Eficacia real de las vacunas COVID-19: revisión de la literatura y meta-análisis
Real-world effectiveness of COVID-19 vaccines: a literature review and meta-analysis
KEYWORDS
1. Introduction
Recientemente, una serie de estudios han informado sobre la EV en el mundo real en todo el mundo. Un entorno de vacunación masiva a nivel nacional en Israel mostró una eficacia del 92% para las infecciones documentadas tras la segunda dosis de la vacuna BNT162b2 (Dagan et al., 2021). El gobierno del Reino Unido adoptó una estrategia de retrasar la segunda dosis para aumentar la cobertura de la vacuna, y un estudio sugirió una efectividad del 51,4% contra la infección por el SARS-CoV-2 tras una dosis de la vacuna BNT162b2 (Chodick et al., 2021). En otro estudio, se observó una eficacia del 73% contra los casos de COVID-19 entre los ancianos tras la vacunación con una dosis de la vacuna ChAdOx1 en Inglaterra (López Bernal et al., 2021). En Chile, la vacuna Sinovac aplicada a la población general de ≥16 años mostró una eficacia del 16,13% tras la primera dosis y del 66,96% tras la segunda (Ministerio de Salud, 2021).
The World Health Organization (WHO) has stated that there is an urgent need to evaluate COVID-19 VE against several major outcomes, including symptomatic COVID-19, severe diseases, and death related to COVID-19 (Patel et al., 2021). Therefore, this review and meta-analysis was conducted to estimate the COVID-19 VE against concerned outcomes in real-world settings based on the latest evidence.
2. Methods
2.1. Search and inclusion criteria
For this literature review and meta-analysis, a systematic search of PubMed was performed using the terms “COVID-19” or “SARS-CoV-2” and “vacc*” and “eff*” to identify articles published between August 6, 2020 (Deplanque and Launay, 2021) and October 6, 2021, from any country, reporting VE in a vaccinated population. In addition, major news media platforms were searched to track reports from governments and health authorities around the world evaluating the effectiveness of the COVID-19 vaccine. The review process is described in detail in Figure 1.
Figure 1. Results of the literature review according to the inclusion criteria.
Flow diagram of the study selection for meta-analysis. Fifty publications and one record reporting COVID-19 vaccine effectiveness in 14 countries from August 6, 2020 to October 6, 2021 were included in the meta-analysis.
Observational studies (cohort, case–control, test-negative case–control) were included. Studies reporting exclusively on the immunogenicity of COVID-19 vaccine, review articles, data only in abstract form, ecological studies, and mathematical modeling analysis studies were excluded. If two or more articles and reports presented results from the same dataset, all articles that included unique data points for the vaccine, study population, or vaccination status were included. In situations where the findings in one article were a subset of findings in another article (e.g., study sites and population), only the most comprehensive article was included in the overall analysis, but the subset was included in subgroup analyses. At least two reviewers examined articles to confirm that the inclusion criteria were satisfied and to reach a consensus when necessary.
Data were extracted by two independent authors in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines (PRISMA) (Page et al., 2021); the checklist is presented in Supplementary Material Table S1. The following information was abstracted: the summary VE; the stratified VE estimates by COVID-19 vaccine against a range of SARS-CoV-2 outcomes, including confirmed SARS-CoV-2 infection by reverse transcription PCR (RT-PCR), and COVID-19-related hospitalization, admission to the intensive care unit (ICU)/severe or critical hospitalization, and death; vaccination status, either partially or fully vaccinated (as the partial and full vaccination status of the individuals varied according to the recommendations of the health authorities in different countries and regions, we relied on those reported in the literature and included these in the analysis of the results); vaccine brand; study population; and study characteristics, such as the study design, study population, and sample size. These were recorded in a Microsoft Excel database.
2.2. Data analysis
Descriptive statistics and percentages were calculated for the article attributes. The real-world effectiveness of COVID-19 vaccines against a range of SARS-CoV-2 outcomes and according to vaccination status (partial and full vaccination), vaccinated population, and vaccine brand were estimated. Estimates of VE expressed as a percentage (%) with their 95% confidence intervals (95% CI) were derived from the effect measures (odds ratio, relative risk, hazard ratio, and incidence rate ratio) using the following equation: VE = [1 − effect measure] × 100. A VE estimate >0% suggests a protective effect. The results were presented in forest plots.
The heterogeneity of outcomes across studies was assessed with the I2 statistic and was quantified as low (≤25%), moderate (25–50%), or high (>50%). A random-effects model was used if the I2 statistic for the data was >25%. Otherwise, a fixed-effects model was chosen. Stratified meta-analyses were conducted to explore potential sources of study heterogeneity.
The Newcastle–Ottawa scale (NOS) (range from 0 to 9 points) was used to assess the quality of the included observational studies; a higher total NOS score suggests better quality (Wells et al., 2011). The influence of the inclusion of a study on the results of the meta-analyses was assessed by sensitivity analysis. Additionally, Egger's test and a funnel plot of the standard error were used to evaluate publication bias in analyses with 10 or more included articles. Analyses were conducted in R software (version 4.1.0; R Foundation) using the metafor package for meta-analyses (‘metafor’, 2021).
3. Results
3.1. Characteristics of the studies
A total of 13 018 records were identified and screened in the literature review; 13 016 were identified in PubMed and two reports were from the official website of a government health department.
As shown in Figure 1, 13 018 records were identified. In the preliminary review, 12901 were excluded because 12 645 were not relevant to research question based on titles, 28 were mathematical modelling analysis, 56 were clinical trial, 21 were interim guidance by official organization, 53 were other enpoints and safety, 88 were systematic review, and 10 were costeffectiveness assessments. Therefore, 115 abstracts and 2 reports remained to be reviewed. Fifty-nine articles were then read in full, of which seven were excluded because they did not meet the methodological inclusion criteria. One report did not provide information on the time span of vaccination or the age and health status of the vaccinated persons, and was therefore also excluded. In total, 50 articles and one report were included from 14 countries, involving 38 821 141 individuals.
All of the included articles were published in 2021 and reported studies of high quality (NOS score ranging from 5 to 8) (Supplementary Material Table S2). Thirty-nine were cohort studies, eight were test-negative case–control studies, and four were case–control studies. The included studies investigated five brands of COVID-19 vaccine: Pfizer-BioNTech (46 articles), Moderna (19 articles), Oxford-AstraZeneca (10 articles), CoronaVac (5 articles), and Janssen (Johnson & Johnson) (1 article). Most articles presented VE estimation for fully vaccinated and partially vaccinated individuals (34 articles, 66.7%); 11 articles (21.6%) only presented effectiveness in partially vaccinated individuals.
3.2. Vaccine effectiveness for full vaccination
The effectiveness of COVID-19 vaccines against a range of SARS-CoV-2 outcomes was estimated. A total of 35 articles reported VE against SARS-CoV-2 infection among fully vaccinated people, and the summary VE was 89.1% (95% CI 85.6–92.6%) for the prevention of SARS-CoV-2 infection (Figure 2). In addition, 15 of the included studies estimated VE against COVID-19-related hospitalization, four studies estimated VE against COVID-19-related ICU admission or severe disease, and eight studies estimated VE against COVID-19-related death. The results showed 97.2% VE (95% CI 96.1–98.3%) for the prevention of hospitalization, 97.4% VE (95% CI 96.0–98.8%) for the prevention of ICU admission or severe disease, and 99.0% VE (95% CI 98.5–99.6%) for the prevention of COVID-19-related death (Figure 3). The Egger's test and funnel plots showed no publication bias for the VE against SARS-CoV-2 infection (t-value of Egger's test = −2.91, P = 0.0988) among fully vaccinated individuals, while there was publication bias of the VE against COVID-19-related hospitalization (t-value of Egger's test = −2.91, P = 0.006) (Supplementary Material Figure S1B). After correcting for publication bias with trim and fill methods, the summary VE against COVID-19-related hospitalization among fully vaccinated individuals was 97.2% (95% CI 94.4–100.0%) (Supplementary Material Figure S1C). The sensitivity analysis suggested lower VE against COVID-19-related hospitalization (93.0%, 95% CI 91.0–96.0%) and ICU admission and severe disease (89.0%, 95% CI 76.0–100.0%) when deleting the results of the study conducted by Haas et al. (Haas et al., 2021) (Supplementary Material Figures S2 and S3).
Figure 2. COVID-19 vaccine effectiveness (VE) for the prevention of SARS-CoV-2 infection in those with a fully vaccinated status.
Forest plot showing VE for the prevention of SARS-CoV-2 infection for fully vaccinated populations; a total of 35 studies contributed information on the effectiveness against SARS-CoV-2 infection.
Figure 3. COVID-19 vaccine effectiveness (VE) for the prevention of COVID-19-related hospitalization, admission to the ICU/severe or critical hospitalization, and death in those with a fully vaccinated status.
Forest plot showing VE for the prevention of COVID-19-related hospitalization, severe disease, and death for fully vaccinated populations; a total of 15 included studies contributed information on effectiveness against COVID-19-related hospitalization, four on effectiveness against COVID-19-related severe disease, and eight on effectiveness against COVID-19-related death.
3.3. Vaccine effectiveness for partial vaccination
Regarding individuals with a partial immunization status, 38 included studies reported VE against SARS-CoV-2 infection, 12 reported VE against COVID-19-related hospitalization, three reported VE against COVID-19-related ICU admission or severe disease, and eight reported VE against COVID-19-related death. The summary VE was 68.8% (95% CI 60.1–77.5%) for the prevention of SARS-CoV-2 infection and 67.8% (95% CI 51.6–83.9%) for the prevention of hospitalization, 66.4% (95% CI 25.9–100.0%) for the prevention of admission to the ICU and severe disease, and 58.4% (95% CI 28.0–88.7%) for the prevention of COVID-19-related death (Supplementary Material Figures S4 and S5). The Egger's test and funnel plots suggested no publication bias of the VE against SARS-CoV-2 infection (t-value of Egger's test = −1.31, P = 0.1956) or hospitalization (t-value of Egger's test = −0.28, P = 0.7839) for partially vaccinated individuals (Supplementary Material Figure S6). The sensitivity analysis suggested higher VE against SARS-CoV-2 infection (75.0%, 95% CI 71.0–80.0%) among the partially vaccinated individuals when deleting the results of the CoronaVac vaccine study from Chile reported by the Ministerio de Salud (Ministerio de Salud, 2021) (Supplementary Material Figure S7 and S8).
3.4. Subgroup analyses
The COVID-19 VE for the prevention of SARS-CoV-2 infection confirmed by RT-PCR was estimated in fully vaccinated individuals in different populations. An analysis in the predefined subgroups of the elderly (age ≥60 years), healthcare workers (HCWs), and the general population (adults ≥16 years) was conducted. There were 15, 17, and 11 articles including four brands of COVID-19 vaccine (Pfizer-BioNTech, Moderna, Oxford-AstraZeneca, and CoronaVac) presenting the VE against SARS-CoV-2 infection among the elderly, HCWs, and the general population, respectively. The summary VE was 83.8% (95% CI 77.1–90.6%) among the elderly, 95.3% (95% CI 92.0–98.6%) among HCWs, and 86.1% (95% CI 77.8–94.4%) among the general population (Figure 4).
Figure 4. COVID-19 vaccine effectiveness (VE) for the prevention of SARS-CoV-2 infection in different populations.
Forest plot showing VE for the prevention of SARS-CoV-2 infection for fully vaccinated populations based on different population groups; a total of 17 included studies contributed information on effectiveness against SARS-CoV-2 infection for healthcare workers (HCWs), 15 on effectiveness against SARS-CoV-2 infection for the elderly, and 11 on effectiveness against SARS-CoV-2 infection for the general population aged ≥16 years.
The VE of the different vaccine brands was also estimated among the fully vaccinated people. For the Pfizer-BioNTech vaccine, a total of 23 articles reported the VE for full vaccination. The summary VE was 91.2% (95% CI 87.9–94.5%) against SARS-CoV-2 infection (Figure 5), 97.6% (95% CI 96.5–98.7%) against COVID-19-related hospitalization, and 98.1% (95% CI 96.3–99.9%) against COVID-19-related death (Figure 6). Five articles estimated the effectiveness of the Moderna vaccine and three estimated the effectiveness of the CoronaVac vaccine, against SARS-CoV-2 infection. The Moderna vaccine presented the highest VE against infection, with a summary VE of 98.1 % (95% CI 96.0–100.0%). The VE against infection of the CoronaVac vaccine was 65.7% (95% CI 63.0–68.5%) (Figure 5). Only one article, from India, reported the effectiveness against infection of the Oxford-AstraZeneca vaccine in fully vaccinated individuals: VE was 88.6% (95% CI 81.6–92.4%) (Zacay et al., 2021). Furthermore, eight articles reported the VE of the Oxford-AstraZeneca vaccine among partially vaccinated people, and the summary VE was 81.8% (95% CI 67.1–96.6%) (Supplementary Material Figure S9). No significant publication bias was detected for the subgroup analysis (P > 0.05).
Figure 5. Summary vaccine effectiveness (VE) against SARS-CoV-2 infection for the different brands in those with a full vaccination status.
Forest plot showing VE for the prevention of SARS-CoV-2 infection for fully vaccinated populations with different vaccine brands; a total of 23 included studies contributed information on the effectiveness of the Pfizer-BioNTech vaccine, five on the effectiveness of the Moderna vaccine, and three on the effectiveness of the CoronaVac vaccine.
Figure 6. Summary vaccine effectiveness (VE) against COVID-19-related hospitalization and death of the Pfizer-BioNTech vaccine among fully vaccinated individuals.
Forest plot showing VE for the prevention of COVID-19-related hospitalization and death for the Pfizer-BioNTech vaccine among fully vaccinated individuals; a total of nine included studies contributed information on effectiveness against COVID-19-related hospitalization and three on effectiveness against COVID-19-related death for the Pfizer-BioNTech vaccine.
4. Discussion
Se observó que había una alta heterogeneidad para el resumen de la EV contra la infección por el SARS-CoV-2 entre los individuos totalmente vacunados. Además de la eficacia real de las diferentes vacunas, la evaluación de la eficacia poblacional depende de una serie de factores, como la población vacunada, la gravedad de la epidemia, la integridad y validez de las fuentes de datos, el diseño del estudio y los posibles sesgos metodológicos (Patel et al., 2021). Por lo tanto, se realizaron análisis de subgrupos y de sensibilidad para explorar la posible heterogeneidad. En consonancia con los resultados de los ensayos clínicos de fase III, la eficacia de las diferentes vacunas contra la infección confirmada en condiciones del mundo real varió (Baden et al., 2021; Palacios et al., 2020; Skowronski y De Serres, 2021; Voysey et al., 2021). La evidencia sintetizada de diferentes entornos de estudio mostró una efectividad del 91,2%, 98,1% y 65,7% de la vacuna de Pfizer-BioNTech, la vacuna Moderna y la vacuna CoronaVac, respectivamente. En el caso de la vacunación completa, se observó una menor VE contra la hospitalización y la enfermedad grave relacionada con el COVID-19 cuando se eliminaron los resultados del estudio realizado por Haas et al. (Haas et al., 2021). Este estudio, con una puntuación de alta calidad, reveló que dos dosis de BNT162b2 eran altamente eficaces en todos los grupos de edad en Israel, basándose en datos de vigilancia a nivel nacional. El análisis de sensibilidad mostró una mayor VE tras omitir los resultados de la vacuna CoronaVac (Hitchings et al., 2021; Ministerio de Salud, 2021). La EV de CoronaVac, una vacuna de virus entero inactivado, puede verse influenciada en un entorno de alta transmisión de la variante Gamma del SARS-CoV-2, ya sea en Brasil o en Chile (Jara et al., 2021; Palacios et al., 2020; Ranzani et al., 2021). Asimismo, la EV está estrechamente relacionada con el estado de vacunación. El análisis de subgrupos por estado de vacunación reveló una eficacia del 66,8%, 67,8%, 66,4% y 58,4% de la vacunación parcial contra la enfermedad con infección confirmada por SARS-CoV-2, la hospitalización relacionada con COVID-19, el ingreso en la UCI/la enfermedad grave y la muerte, respectivamente, a pesar de ser menos eficaz que la vacunación completa. Por lo tanto, este hallazgo apoya la propuesta en muchos países de ampliar el intervalo de dosificación para optimizar la cobertura de la vacuna con el creciente número de nuevas infecciones y la propagación de las variantes del SARS-CoV-2 (Chodick et al., 2021; Krutikov et al., 2021; Shrotri et al., 2021). Además, varios estudios han mostrado una mayor EV para períodos de tiempo más largos desde la vacunación, ya sea para la vacunación parcial o completa (Jones et al., 2021; Rudolph et al., 2021; Zaqout et al., 2021).
Dada la mayor mortalidad observada en los ancianos de los centros de atención a largo plazo y el mayor riesgo de exposición de los trabajadores sanitarios ((Equipo de respuesta a la COVID-19 de los CDC, 2020); Wu y McGoogan, 2020; Zhou et al., 2020), muchos países han dado prioridad a la vacunación de estos dos grupos de alto riesgo (Britton et al., 2021; López Bernal et al., 2021). Sin embargo, los pacientes de edad avanzada han estado menos representados en los ensayos clínicos, que han inscrito principalmente a poblaciones jóvenes (Prendki et al., 2020). En este estudio, sintetizamos las pruebas del mundo real por población vacunada. El efecto más protector se observó en los trabajadores sanitarios (VE = 95,3%), mientras que se observó un menor VE en los ancianos (VE = 83,8%). Debido a la inmunosenescencia y a las comorbilidades, los ancianos son más susceptibles a las infecciones y tienen peores respuestas a la vacunación (Brosh-Nissimov et al., 2021; Ciabattini et al., 2018; Frasca et al., 2010; McElhaney et al., 2013). Por lo tanto, más allá de la vacunación, es necesario implementar más medidas para los ancianos para reducir los resultados graves relacionados con las infecciones y controlar la transmisión en los centros de atención.
Este meta-análisis tiene algunas limitaciones. En primer lugar, no fue posible estimar la eficacia a largo plazo de las vacunas debido a la limitada duración del seguimiento. En un estudio de casos y controles negativo realizado en Inglaterra, la protección de la vacunación completa con la vacuna Oxford-AstraZeneca en los ancianos se mantuvo desde la segunda semana (VE = 22,0%, IC del 95%: 11,0-32,0%) después de la vacunación hasta el final del seguimiento (más de 6 semanas) (VE = 73,0%, IC del 95%: 27,0-90,0%) (López Bernal et al., 2021). En el sistema de salud de la Clínica Mayo, la eficacia tras la segunda dosis de la vacuna de Pfizer-BioNTech o de la vacuna Moderna aumentó del 53,6% (IC del 95%: 40,9-63,8%) en la primera semana al 92,5% (IC del 95%: 70,2-99,1%) en la sexta semana (Pawlowski et al., 2021). Según las pruebas disponibles, hay un aumento de la EV en las seis semanas siguientes a la vacunación completa, pero es difícil revelar el pico de eficacia y la duración real de la protección de la inmunización.
En segundo lugar, no se estimó la EV contra el contagio a otras personas. Un estudio de cohortes retrospectivo realizado en EE.UU. sugirió una eficacia del 80,0% (IC del 95%: 91,0-56,0%) contra la infecciosidad a otras personas tras la segunda dosis de la vacuna de Pfizer-BioNTech (Tande et al., 2021). Además, se estimó que una sola dosis de la vacuna Moderna reducía la posible transmisión a otros en un 61,0% (IC del 95%: 31,0-79,0%) (Lipsitch y Kahn, 2021). La vacuna podría reducir el riesgo de transmisión, pero se necesitan más estudios para evaluar la EV real de cada vacuna.
En tercer lugar, la aparición de variantes de SARS-CoV-2 ha provocado un aumento de las infecciones graves (Gómez et al., 2021). Las cuatro variantes dominantes de interés (VOC) son B.1.1.7 (Alfa, Reino Unido, septiembre-2020), B.1.351 (Beta, Sudáfrica, mayo-2020), P.1 (Gamma, Brasil, noviembre-2020) y B.1.617.2 (Delta, India, octubre-2020) (OMS, 2021a). Varios ensayos clínicos han informado de la eficacia de la vacuna contra las variantes (Haas et al., 2021). No hubo eficacia contra el COVID-19 de leve a moderado debido a la variante B.1.351 (VE = 21,9%, IC del 95%: -49,9% a 59,8%) después de dos dosis de la vacuna ChAdOx1 nCoV-19 (Madhi et al., 2021). Sin embargo, dos dosis de la vacuna de Pfizer-BioNTech mostraron una eficacia del 87,0% (IC del 95%: 81,8-90,7%) contra la variante B.1.1.7 y del 72,1% (IC del 95%: 66,4-76,8%) contra la variante B.1.351 (Abu-Raddad et al., 2021). Además, la VE para dos dosis de la vacuna CoronaVac fue del 59,0% (IC del 95%: 16,0-81,6%) contra la variante B.1.617.2 (Li et al., 2021). Una dosis única de la vacuna Ad26.COV2.S también mostró una eficacia del 68,1% (IC del 95%: 48,8-80,7%) contra la variante P.1 para prevenir la COVID-19 de moderada a grave (Sadoff et al., 2021). Las estimaciones de la VE contra las variantes del SARS-CoV-2 en entornos reales son escasas, por lo que no fue posible evaluar la VE con las variantes. Esto debe examinarse en futuros estudios.
Los estudios realizados en el mundo real han demostrado que las vacunas aprobadas son altamente protectoras contra el SRAS-CoV-2; por lo tanto, el objetivo debe ser la vacunación completa según el calendario estándar para lograr la máxima EV. Cabe señalar que la vacunación no puede eliminar el riesgo de infección (Brosh-Nissimov et al., 2021), por lo que deben tomarse en serio las medidas de prevención y control, especialmente para los grupos de alto riesgo.
En conclusión, de acuerdo con los resultados de los ensayos clínicos de fase III, las vacunas autorizadas son altamente protectoras contra el SARS-CoV-2 en entornos reales. Además, la EV real depende no sólo de la eficacia de la propia vacuna, sino también de la población vacunada y de su estado. Las medidas preventivas siguen siendo esenciales.
Acknowledgements
The authors are very thankful to everyone who participated in this study.
Declarations
Funding source: This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.
Ethical approval: This study did not require ethical approval because the meta‐analysis is based on published research, and the original data are anonymous.
Conflict of interest: The authors declare no conflict of interest.
Author contributions
Weidong Zhang, Caifang Zheng, and Weihao Shao designed the study. Caifang Zheng and Weihao Shao designed the search strategies and performed the literature search. Xiaorui Chen, Bowen Zhang, and Gaili Wang reviewed the literature and extracted the available data. Caifang Zheng and Weihao Shao analyzed the data and wrote the paper. All authors approved the submitted and final versions.
Appendix. Supplementary materials
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Caifang Zheng and Weihao Shao contributed equally to this manuscript.
CaifangZhengWeihaoShaoXiaoruiChenBowenZhangGailiWangWeidongZhang
https://www.sciencedirect.com/science/article/pii/S1201971221008572
¿Que hemos aprendido?
Deberemos asumir que los avances en la ciencia son complicados de entender, y que los mismos expertos en unos temas se pueden contradecir en otros, si con la pandemia actual se están observando contradicciones, podemos pronosticar que en los próximos avances en biotecnologia, en IA en robotización se producirán muchas confusiones, alimentadas por los medios de comunicación ,si actúan como con esta pandemia.
https://articulosclaves.blogspot.com/2021/07/pandemia-y-ciencia-bajo-presion-que.html
-Omicron y la incertidumbre-Agencia Sinc.es
· https://notistecnicas.blogspot.com/2021/12/omicron-y-la-incertidumbre.html
· https://notistecnicas.blogspot.com/2021/12/hkumed-descubre-que-omicron-sars-cov-2.html
COVID-19 Año 2: Qué sabemos sobre Omicron, la variante que está provocando millones de infecciones.
· El Dr. JM Miró, del Hospital Clínic de Barcelona, ofrece 45 minutos de actualización sobre Omicron, la variante del SARS-CoV-2 que está provocando millones de infecciones en todo el mundo..
· https://www.youtube.com/watch?v=X_FuPGY5d18
· https://www.youtube.com/channel/UCvqwrga5-pwV9Dpm8Tj7Nww
-Omicron :Resumen Grupo de Investigacion Cientifica en Salud y tecnologia
· Grupo de Investigacion Cientifica en Salud y tecnologia de Cochapamba, conformado por: investigadores, médicos especialistas, medicos generales, medicos residentes, estudiantes de medicina -Omicron ACTUALIZADO 22/12/21
· https://notistecnicas.blogspot.com/2021/12/omicron-resumen-grupo-de-investigacion.html
Las mutaciones del coronavirus SARS-CoV-2
Marcos López Hoyos: “La COVID seguirá mutando a una variante menos agresiva que la convertirá en un catarro”
Variantes
https://articulosclaves.blogspot.com/2022/02/a-vueltas-con-deltacron-otra-vez-se.html
-Omicron / Repaso al tema mutaciones
· https://notistecnicas.blogspot.com/2021/12/omicron-repaso-al-tema-mutaciones.html
https://notistecnicas.blogspot.com/2020/03/las-mutaciones-del-coronavirus-sars-cov.html
-Coronavirus: qué se sabe de las mutaciones del virus del covid-19 (y cómo los científicos las están siguiendo en tiempo real)
-Cómo son las mutaciones en los virus y qué sabemos en el caso del SARS-CoV-2
-Coronavirus: cómo mutan los virus y cómo prevén los científicos que puede evolucionar el covid-19
La evolución es impredecible.:Si el virus consigue por ejemplo replicar más rápido o generar más progenie prescindiendo de funciones supresoras de inmunidad celular, podría haber más patogenia y más dispersión al mismo tiempo.
-El virus muta, obtiene ventaja y la naturaleza decide. Ella al azar ha decidido que Omicron es muy transmisible y menos virulento, por eso se extiende como la pólvora.
https://articulosclaves.blogspot.com/2021/12/mutaciones-virus.html
Coronavirus: qué se sabe de las mutaciones del virus del covid-19 (y cómo los científicos las están siguiendo en tiempo real)
Cómo son las mutaciones en los virus y qué sabemos en el caso del SARS-CoV-2
Habrá otra variante y mas olas
https://articulosclaves.blogspot.com/2022/01/el-pasaporte-covid-no-frena.html
La vigilancia genómica ha sido una excelente herramienta que ha ayudado a conocer como mutaba el virus.
https://articulosclaves.blogspot.com/2022/01/habra-otra-variante-esto-es-lo-que-el.html
Variantes, casuística
· https://articulosclaves.blogspot.com/2022/01/humans-2-omicron-1-etopol.html
· https://articulosclaves.blogspot.com/2022/01/ihu-no-se-impuso-la-variante-delta-y.html
Variantes en estudio
· https://twitter.com/hashtag/Flurona?src=hashtag_click
· https://twitter.com/hashtag/Deltacron?src=hashtag_click
Estimated transmissibility and impact of SARS-CoV-2 lineage B.1.1.7 in England
https://www.science.org/doi/10.1126/science.abg3055
La infección #Ómicron mejora la inmunidad neutralizante contra #Delta. Esto sugiere que Ómicron ayudará a expulsar a Delta, ya que debería disminuir la probabilidad de que alguien infectado con Omicron se vuelva a infectar con Delta
· https://articulosclaves.blogspot.com/2021/12/mutaciones-virus.html
La infección #Ómicron mejora la inmunidad neutralizante contra #Delta. Esto sugiere que Ómicron ayudará a expulsar a Delta, ya que debería disminuir la probabilidad de que alguien infectado con Omicron se vuelva a infectar con Delta
- HKUMed descubre que Omicron SARS-CoV-2 puede infectar más rápido y mejor que Delta en el bronquio humano pero con una infección menos grave en el pulmón/ Evidence for a mouse origin of the SARS-CoV-2 Omicron variant-
· https://notistecnicas.blogspot.com/2021/12/hkumed-descubre-que-omicron-sars-cov-2.html
Transmission of SARS-CoV-2 by children and young people in households and schools: A meta-analysis of population-based and contact-tracing studies
· https://www.journalofinfection.com/article/S0163-4453(21)00633-2/fulltext
"Un estudio del Imperial College de Londres concluye que la inmunidad natural generada después de la infección por ómicron roza el 19% frente al 85% que proporcionaba Delta"
https://www.imperial.ac.uk/news/232698/omicron-largely-evades-immunity-from-past/
https://articulosclaves.blogspot.com/2022/01/omicron-se-transmite-con-mas-rapidez.html
-Asymptomatic transmission and high community burden of seasonal influenza in an urban and a rural community in South Africa, 2017–18 (PHIRST): a population cohort study
https://www.thelancet.com/journals/langlo/article/PIIS2214-109X(21)00141-8/fulltext
- La tercera ola y el gráfico de Victor Tseng
https://notistecnicas.blogspot.com/2022/01/la-tercera-ola-y-el-grafico-de-victor.html
Hacia el fin de la excepcionalidad
https://notistecnicas.blogspot.com/2022/01/hacia-el-fin-de-la-excepcionalidad.html
Early assessment of the clinical severity of the SARS-CoV-2 Omicron variant in South Africa
Severity of Omicron variant of concern and vaccine effectiveness against symptomatic disease: national cohort with nested test negative design study in Scotland
Resistence of functional memory B cells recognizing SARS-CoV-2 variants despite loss of specific IgG
· https://www.cell.com/iscience/fulltext/S2589-0042(21)01629-
Maduración de la afinidad : las células B de memoria pueden modificar los Ac para adaptarse a las modificaciones de las variantes
Targeting memory T cell metabolism to improve immunity
· https://notistecnicas.blogspot.com/2021/12/t-cell-receptors-tcrs.html
SARS-CoV-2 spike T cell responses induced upon vaccination or infection remain robust against Omicron
· https://notistecnicas.blogspot.com/2021/12/sars-cov-2-spike-t-cell-responses.html
Maduración de la afinidad : las células B de memoria pueden modificar los Ac para adaptarse a las modificaciones de las variantes
· https://www.cell.com/iscience/fulltext/S2589-0042(21)01629-1
· https://www.medrxiv.org/content/10.1101/2021.12.27.21268278v1.full.pdf
The omicron (B.1.1.529) SARS-CoV-2 variant of concern does not readily infect Syrian hamsters
· https://www.biorxiv.org/content/10.1101/2021.12.24.474086v1
Firma de las células T CD8+ de memoria de larga duración en la infección aguda por SARS-CoV-2 e Interferon
· https://notistecnicas.blogspot.com/2021/12/firma-de-las-celulas-t-cd8-de-memoria.html
· https://notistecnicas.blogspot.com/2021/01/asi-funcionan-las-vacunas-de-arn.html
· https://notistecnicas.blogspot.com/2020/12/de-hungria-un-futuro-nobel-retrato-de.html
Comparison of outcomes from COVID infection in pediatric and adult patients before and after the emergence of Omicron
· https://www.medrxiv.org/content/10.1101/2021.12.30.21268495v1
SARS-CoV-2 and influenza virus co-infection
Ómicron infecta menos las células pulmonares
· Al menos en modelos celulares y en hámsteres. Es verdad que no tenemos el dato en humanos, pero existen varios trabajos preliminares que sugieren que la variante ómicron se multiplica peor en células pulmonares, lo cual podría ser indicativo de su menor virulencia (aunque habría que comprobar qué ocurre en otros órganos).
· https://www.biorxiv.org/content/10.1101/2021.12.24.474086v1
Early Remdesivir to Prevent Progression to Severe Covid-19 in Outpatients
· https://www.nejm.org/doi/full/10.1056/NEJMoa2116846?s=09
Preclinical studies demonstrate sotrovimab retains activity against the full combination of mutations in the spike protein of the Omicron SARS-CoV-2 variant
· https://www.gsk.com/en-gb/media/press-releases/sotrovimab-retains-activity/
SARS-CoV-2 entry sites are present in all structural elements of the human glossopharyngeal and vagal nerves: clinical implications
· https://www.biorxiv.org/content/10.1101/2021.12.30.474580v1
Early assessment of the clinical severity of the SARS-CoV-2 Omicron variant in South Africa· https://www.medrxiv.org/content/10.1101/2021.12.21.21268116v1?fbclid=IwAR0HPDCG_7NOhYPVgZ9HDNOM6Eae1OgoGZLYL35snjumdoCPFF9wFxU7n5g
Severity of Omicron variant of concern and vaccine effectiveness against symptomatic disease: national cohort with nested test negative design study in Scotland
Persistence of functional memory B cells recognizing SARS-CoV-2 variants despite loss of specific IgG
Maduración de la afinidad : las células B de memoria pueden modificar los Ac para adaptarse a las modificaciones de las variantes
· https://www.cell.com/iscience/fulltext/S2589-0042(21)01629-1
· El Paxlovid es un inhibidor de una de las proteasas del SARS-CoV-2, la denominada 3CL. El tratamiento se combina con otro inhibidor de las proteasas, el ritonavir, que ha sido empleado contra el VIH.
El anticuerpo monoclonal Sotrovimab, de la empresa GSK, también parece que es eficaz contra ómicron.
· https://www.gsk.com/en-gb/media/press-releases/sotrovimab-retains-activity/
El Remdesivir, un inhibidor de la ARN polimerasa viral, es otro antiviral que enpacientes no hospitalizados con síntomas covid-19 Hasta la fecha, la actividad antiviral de Remdesivir ha sido confirmada in vitro contra todas las otras variantes del SARS-CoV-2, incluyendo alfa, beta, gamma, delta y épsilon.
· https://www.nejm.org/doi/full/10.1056/NEJMoa2116846?s=09
Co-infection with SARS-CoV-2 and Influenza A Virus in Patient with Pneumonia, China
· https://wwwnc.cdc.gov/eid/article/26/6/20-0299_article
The clinical characteristics of pneumonia patients co-infected with 2019 novel coronavirus and influenza virus in Wuhan, China
SARS-CoV-2 and influenza virus co-infection
· https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)31052-7/fulltext
Estudio danés sobre transmisión de Ómicron en vacunados más q en no vacunados
· https://www.medrxiv.org/content/10.1101/2021.12.27.21268278v1
Análisis de Rafa Toledo
· https://notistecnicas.blogspot.com/2021/12/omicron-repaso-al-tema-mutaciones.html
· https://999plazaradio.valenciaplaza.com/omicron-coronavirus-vacunas-inmunizacion
· https://notistecnicas.blogspot.com/2022/01/febrero-sera-clave-empezaran-liberarse.html
Viral dynamics and duration of PCR positivity of the SARS-CoV-2 Omicron variant
https://www.medrxiv.org/content/10.1101/2022.01.13.22269257v1
https://www.medrxiv.org/content/10.1101/2022.01.10.22269010v2.full.pdf
Se inicia en ensayo clínico para analizar la eficacia
y seguridad de una vacuna de Pfizer/BioNTech diseñada específicamente contra la
variante ómicron del SARS-CoV-2
Vacunas
Vacunados versus no vacunados-Morbidity and Mortality Weekly Report (MMWR)
https://notistecnicas.blogspot.com/2022/01/vacunados-versus-no-vacunados-morbidity.html
El supuesto milagro de las vacunas dic 2020 reeditado
https://articulosclaves.blogspot.com/2022/02/el-supuesto-milagro-de-las-vacunas-dic.html
·Vacunados/No vacunados
· https://articulosclaves.blogspot.com/2021/12/vacunados-no-vacunados-ny-mayo.html
Las vacunas inmunizan es un hecho incuestionable.
· https://twitter.com/alfwarrior/status/1403313688623435782
· https://twitter.com/alfwarrior/status/1476452714997506050
· https://articulosclaves.blogspot.com/2022/01/las-vacunas-inmunizan.html
https://twitter.com/RanIsraeli/status/1483545718359048197
Triste época: 31 marzo 2020, total fallecidos 849 diarios (no habían las vacunas)
Vacunación
https://articulosclaves.blogspot.com/2022/01/vacunados-versus-no-vacunados-morbidity.html
https://notistecnicas.blogspot.com/2021/01/asi-funcionan-las-vacunas-de-arn.html
Vacunación niños
https://articulosclaves.blogspot.com/2022/02/rafael-toledo-catedratico-considero-que.html
Inmunidad
· https://notistecnicas.blogspot.com/2021/07/drosten-y-la-inmunidad-de-grupo.html
· https://notistecnicas.blogspot.com/2021/09/inmunologia-basica-o-como-nos.html
· https://notistecnicas.blogspot.com/2021/12/firma-de-las-celulas-t-cd8-de-memoria.html
· https://notistecnicas.blogspot.com/2021/12/sars-cov-2-spike-t-cell-responses.html
Darle al virus donde más le duele: los dos nuevos antivirales contra SARS-CoV-2
· https://notistecnicas.blogspot.com/2021/12/epidemiologia-y-dinamica-de-transmision.html
· https://notistecnicas.blogspot.com/2022/01/enlaces-coronavirusmutaciones.html
· https://notistecnicas.blogspot.com/2021/12/inmunidad-de-grupo-agutierrez.html
El débil ataque de Omicron a los pulmones podría hacerlo menos peligroso.
Omicron’s feeble attack on the lungs could make it less dangerous
· Mounting evidence from animal studies suggests that Omicron does not multiply readily in lung tissue, which can be badly damaged in people infected with other variants.
· https://www.nature.com/articles/d41586-022-00007-8
SARS-CoV-2 Omicron triggers cross-reactive neutralization and Fc effector functions in previously vaccinated, but not unvaccinated individuals
https://www.medrxiv.org/content/10.1101/2022.02.10.22270789v1
Eficacia Vacunas
Meta-análisis sobre casi 40.000.000 de personas vacunadas, en más de 14 países, y analizando 50 papers de alto impacto concluye que:
"Las vacunas autorizadas son ALTAMENTE efectivas contra la COVID en la práctica real"
· https://articulosclaves.blogspot.com/2022/01/las-vacunas-inmunizan.html
https://notistecnicas.blogspot.com/2021/07/el-concepto-de-eficacia-en-las-vacunas.html
·The novel coronavirus originating in Wuhan, China: challenges for global health governance.
Coronavirus disease 2019 (COVID-19) situation report—100.
La evolución de las vacunas: de Edward Jenner a Katalin Karikó
El aumento de las células T citotóxicas del LBA está relacionado con el daño epitelial y la enfermedad de las vías respiratorias
https://www.uptodate.com/landing/covid19
Inmunidad
https://articulosclaves.blogspot.com/2022/02/asi-es-la-inmunidad-innata-la-razon-por.html
Muchas personas opinando en las redes, pero muy pocos PRIMERO se leen los informes de Farmacologia
Farmacovigilancia y seguridad de las vacunas frente al SARS-CoV-2
https://notistecnicas.blogspot.com/2021/03/farmacovigilancia-y-seguridad-de-las.html - Marzo 2021-
10-11 y 12 º Informe de Farmacovigilancia sobre Vacunas COVID-19
https://notistecnicas.blogspot.com/2022/02/10-11-y-12-informe-de-farmacovigilancia.html
https://notistecnicas.blogspot.com/2021/04/4-informe-de-farmacovigilancia-sobre.html
https://notistecnicas.blogspot.com/2021/05/portadacovid19-5-informe-de.html
https://notistecnicas.blogspot.com/2021/07/7-informe-de-farmacovigilancia-sobre.html
https://notistecnicas.blogspot.com/2021/12/8-y-9-informe-de-farmacovigilancia.html
https://notistecnicas.blogspot.com/2022/02/la-logica-de-la-ciencia.html
Interferon
· https://notistecnicas.blogspot.com/2021/06/interferon-resistance-of-emerging-sars.html
https://notistecnicas.blogspot.com/2022/01/omicron-e-interferon.html
Interferon y otros farmacos que se utilizan en el virus de la hepatitis C (fibrosis higado) - En estudio, relación interferon con coronavirus -Marzo 2020
La combinación de tres antivirales ( interferón beta-1b más lopinavir-ritonavir y ribavirina) se muestra prometedora para tratar la Covid-19 -Mayo 2020
Resistencia al interferón de las variantes emergentes del SARS-CoV-2 -Junio 2021
Hepa C
-Interferon y relación con fibrosis pulmonar
https://notistecnicas.blogspot.com/2020/03/murcielagos-vs-interferon-medicacion.html
https://notistecnicas.blogspot.com/2020/03/en-estudio-relacion-interferon-con.html
https://notistecnicas.blogspot.com/2020/05/fibrosis-pulmonar-y-covid.html
https://notistecnicas.blogspot.com/2021/06/interferon-resistance-of-emerging-sars.html
https://notistecnicas.blogspot.com/2021/09/los-farmacos-contra-el-virus-de-la.html
Antivirales
https://notistecnicas.blogspot.com/2020/05/la-combinacion-de-tres-antivirales.html
https://notistecnicas.blogspot.com/2021/09/el-remdesivir-reduce-un-87-el-riesgo-de.html
Otros
enlaces anteriores
https://notistecnicas.blogspot.com/2020/03/bioestadistica-econometria-graficas.html
https://notistecnicas.blogspot.com/2015/01/hepatitis-c-raymond-schinazzifarmacos.html
En este documental de Eduard Punset se explica como se conocía la peligrosidad de los coronavirus SARS y como en cualquier momento podría aparecer un virus como el que padecemos actualmente.
https://www.youtube.com/watch?v=7PHTix2AFEg
Redes
https://www.youtube.com/watch?v=xz_M-TRJGgk
El retorno de las epidemias
https://www.youtube.com/watch?v=a3-mIeOJnbU
Bioquimica
https://www.youtube.com/watch?v=DDXY1ig1v68
La tendencia general
https://articulosclaves.blogspot.com/2022/01/la-tendencia-general-lopez-acunala.html
Ver gráficos análisis Sudáfrica y otros países (11-2021 y 12-2021)
https://articulosclaves.blogspot.com/2022/01/vacunacion-o-restriccionesel-debate.html
https://articulosclaves.blogspot.com/2021/12/catalunya-toque-de-queda-se-han.html
https://articulosclaves.blogspot.com/2021/12/senales-mixtas-ante-senales-mixtas-hay.html
https://articulosclaves.blogspot.com/2022/01/analizando-sudafrica-y-ahora-uk-verian.html
Visión estática de la pandemia
https://articulosclaves.blogspot.com/2022/01/vision-estatica-de-la-pandemia-y-seguir.html
La tendencia general…
https://articulosclaves.blogspot.com/2022/01/la-tendencia-general-lopez-acunala.html
Long-Term Mortality Following COVID-19 Infection: A National Cohort Study From Estonia
https://papers.ssrn.com/sol3/papers.cfm?abstract_id=4028547
Covid-19 en España durante 2021
Boscá, J. E., J. Cano y J. Ferri (2022). “Covid-19 en España durante 2021.” FEDEA, Documento de Trabajo no. 2022-01. Madrid.
https://policy.fedea.net/covid-19-en-espana-durante-2021/
https://es.scribd.com/document/554801455/covid#download&from_embed
Contra la banalización de la pandemia y por otro lado contra el alarmismo de la pandemia
https://articulosclaves.blogspot.com/2022/01/contra-la-banalizacion-de-la-pandemia.html
https://articulosclaves.blogspot.com/2022/02/hem-fet-el-pressec-amb-els-confinaments.html
Tests masivos
https://articulosclaves.blogspot.com/2022/02/acaben-ya-con-los-test-masivos-covid-y.html
Algunas de las secuelas respiratorias asociadas a la COVID19 larga derivan en parte de la presencia de linfocitos T citotóxicos activos y persistentes, y de cierta evidencia de muerte celular a nivel pulmonar.
https://www.cell.com/immunity/fulltext/S1074-7613(22)00046-2
«Para los vacunados con dos dosis y contagiados con ómicron, el momento de ponerse la tercera dosis será cuando haya una variante distinta de ómicron»
https://www.elcomercio.es/sociedad/margarita-advierte-omicron-20220211033709-nt.html
Complications Following SARS-CoV-2 Infection in Victoria, Australia: A Record Linkage Study
https://papers.ssrn.com/sol3/papers.cfm?abstract_id=4025054
Rates of COVID-19 Cases and Deaths by Vaccination Status
https://covid.cdc.gov/covid-data-tracker/#rates-by-vaccine-status
F.Simon
Dinamarca
https://www.sst.dk/da/nyheder/2022/ingen-nye-udvidelser-af-covid-19-vaccinationsprogrammet
Estamos desde hace más de 20 en la sociedad de la información y el conocimiento, nunca hemos tenido más conocimiento, herramientas, materiales, documentación, informes verificados por pares y hay una parte de la población con altavoz en las redes que difunde mensajes anti ciencia.
https://notistecnicas.blogspot.com/2022/02/la-logica-de-la-ciencia.html
https://www.uptodate.com/landing/covid19
Datos a 14-2-2022
https://datosmacro.expansion.com/otros/coronavirus/espana
Enlaces anteriores 9-1-2022
https://notistecnicas.blogspot.com/2022/01/enlaces-coronavirusmutaciones.html
https://notistecnicas.blogspot.com/2022/01/ii-enlaces-fuentes-sobre-el-virus.html
Resumen pandemia 13-1-2022
https://articulosclaves.blogspot.com/2022/01/rsumen-de-la-pandemia-13-enero-2022.html
Resumen pandemia 11-4-2022
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