchaws Meskas, ntawm 50% tuag hauv tsev kho mob. Kev tuag los ntawm kev mob raws plab poob qis thaum muaj hnub nyoog, ob zaug siab dua ntawm cov menyuam mos hnub nyoog 1-3 lub hlis piv rau 4-6 lub hlis ntawm hnub nyoog, thiab 10 npaug siab dua ntawm cov hnub nyoog 12 lub hlis.

Qhov kev pheej hmoo ntawm kev tuag los ntawm kev mob raws plab yog 4 npaug siab dua ntawm cov neeg dub (thiab hauv qee lub xeev 10 npaug siab dua) dua li ntawm cov neeg dawb; 5 npaug siab dua ntawm cov menyuam mos uas nws niam hnub nyoog qis dua 17 xyoo; 2 npaug siab dua ntawm cov niam txiv uas tseem tsis tau yuav; 3 npaug siab dua ntawm cov niam txiv uas tsis kawm ntawv tiav.

Kev tuag los ntawm kev mob raws plab yog siab dua nyob rau lub caij ntuj no dua li lub caij ntuj sov, thiab tus kab mob rotavirus tau xav tias yog lub luag haujlwm. Nws kwv yees tias 70-80 tus menyuam yaus ib xyoos twg tuag los ntawm tus kabmob rotavirus.

6. Cov tsos mob ntawm tus kab mob raws plab - txuam nrog kev tuag hauv Asmeskas cov menyuam yaus, xyoo 1968 txog 1991. (Kilgore, 1995, JAMA)

Txij xyoo 1968 txog 1985, kev tuag los ntawm kev mob raws plab hauv Tebchaws Meskas tau txo qis los ntawm 75% (ntawm cov menyuam mos - los ntawm 79%), thiab tom qab ntawd ruaj khov. Nyob nruab nrab ntawm xyoo 1985 thiab 1991, 300 tus neeg hauv ib xyoos tau tuag los ntawm zawv plab, 240 tus menyuam yaus. Qhov kev tuag ntawm tus mob raws plab ntawm cov menyuam yaus yog 1: 17,000. Txij xyoo 1985, ib nrab ntawm lawv tau tuag ua ntej muaj hnub nyoog 1.5 hli (uas yog, ua ntej hnub nyoog txhaj tshuaj tiv thaiv).

Ntawm no yog ib daim duab ntawm kev tuag los ntawm raws plab los ntawm 1968 txog 1991:

Txhua lub caij ntuj no, ib tus tuaj yeem pom qhov siab tshaj plaws hauv kev tuag, uas ploj mus nyob rau hauv nruab nrab-80s, thiab tsuas yog cov peaks me me nyob hauv pab pawg ntawm 4-23 lub hlis. Txij li thaum rotavirus mob yuav luag tshwj xeeb rau lub caij ntuj no, cov kws sau ntawv ntseeg tias qhov no yog kev tuag los ntawm rotavirus.

Cov kws sau ntawv xaus lus tias cov tshuaj tiv thaiv kab mob rotavirus yuav muaj qhov ntsuas tau tab sis muaj txiaj ntsig me me rau cov neeg mob raws plab.

7. Kev kis kab mob ntawm tus kab mob rotavirus hauv Tebchaws Meskas: kev soj ntsuam thiab kwv yees cov kab mob hnyav. (Iav, 1996, J Infect Dis)

Nws kwv yees tias 873,000 tus neeg hauv ib xyoos tuag los ntawm rotavirus thoob ntiaj teb. Tab sis tsis muaj cov ntaub ntawv hais txog kev tuag ntawm tus kab mob rotavirus hauv cov tebchaws tsim kho, thiab yog li ntawd xyoo 1985 IOM tau txiav txim siab tias cov tshuaj tiv thaiv no tsis yog qhov tseem ceeb rau Tebchaws Meskas. Tab sis lawv tau ua raws li ib txoj kev tshawb fawb yav tom ntej, txawm hais tias lwm cov kev tshawb fawb tau pom tias ib feem peb ntawm cov menyuam yaus nyob hauv tsev kho mob raws plab muaj kab mob rotavirus.

Txij li thaum tsis muaj menyuam hauv Tebchaws Meskas tau tuag nrog kev kuaj mob rotavirus raws plab, ntau tus kws kho menyuam yaus ntseeg tias tus kabmob rotavirus yeej tsis mob hnyav lossis tuag taus. Txawm li cas los xij, kev tshuaj xyuas ntawm cov ntaub ntawv kev tuag (hauv kev tshawb fawb yav dhau los) tau muab qhov xav tau, txawm tias muaj xwm txheej, pov thawj tias rotavirus tuag.

Raws li ob txoj kev tshawb fawb dhau los, cov kws sau ntawv kwv yees tias 55,000 tus menyuam yaus hauv ib xyoos tau mus pw hauv tsev kho mob los ntawm rotavirus thiab 20 tus menyuam tuag, piv txwv li. 1 ntawm 200,000. Lawv ntseeg tias cov menyuam mos no muaj lwm yam mob, piv txwv li, lawv ntxov ntxov.

Cov kws sau ntawv xaus lus tias tsawg dua 40 tus menyuam yaus tuag los ntawm tus kabmob rotavirus hauv ib xyoos, txawm hais tias lawv tsis piav qhia qhov twg lawv tau txais 40 los ntawm yog tias lawv suav tsuas yog 20 hauv cov lus ntawm tsab xov xwm.

CDC sau tias 20-60 tus menyuam hauv ib xyoos tuag los ntawm rotavirus, tab sis lawv tsis piav qhia qhov twg lawv tau txais 60 tus menyuam los ntawm yog tias lawv tus kheej tshawb fawb tau suav tsuas yog 20.

8. Cov tshuaj tiv thaiv kab mob rotavirus: kev tiv thaiv kab mob thiab kev pheej hmoo ntawm kev sib kis. (Anderson, 2008, Lancet Infect Dis)

- Thawj koob tshuaj tiv thaiv kab mob rotavirus (Rotashield) tau tso cai rau xyoo 1998 thiab muaj 4 hom kab mob. Nws tau raug rho tawm hauv xyoo 1999 vim tias nws tau cuam tshuam nrog kev nkag siab. Intussusception yog thaum ib feem ntawm txoj hnyuv quav ntawm nws tus kheej zoo li lub tsom iav.

- Cov pej xeem tsis kam tso tawm txawm tias qhov tsawg tshaj plaws ntawm kev pheej hmoo ntawm kev mob tshwm sim loj. Txawm tias tsawg li 1 ntawm 10,000.

- Xyoo 1998 cov tshuaj tiv thaiv Rotarix (GSK) tau tso cai. Muaj ib hom kab mob. Cov kab mob sib cais los ntawm tus menyuam muaj tus kab mob no tau txo qis los ntawm 33 qhov kev hloov pauv los ntawm lub raum hlwb ntawm African liab liab. Cov tshuaj tiv thaiv kab mob sib kis tau zoo hauv tib neeg txoj hnyuv.

- Cov tshuaj tiv thaiv Rotateq (Merck) tau tso cai rau xyoo 1996. Muaj 5 hom kab mob. (Peb tus phooj ywg Paul Offit tuav plaub patents rau cov tshuaj tiv thaiv no.)

Tsis zoo li lwm cov tshuaj tiv thaiv nyob, Rotatec tsis yog tshuaj tiv thaiv kab mob, tab sis yog tshuaj tiv thaiv rov qab.

rotavirus genome muaj 11 ntu RNA. Hauv cov tshuaj tiv thaiv kab mob Rotatek, qee ntu tau hloov pauv los ntawm tib neeg rotavirus mus rau bovine rotavirus. Cov tshuaj tiv thaiv zoo li no, qhov twg qee ntu ntawm RNA ntawm tus kab mob raug hloov nrog ntu ntawm cov tsiaj ntawm tus kab mob, yog hu ua cov tshuaj tiv thaiv rov qab. Rotatec yog tshuaj tiv thaiv pentavalent. Plaub hom serotypes feem ntau (G1-G4) yog ua ke nrog bovine serotype P. Qhov thib tsib hom muaj bovine serotype G ua ke nrog tib neeg serotype P. Peb hom tshuaj tiv thaiv yog reassortant los ntawm ib tug tib neeg thiab kaum bovine ntu. Lwm ob yog reassorted los ntawm ob tug tib neeg thiab cuaj bovine ntu. Xws li tus kab mob no tsis sib npaug zoo hauv cov hnyuv, yog li Rotatek muaj 100 npaug ntawm cov kab mob ntau dua li Rotarix.

Cov tshuaj tiv thaiv thawj zaug (Rotashield) kuj tseem muaj txiaj ntsig, tab sis nws siv ntu ntawm tus kab mob liab.

Cov tshuaj tiv thaiv muaj polysorbate 80 thiab fetal bovine serum.

Hauv kev sim tshuaj ntawm ob qho tshuaj tiv thaiv, tib yam tshuaj tiv thaiv tau siv los ua cov placebo, tab sis tsis muaj tus kab mob [1], [2].

- Thaum lub sijhawm kev sim tshuaj Rotashield, cov tshuaj tiv thaiv kab mob tau pib kuaj pom hauv cov quav ntawm cov neeg uas tau txais cov placebo ib xyoos tom qab pib qhov kev sim, thiab tso tseg tsis pom tom qab 100 hnub tom qab kev sim, qhia txog kev tsim "lub zej zog reservoir. ".

- Hauv kev sim tshuaj, Rotarix pom tias kwv yees li 50-80% ntawm cov menyuam mos tau tso tus kabmob tom qab thawj koob tshuaj. Ib txoj kev tshawb fawb hauv Singapore pom tias 80% ntawm cov menyuam mos tso tus kab mob los ntawm 7 hnub tom qab txhaj tshuaj, thiab 20% txuas ntxiv tso nws ib hlis tom qab txhaj tshuaj. Kev tshawb fawb hauv Dominican koom pheej pom tias 19% ntawm cov menyuam ntxaib tsis tau txhaj tshuaj tiv thaiv kab mob los ntawm lawv cov kwv tij uas tau txhaj tshuaj.

- Tom qab thawj koob tshuaj Rotatec, 13% ntawm cov menyuam yaus tso tus kabmob.

Ntawm no nws tau tshaj tawm tias 21% ntawm cov menyuam yaus tso tus kab mob tom qab Rotatek, thiab ntawm no yog 87%.

Nws tshaj tawm tias ntawm cov menyuam mos ntxov ntxov, 53% tso tus kab mob tom qab Rotatek.

- Kev cais tawm ntawm cov tshuaj tiv thaiv kab mob thiab nws qhov kev sib kis tau ntseeg tias yog ib qho kev mob tshwm sim uas tsis xav tau. Txawm li cas los xij, nws kuj muaj cov txiaj ntsig zoo. Kev kis tus kab mob uas tsis tau txhaj tshuaj yuav tsim kev tiv thaiv kab mob hauv lawv, ib yam li tshwm sim nrog cov tshuaj tiv thaiv kab mob polio. Cov txiaj ntsig no yuav muaj txiaj ntsig tshwj xeeb hauv cov tebchaws txom nyem, qhov chaw txhaj tshuaj tiv thaiv tsawg, kev tuag siab, thiab muaj cov neeg tiv thaiv kab mob tsawg. Tau kawg, hauv cov teb chaws tsim kho, qhov chaw tuag tsawg thiab muaj ntau tus neeg tiv thaiv kab mob thiab cov neeg feem coob nyiam kom tsis txhob muaj kev pheej hmoo, kev cais cov tshuaj tiv thaiv kab mob tuaj yeem pom tias muaj kev cuam tshuam.

- Muaj 100 billion tus kab mob hauv 1 gram ntawm cov quav los ntawm tus menyuam muaj mob. Tsuas yog 10 feem xwb thiaj txaus rau kev kis kab mob. Yog li ntawd, cov neeg laus uas hloov cov pawm rau cov menyuam yaus muaj kev pheej hmoo kis mob rau lawv tus kheej. Cov neeg tsis muaj zog tiv thaiv kab mob yuav tsum tsis txhob hloov cov pawm rau tus menyuam mos uas tau txhaj tshuaj, tshwj xeeb tshaj yog thaum 2 lub lis piam tom qab Rotatek, thiab 4 lub lis piam tom qab Rotarix.

9. Cov txiaj ntsig ntawm kev noj zaub mov tshwj xeeb rau tus kab mob rotavirus ntawm cov menyuam yaus. (Krawczyk, 2016, Indian J Pediatr)

Kev pub niam mis tshwj xeeb txo qhov kev pheej hmoo ntawm tus kab mob rotavirus los ntawm 38%. Kuj: [1], [2], [3], [4], [5], [6], [7], [8].

Nws tshaj tawm tias cov niam hauv Sweden muaj ntau cov tshuaj tiv thaiv kab mob rotavirus hauv cov kua mis thaum lub caij nplooj ntoos hlav dua li lub caij nplooj zeeg.

Nws tshaj tawm tias cov ntshav zinc muaj feem cuam tshuam nrog kev tiv thaiv rotavirus. Kev txhaj tshuaj tiv thaiv lig (ntawm 17 lub lis piam) muaj txiaj ntsig zoo dua li kev txhaj tshuaj ntawm 10 lub lis piam.

10. Inhibitory nyhuv ntawm peast mis nyuj rau kis kab mob ntawm lub qhov ncauj rotavirus tshuaj tiv thaiv. (Lub hli, 2010, Pediatr Infect Dis J)

Hauv cov tebchaws txom nyem, cov tshuaj tiv thaiv kab mob rotavirus tsis tshua muaj tshuaj tiv thaiv kab mob thiab tsis muaj txiaj ntsig zoo dua li hauv cov tebchaws tsim. Yog tias hauv Finland Rotarix ua rau muaj kev tiv thaiv kab mob hauv ntau dua 90% ntawm cov menyuam mos, hauv South America tsuas yog 70%, thiab hauv South Africa, Malawi, Bangladesh thiab India - hauv 40-60%. Lwm cov tshuaj tiv thaiv qhov ncauj (rau tus mob polio thiab tus kab mob cholera) kuj tsis tshua muaj txiaj ntsig hauv cov tebchaws txom nyem.

Vim li cas qhov no tshwm sim tseem tsis tau paub, tab sis ib qho kev piav qhia yog tias cov niam hauv cov teb chaws no feem ntau yuav pub niam mis rau lawv cov menyuam thaum txhaj tshuaj tiv thaiv. Tsis tas li ntawd, cov niam hauv cov teb chaws txom nyem muaj feem ntau yuav muaj kev tiv thaiv kab mob rotavirus, uas tau nthuav tawm ntau cov tshuaj tiv thaiv hauv cov kua mis, thiab cov tshuaj tiv thaiv IgG kis los ntawm cov placenta.

Cov kws sau ntawv tau coj cov qauv mis niam los ntawm Is Nrias teb, Nyab Laj, Kaus Lim Qab Teb thiab Tebchaws Meskas thiab kuaj seb nws puas muaj kev cuam tshuam rau rotavirus.

Nws tau pom tias cov qauv mis niam los ntawm Is Nrias teb muaj cov tshuaj tiv thaiv kab mob rotavirus feem ntau, cov mis nyuj los ntawm Nyab Laj thiab Kaus Lim Qab Teb muaj cov tshuaj tiv thaiv tsawg dua, thiab cov mis nyuj los ntawm Tebchaws Meskas muaj tsawg kawg nkaus.

Cov kws sau ntawv pom zoo kom tsim cov tshuaj tiv thaiv kab mob parenteral rotavirus thiab tshawb xyuas seb qhov txwv tsis pub muaj kab mob siab B thaum txhaj tshuaj tiv thaiv yuav cuam tshuam rau nws txoj kev tiv thaiv kab mob. 1 mas].

Ntawm no nws tau tshaj tawm tias kev zam los ntawm kab mob siab B ib teev ua ntej thiab ib teev tom qab txhaj tshuaj tiv thaiv tsis cuam tshuam rau kev tiv thaiv kab mob ntawm cov tshuaj tiv thaiv txhua txoj kev. Ntau: [1], [2].

11. Cov tshuaj tiv thaiv kab mob rotavirus raws plab: tshuaj tiv thaiv siv. (Soares-Weiser, 2012, Cochrane Database Syst Rev)

Cochrane Systematic Review. Hauv cov teb chaws tsim kho, kev txhaj tshuaj tiv thaiv txo qis kev pheej hmoo ntawm kev mob raws plab li ntawm 40% thiab kev pheej hmoo ntawm tus kab mob rotavirus mob plab hnyav li 86%.

Kev txhaj tshuaj tiv thaiv tsis tau pom los txo cov neeg tuag.

Cov xwm txheej tsis zoo (SAE) tau tshaj tawm hauv 4.6% ntawm cov tshuaj tiv thaiv Rotaryx thiab 2.4% ntawm cov tshuaj tiv thaiv Rotatec. Cov txiaj ntsig zoo sib xws ntawm SAE tau sau tseg hauv pawg "placebo".

12. Tus nqi-zoo thiab muaj peev xwm cuam tshuam ntawm kev txhaj tshuaj tiv thaiv kab mob rotavirus hauv Tebchaws Meskas. (Widdowson, 2007, Pediatrics)

Kev txhaj tshuaj tiv thaiv kab mob rotavirus hauv Tebchaws Meskas yuav tiv thaiv 63% ntawm tag nrho cov mob rotavirus, thiab 79% ntawm tag nrho cov mob hnyav. Qhov no yuav ua rau muaj kev tiv thaiv 13 tus neeg tuag thiab 44,000 lub tsev kho mob hauv ib xyoos.

Rau ib koob tshuaj ntau dua $ 12, kev txhaj tshuaj tiv thaiv yuav tsis muaj txiaj ntsig zoo los ntawm kev noj qab haus huv pej xeem sawv daws, thiab rau koob tshuaj ntau dua $ 42, nws yuav tsis raug rau kev sib raug zoo. Hnub no Rotatek nqi $69- $83 ib koob thiab Rotarix $91- $110. 1 mas].

13. Kev ua tau zoo ntawm cov tshuaj tiv thaiv kab mob monovalent rotavirus (Rotarix) tiv thaiv kab mob plab hnyav tshwm sim los ntawm serotypically unrelated G2P [4] hom kab mob hauv pazil. (Correia, 2010, J Infect Dis)

Hauv tebchaws Brazil, tus kab mob rotavirus G2P [4], uas tshwm sim hauv 19% -30% ntawm cov neeg mob ua ntej txhaj tshuaj tiv thaiv, hloov tag nrho lwm hom kab mob 15 lub hlis tom qab pib txhaj tshuaj. Cov tshuaj tiv thaiv (Rotarix) kev ua tau zoo ntawm tus kab mob no yog 77% ntawm cov menyuam yaus hnub nyoog 6-11 hli, thiab -24% (tsis zoo) ntawm cov menyuam yaus hnub nyoog 12 xyoos. Ntau: [1], [2].

Nws tshaj tawm tias tom qab pib txhaj tshuaj tiv thaiv hauv Brazil, cov kab mob rotavirus ib txwm raug hloov los ntawm tus kab mob tshiab, G12P [8]. Cov kev hloov pauv kuj tau tshwm sim hauv Paraguay thiab Argentina.

14. Kev ua tau zoo ntawm cov tshuaj tiv thaiv kab mob monovalent rotavirus hauv Colombia: kev tshawb fawb txog kev tswj xyuas. (Cotes-Cantillo, 2014, Tshuaj Tiv Thaiv)

Kev siv tshuaj tiv thaiv (Rotarix) hauv Colombia ntawm cov menyuam yaus hnub nyoog 6-11 lub hlis yog 79%; los ntawm cov mob hnyav raws plab 63%; thiab 67% ntawm cov mob hnyav heev.

Kev ua tau zoo ntawm cov menyuam yaus tshaj 12 lub hlis yog -40%; los ntawm cov mob hnyav - 6%; thiab los ntawm cov mob hnyav heev -156% (kev ua haujlwm tsis zoo).

Qhov kev ua tau zoo ntawm cov tshuaj tiv thaiv tag nrho rau txhua lub hnub nyoog yog -2%; los ntawm cov mob hnyav -54%; thiab los ntawm cov mob hnyav heev -114% (kev ua haujlwm tsis zoo).

Nws tshaj tawm tias nyob hauv nruab nrab Australia qhov kev ua tau zoo ntawm ob koob tshuaj Rotarix yog 19% thiab qhov koob tshuaj ib zaug tsis ua haujlwm.

Nws tshaj tawm tias tsis muaj kev sib raug zoo ntawm tus nqi ntawm cov tshuaj tiv thaiv uas tsim tawm thiab kev kho mob ntawm cov tshuaj tiv thaiv.

15. Kev sib txawv ntawm cov tshuaj tiv thaiv kab mob RotaTeq® los ntawm hom tsiaj qus uas siv NSP3 gene nyob rau hauv qhov rov qab transcription polymerase saw cov tshuaj tiv thaiv. (Jeong, 2016, J Virol Methods)

Cov kws sau ntawv tau tshuaj xyuas cov quav ntawm 1,106 tus menyuam mos uas muaj mob plab thiab pom cov kab mob A rotaviruses hauv ib lub hlis twg ntawm lawv. 13.6% ntawm cov kab mob kuaj pom yog tshuaj tiv thaiv.

16. Kev kuaj xyuas cov tshuaj tiv thaiv kab mob rotateq, muab ob npaug-reassortant rotavirus hauv tus menyuam hnub nyoog 7 xyoo uas muaj mob plab hnyuv. (Hemming, 2014, Pediatr Infect Dis J)

Txij li thaum rotavirus genome muaj cais ntu, thaum ob hom kab mob sib txawv ntawm tus kab mob kis rau tib lub xovtooj, lawv tuaj yeem pauv ntu thiab tsim ib hom tshiab. Qhov no yog tib reassortment uas tshwm sim uncontrollably.

Ib rooj plaub ntawm gastroenteritis nyob rau hauv ib tug ntxhais muaj xya xyoo tau tshaj tawm ntawm no. Ib hom kab mob rotavirus raug cais tawm ntawm nws cov quav, uas yog qhov rov ua dua ntawm ob hom tib neeg-bovine los ntawm cov tshuaj tiv thaiv Rotatek. Txawm li cas los xij, tus ntxhais tsis tau txhaj tshuaj tiv thaiv kab mob rotavirus. Tsis tas li ntawd, nws tsis tau hu rau leej twg uas tau txhaj tshuaj tiv thaiv. Nws ob tug kwv tij kuj muaj cov tsos mob zoo sib xws ntawm tus kab mob plab, lawv kuj tsis tau txhaj tshuaj, thiab tsis tau ntsib nrog cov tshuaj tiv thaiv.

Cov kab mob sib kis tau raug cais tawm tau pom tias muaj kev ruaj khov thiab kis tau zoo heev. Cov kws sau ntawv ntseeg tias tus kabmob tshiab no feem ntau yuav kis mus rau cov pejxeem. Yav dhau los, cov kab mob reassortant twb raug cais tawm, tab sis tsuas yog los ntawm cov tshuaj tiv thaiv Rotatecs tsis ntev los no: [1], [2], [3].

Nws tshaj tawm txog kev tshawb pom cov kab mob tshiab los ntawm kev rov ua dua ntawm tus kab mob qus nrog cov tshuaj tiv thaiv Rotarix.

Nws tshaj tawm tias 17% ntawm cov menyuam yaus tso tus kab mob tom qab txhaj tshuaj tiv thaiv, thiab 37% ntawm lawv tso tus kab mob rov ua dua ob zaug. Qee cov menyuam yaus tso tus kab mob no ntev tom qab txhaj tshuaj tiv thaiv, txij li 9 txog 84 hnub tom qab txhaj tshuaj zaum kawg.

17. Cov tshuaj tiv thaiv-derived NSP2 ntu hauv rotaviruses los ntawm cov menyuam yaus uas muaj mob plab hnyuv hauv Nicaragua. (Bucardo, 2012, Infect Genet Evol)

Cov kws sau ntawv tau tshuaj xyuas cov kab mob rotavirus hauv cov menyuam yaus uas tau txhaj tshuaj tiv thaiv kab mob gastroenteritis hauv Nicaragua, thiab nrhiav pom cov kab mob tshiab uas tau tsim los ntawm kev sib xyaw ntawm cov tsiaj qus thiab cov tshuaj tiv thaiv kab mob los ntawm Rotatek.

18. Kev txheeb xyuas cov tshuaj tiv thaiv kab mob RotaTeq rotavirus hauv cov menyuam mos uas muaj mob plab tom qab txhaj tshuaj tiv thaiv niaj hnub. (Donato, 2012, J Infect Dis)

Ntawm cov menyuam yaus uas mob raws plab hauv ob lub lis piam tom qab txhaj tshuaj, 21% tau mob los ntawm cov tshuaj tiv thaiv kab mob. Ntawm cov tshuaj tiv thaiv cais tawm, 37% yog cov kab mob rov ua dua los ntawm ob hom tshuaj tiv thaiv Rotatek.

kaum cuaj. Kab mob rotavirus ntau zaus thiab kev pheej hmoo ntawm tus kab mob celiac autoimmunity nyob rau hauv thaum yau: kev tshawb fawb ntev. (Stene, 2006, Am J Gastroenterol)

Kev kis kab mob rotavirus tsis tu ncua yog txuam nrog kev pheej hmoo ntawm kab mob celiac.

HLA-DQ2 (ib noob txuam nrog kab mob celiac) muaj nyob rau hauv 20-30% ntawm cov neeg noj qab haus huv. Txawm li cas los xij, kab mob celiac cuam tshuam tsawg dua 1% ntawm cov neeg. 1 mas].

20. Kev txhaj tshuaj tiv thaiv kab mob rotavirus thiab hom 1 mob ntshav qab zib mellitus: Ib qho xwm txheej zes - tswj kev kawm. (Chodick, 2014, Pediatric Infectious Disease)

Qhov xwm txheej ntawm hom 1 mob ntshav qab zib mellitus ntawm cov menyuam yaus hnub nyoog qis dua 18 xyoo hauv tebchaws Ixayees tau nce 6% hauv ib xyoos ntawm xyoo 2000 thiab 2008. Thiab ntawm cov menyuam yaus hnub nyoog qis dua 5 xyoos, nws tau nce 104% hauv 6 xyoo. Cov kws sau ntawv tau qhia tias kev kis kab mob yog ib qho tseem ceeb ntawm tus kab mob, uas qhia tias kev txhaj tshuaj tiv thaiv kab mob rotavirus tuaj yeem txo qhov kev pheej hmoo ntawm ntshav qab zib. Txawm li cas los xij, nws tau pom tias cov tshuaj tiv thaiv tau txais hom 1 ntshav qab zib 7.4 npaug ntau dua li qhov tsis tau txhaj tshuaj.

21. Cov tshuaj tiv thaiv kab mob rotavirus hauv Fab Kis: vim yog peb tus menyuam mos tuag thiab ntau cov tshuaj tiv thaiv mob hnyav dhau lawm tsis pom zoo rau kev txhaj tshuaj rau menyuam yaus niaj hnub. (Michal-Teitelbaum, 2015, BMJ)

Txij li thaum pib txhaj tshuaj tiv thaiv kab mob rotavirus hauv Fab Kis, 508 cov kev mob tshwm sim (201 ntawm qhov hnyav) tau tshaj tawm, thiab 47 tus neeg mob intussusception. 2 tus me nyuam tuag ntawm intussusception thiab lwm tus tuag ntawm necrotizing enterocolitis. Hauv tsib xyoos ua ntej txhaj tshuaj tiv thaiv, Fabkis tau sau tseg tsuas yog ib tus neeg tuag los ntawm kev mob ntshav qab zib.

Yog li, cov tshuaj tiv thaiv kab mob rotavirus tsis suav nrog hauv lub sijhawm txhaj tshuaj tiv thaiv hauv tebchaws, thiab tsis tau txais nyiaj los ntawm lub xeev.

Hauv kev sim tshuaj tiv thaiv, kev txhaj tshuaj tiv thaiv tsis tau pom los txo qis kev tuag tag nrho, tsis hais nyob rau hauv cov teb chaws tsim los yog tsim.

22. Merck tau tshaj tawm tias hauv kev sim tshuaj ntawm Rotatek, qhov kev pheej hmoo ntawm kev qaug dab peg hauv cov neeg txhaj tshuaj tau nce 2 npaug piv rau pawg "placebo". Kawasaki syndrome tau tshaj tawm hauv 5 Rotatecs txhaj tshuaj tiv thaiv thiab 1 hauv pawg placebo. Ntawm cov me nyuam mos ntxov ntxov, cov teeb meem tsis zoo loj tau tshaj tawm hauv 5.5% ntawm cov menyuam yaus txhaj tshuaj thiab hauv 5.8% ntawm cov neeg tau txais "placebo".

GSK tau tshaj tawm tias hauv kev sim tshuaj Rotarix, kev tuag yog 0.19% hauv pawg tshuaj tiv thaiv thiab 0.15% hauv pawg placebo. Qhov kev pheej hmoo ntawm Kawasaki syndrome nyob rau hauv cov tshuaj tiv thaiv tau nce 71%.

Nws tau tshaj tawm tias hauv qhov kev sim tshuaj loj tshaj plaws, Rotarix (63,000 tus menyuam), muaj 2.7 npaug ntau dua kev mob ntsws ntsws tuag hauv pawg tshuaj tiv thaiv ntau dua li hauv pawg placebo. FDA ntseeg tias qhov no feem ntau yuav muaj xwm txheej. Nws yog qhov ua tau tias cov tshuaj tiv thaiv ua rau muaj kev pheej hmoo ntawm Kawasaki syndrome. Ntau [1], [2].

23. Kev tshuaj xyuas cov kab mob kis los ntawm cov menyuam yaus cov ntaub so ntswg tom qab txhaj tshuaj tiv thaiv. (Hewitson, 2014, Adv Virol)

Xyoo 2010, ib pab pawg kws tshawb fawb ywj pheej nrhiav pom porcine circovirus PCV1 hauv cov tshuaj tiv thaiv Rotarix, thiab FDA tau txiav txim siab ncua kev txhaj tshuaj. FDA thawj zaug tau hais tias Rotatec tsis muaj tus kab mob swine, tab sis ob lub hlis tom qab nws tau pom tias Rotatec muaj ob tus kab mob swine, PCV1 thiab PCV2. FDA tau hu ib pawg neeg txiav txim siab tias cov kab mob no feem ntau yuav tsis muaj mob rau tib neeg, thiab tias cov txiaj ntsig ntawm kev txhaj tshuaj tiv thaiv ntau dua qhov kev puas tsuaj. Pawg neeg kuj tau pom zoo tias cov tuam txhab tsim cov tshuaj tiv thaiv tsis muaj kab mob swine. Ib lub lis piam tom qab pom tus kab mob no hauv Rotatek, FDA tau pom zoo tias cov kws kho mob txuas ntxiv txhaj tshuaj tiv thaiv ob qho tib si. Yim xyoo dhau los txij thaum ntawd los, tab sis cov tuam txhab lag luam tsis maj nrawm los tsim cov tshuaj tiv thaiv yam tsis muaj kab mob swine.

Hauv txoj kev tshawb no, cov kws sau ntawv xav txiav txim siab seb tus kab mob swine puas sib kis hauv tib neeg txoj hnyuv. Lawv tsis pom tus kab mob swine, tab sis lawv tau pom tus kab mob endogenous M7 baboon nyob rau hauv cov tshuaj tiv thaiv Rotatek, uas tej zaum tau txais los ntawm lub raum hlwb ntawm African liab liab, uas tus kab mob rau cov tshuaj tiv thaiv yog zus.

Cov tshuaj tiv thaiv Suav siv cov yaj ntawm tus kab mob rotavirus, uas yog cog rau ntawm lub raum hlwb ntawm nyuj, thiab tus kab mob npua tsis pom nyob rau hauv cov tshuaj tiv thaiv.

Nws tshaj tawm tias tus kab mob PCV2 swine, uas tau paub txog 40 xyoo thiab tsis muaj kev phom sij, dheev hloov pauv, kis thoob plaws ntiaj teb, piglets pib mob nrog nws, thiab nws ua rau tuag rau npua. 1 ntau]

24. Intussusception txaus ntshai tom qab txhaj tshuaj tiv thaiv kab mob rotavirus hauv Asmeskas menyuam mos. (Yih, 2014, N Engl J Med)

Cov tshuaj tiv thaiv Rotatek yog txuam nrog rau cuaj-plaub txoj kev pheej hmoo ntawm intussusception (1 ntawm 65,000). Qhov no yog qhov kev txiav txim siab qis dua qhov kev pheej hmoo los ntawm kev rho tawm cov tshuaj tiv thaiv Rotashield (1-2 / 10,000).

25. Kev pheej hmoo ntawm intussusception tom qab txhaj tshuaj tiv thaiv kab mob monovalent rotavirus. (Weintraub, 2014, N Engl J Med)

Rotarix ua rau muaj kev pheej hmoo ntawm intussusception los ntawm qhov tseem ceeb ntawm 8.4 ib lub lis piam tom qab txhaj tshuaj tiv thaiv thawj zaug.

26. Intussusception txaus ntshai thiab tiv thaiv kab mob cuam tshuam nrog cov tshuaj tiv thaiv kab mob rotavirus hauv Australia's National Immunization Program.(Carlin, 2013, Clin Infect Dis)

Hauv tebchaws Australia, Rotarix tau nce qhov kev pheej hmoo ntawm intussusception hauv lub lis piam tom qab txhaj tshuaj tiv thaiv los ntawm 6.8-fold, thiab Rotatek los ntawm 9.9-fold.

Ntawm no nws tau tshaj tawm tias hauv Mexico, Rotarix nce qhov kev pheej hmoo ntawm intussusception los ntawm ib qho ntawm 6.5.

27. Kev pheej hmoo ntawm intussusception tom qab txhaj tshuaj tiv thaiv kab mob rotavirus: Cov ntaub ntawv pov thawj raws li kev tshuaj xyuas meta-kev soj ntsuam ntawm kev sib koom tes thiab kev tswj xyuas cov ntaub ntawv. (Kassim, 2017, Tshuaj Tiv Thaiv)

Meta-analysis ntawm 11 kev tshawb fawb. Thawj koob tshuaj tiv thaiv kab mob rotavirus ua rau muaj kev pheej hmoo ntawm intussusception los ntawm 3.5-8.5 zaug.

Ntau cov kev tshawb fawb pom tau tias muaj kev pheej hmoo ntawm intussusception tom qab txhaj tshuaj: [1], [2], [3], [4], [5].

Nws tshaj tawm tias tus naj npawb ntawm cov neeg mob intussusception hauv kev tshawb fawb zoo li yuav raug tshaj tawm los ntawm 44%.

28. Cov tshuaj tiv thaiv kab mob rotavirus thiab intussusception: cov niam txiv hauv Tebchaws Meskas yuav txaus siab npaum li cas thiaj tau txais cov txiaj ntsig tshuaj tiv thaiv? (Sansom, 2001, Am J Epidemiol)

Txawm hais tias muaj txiaj ntsig zoo ntawm kev txhaj tshuaj, tsis muaj tshuaj tiv thaiv zoo tag nrho. Cov kev tshawb fawb tom qab tau pom tias cov tshuaj tiv thaiv kab mob rotavirus uas tau tso cai tshiab ua rau muaj kev pheej hmoo ntawm intussusception. Txawm li cas los xij, nws tsis paub tias qhov kev pheej hmoo yuav ua li cas rau cov niam txiv, thiab lawv yuav pom zoo them nyiaj npaum li cas rau cov tshuaj tiv thaiv.

Txhawm rau ua tiav 50% kev pab them nqi, cov niam txiv txaus siab zam 2,897 intussusceptions hauv ib xyoos, ua rau 579 kev phais thiab 17 tus neeg tuag ntxiv. Thiab kom ua tiav 90% kev pab them nqi, cov niam txiv txaus siab zam tsis pub ntau tshaj 1,794 tus neeg mob intussusception, suav nrog 359 qhov kev phais thiab 11 qhov tshuaj tiv thaiv tuag.

Nees nkaum tus menyuam tuag yam tsis tau txhaj tshuaj tiv thaiv kab mob rotavirus.

Cov niam txiv cov nyiaj tau los qis dua, lawv yuav txaus siab dua.

Cov niam txiv txaus siab them $ 110 rau peb koob tshuaj tiv thaiv tsis muaj kev pheej hmoo, tab sis tsuas yog $ 36 rau peb koob tshuaj tiv thaiv kev pheej hmoo.

Lwm cov kev tshawb fawb tau pom tias cov niam txiv nyiam kev tuag los ntawm cov kab mob ntau dua li cov tshuaj tiv thaiv, thiab qhov kev tshawb fawb no tau lees paub qhov tseeb.

29. Cov tshuaj tiv thaiv tom qab rotavirus intussusception hauv cov menyuam ntxaib zoo ib yam: Cov ntaub ntawv qhia. (La Rosa, 2016, Hum Vaccin Immunother)

Ob tug menyuam ntxaib tau txhaj tshuaj Rotarix, ib lub lim tiam tom qab ntawd, ib tus ntawm lawv tau tsim cov tsos mob ntawm intussusception thiab tau ua haujlwm sai. Ob peb teev tom qab ua haujlwm, lwm tus ntxaib tau tsim cov tsos mob zoo sib xws thiab tau ua haujlwm rau. Tab sis tsis yog li ntawd ceev.

30. Tus menyuam mos uas mob plab hnyuv loj tshwm sim los ntawm kev kis kab mob thib ob nrog Rotarix-derived strain. (Sakon, 2017, Eur J Pediatr)

Ib tug ntxhais muaj ob hlis hauv Nyij Pooj tau txhaj tshuaj Rotarix, thiab 10 hnub tom qab, nws tus viv ncaus uas muaj ob xyoos tau mus pw hauv tsev kho mob nrog mob plab hnyuv loj. Nws tau pom tias nws tau cog lus los ntawm nws tus muam ib qho tshuaj tiv thaiv tus kab mob uas hloov pauv.

Nov yog tib qhov xwm txheej uas tau tshaj tawm hauv Tebchaws Meskas nrog cov tshuaj tiv thaiv Rotatek. Tus menyuam tau txhaj tshuaj 10 hnub tom qab kis nws tus tij laug nrog tus kab mob rotavirus rov qab los ntawm ob hom tshuaj tiv thaiv.

31. Kev txhaj tshuaj tiv thaiv kab mob rotavirus tsis tu ncua nyob rau hauv cov ntaub ntawv tshiab ntawm kev tiv thaiv kab mob sib kis loj heev: Ib qho laj thawj los tshuaj xyuas. (Uygungil, 2010, J Allergy Clin Immunol)

Cov me nyuam tsis muaj zog tiv thaiv kab mob tuaj yeem raug mob plab hnyuv loj rau lub sijhawm ntev tom qab txhaj tshuaj. Txawm li cas los xij, thaum muaj hnub nyoog ob lub hlis thaum txhaj tshuaj tiv thaiv, nws tseem yuav pom tias tus menyuam mos puas muaj kev tiv thaiv kab mob los yog tsis. Cov kws sau ntawv thov kom tshuaj xyuas cov menyuam yaus txog kev yug menyuam tsis xws luag ua ntej txhaj tshuaj tiv thaiv. 1 mas].

32. Hauv 10 xyoo ntawm xyoo 2007 thiab 2016, VAERS tau sau 514 tus neeg tuag thiab 230 tus neeg xiam oob qhab tom qab txhaj tshuaj tiv thaiv kab mob rotavirus. Ua ntej pib txhaj tshuaj tiv thaiv, 20 tus neeg tuag tau sau tseg hauv ib xyoos, uas yog 1: 200, 000 (thiab txawm tias lawv, tsis yog qhov tseeb tias nws yog los ntawm rotavirus).

Nrog VAERS suav txog 1% -10% ntawm tag nrho cov mob, txoj hauv kev tuag tom qab txhaj tshuaj tiv thaiv yog 25-250 npaug ntau dua li qhov yuav tuag los ntawm rotavirus.