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People with immunodeficiency must be a priority in COVID-19 vaccination efforts

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Vaccine prioritization The demand for coronavirus vaccines is much higher than the supply, so it is necessary and important. These policies ensure that the highest risk population is protected from COVID-19. This includes front-line workers (that is, nurses and doctors facing patients), the elderly, and people with serious complications. Other non-healthcare priorities are those adopted by firefighting, retail, public transport, and logistics.

These phased distribution efforts were needed to ensure a compassionate framework for high-risk people. While these initial plans were in place, findings from two case studies of immunocompromised people highlighted new priorities for vaccination. These new data highlight two bitter facts. People with immunodeficiency lack the ability to fight COVID-19, which also serves as an unintended starting point for the evolution of SARS-CoV-2, while deteriorating health.

People with immunodeficiency have weakened the immune system, so the virus attaches longer and Copy yourself To a high degree. Through this process, the virus adapts to the human cellular environment faster than normal. Promotion of mutation And the formation of potentially more contagious variants. This is similar in some respects to the fact that inaccurate or inconsistent administration of antibiotics can cause the development of antibiotic-resistant strains.

The first evidence of accelerated evolution of SARS-CoV-2 within immunocompromised individuals Reported in New England Journal of Medicine In late December 2020From a 45-year-old man with an autoimmune disease called Catastrophic antiphospholipid antibody syndrome (CAPS) A person who has a contract with COVD-19. Patients with CAPS are often treated with combination therapies that suppress the immune system and suppress autoimmunity. Men initially succeeded in fighting the virus, and about 39 days after infection, the viral load decreased. However, a month later, he was hospitalized with symptoms of COVID-19 and retested positive, one of three recurrences.

During the 154-day battle with COVID-19, the research team continued to take samples from patients to characterize the evolution of the virus. Using sequencing technology, researchers monitored the viral genome through infection. The result was amazing. They confirmed that the virus in his body had evolved significantly compared to the existing strains that were in circulation at the time.Some strains contained the same mutation that was later discovered Circulating COVID-19 variants such as E484K and N501Y It is associated with increased transmission.

Secondary evidence of accelerated COVID-19 evolution was reported in early February 2021... People receiving chemotherapy for B-cell lymphoma were immunocompromised when they were also infected with COVID-19. In a manner similar to the first study, researchers took samples from humans and evaluated how SARS-CoV-2 evolved in the body.

Once again, they saw an important evolution of the virus. Through a 102-day test, they detected many viral variants unique to this person.One predominant viral variant in the population contains a deletion of amino acid 69/70 and the mutation is Circular variant..

Further investigation showed the danger of these mutants because they were able to evade detection by antibodies known to neutralize the original SARS-CoV-2. The rapid evolution of the virus indicates an urgent need to prioritize vaccination of immunosuppressed patients, as mutations are concentrated in the spike area and are thought to alter the structure of the spike.

Despite this evidence, the urgency of prioritizing vaccination of immunosuppressed people is not reflected in public health programs.In We And Canada, Although prioritizing “patients with underlying disease” is mentioned, there is no particular focus on targeting immunocompromised patients.The· European Union and UK Focus It is the same. Vaccine efforts continue to focus on healthcare professionals and the elderly, despite the rapid expansion of vaccine availability in some US states and the current eligibility of people in other categories. I will.

Policy makers need to consider new data from the scientific community. The pivot to immunizing immunocompromised people can still use the existing framework of focusing on the oldest and most at-risk populations, which require a slight deviation from current plans. I will.

The generosity of immunocompromised people who provided samples for the study, both died of COVID-19, cannot be underestimated. Samples taken through their treatment illuminated aspects that were overlooked for the treatment of more compassionate patients. Ignoring public health perspectives, immunocompromised people should be prioritized for COVID-19 vaccination to avoid serious health complications.

By significantly changing the course and prioritizing vaccination of immunocompromised people, limiting the chances of viral evolution and protecting this group of vulnerable people from serious COVID-19 complications, the public Addressing hygiene concerns can achieve two important goals.

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