Yaya tasirin rigakafi ke da tasiri bayan murmurewa Covid dangane da allurar? An Nazarin Isra'ila by Gazit et al. An gano cewa waɗanda aka yi wa alurar riga kafi suna da haɗarin kamuwa da cuta sau 27 fiye da na Covid-murmure. A lokaci guda, waɗanda aka yi wa allurar sun kasance da yuwuwar a kwantar da su a asibiti sau tara don Covid. Sabanin haka, a Nazarin CDC by Bozio et al. yayi iƙirarin cewa Covid-murmure ya ninka sau biyar mafi kusantar asibiti don Covid fiye da allurar. Duk karatun biyu ba zai iya zama daidai ba.
Na yi aiki a kan cututtukan rigakafin rigakafi tun lokacin da na shiga jami'ar Harvard kusan shekaru ashirin da suka gabata a matsayin mai ilimin halittu. Ban taba ganin babban rashin jituwa tsakanin nazarin da ya kamata ya amsa tambaya daya ba. A cikin wannan labarin, na rarraba karatun biyu a hankali, na bayyana yadda nazarin ya bambanta, kuma na bayyana dalilin da yasa binciken Isra'ila ya fi dogara.
Nazarin Isra'ila
A cikin binciken na Isra'ila, masu binciken sun bi diddigin mutane 673,676 da aka yi wa allurar rigakafin da ba su san cewa ba su da Covid da 62,833 da ba a yi musu allurar rigakafin Covid-XNUMX ba. Sauƙaƙan kwatanta ƙimar Covid na gaba a cikin waɗannan rukunin biyu zai zama yaudara. Wataƙila waɗanda aka yi wa alurar riga kafi sun tsufa kuma, don haka, sun fi fuskantar kamuwa da cututtukan cututtuka, suna ba ƙungiyar da aka murmure ta Covid fa'ida mara kyau. A lokaci guda, majinyacin da aka yi wa alurar riga kafi ya karɓi maganin tun da daɗewa bayan mai haƙuri na Covid-XNUMX ya kamu da rashin lafiya. Yawancin marasa lafiya da aka murmure daga Covid sun kamu da cutar kafin a sami rigakafin. Saboda rigakafi yana raguwa a kan lokaci, wannan gaskiyar zai ba da fa'ida mara adalci ga rukunin da aka yi wa allurar.
Don yin kwatancen gaskiya da rashin son zuciya, masu bincike dole ne su dace da marasa lafiya daga ƙungiyoyin biyu akan shekaru da lokaci tun allurar rigakafi/cuta. Wannan shine ainihin abin da marubutan binciken suka yi, wanda ya yi daidai da jinsi da wuri.
Don bincike na farko, marubutan binciken sun gano wata ƙungiya tare da mutane 16,215 waɗanda suka murmure daga Covid da 16,215 waɗanda suka dace da waɗanda aka yi wa rigakafin. Marubutan sun bi waɗannan ƙungiyoyin cikin lokaci don tantance nawa ne ke da alamun cutar ta Covid na gaba.
A ƙarshe, marasa lafiya 191 a cikin rukunin da aka yi wa rigakafin da 8 a cikin rukunin da aka murmure daga Covid sun sami alamun cutar Covid. Waɗannan lambobin suna nufin cewa waɗanda aka yi wa alurar riga kafi sun kasance 191/8 = sau 23 mafi kusantar kamuwa da cutar alama ta gaba fiye da murmurewa Covid-27. Bayan daidaita ƙididdiga na ƙididdiga don cututtukan cututtuka a cikin bincike na farfadowa na logistic, marubutan sun auna haɗarin dangi na 95 tare da 13% tazarar amincewa tsakanin 57 da XNUMX sau mafi kusantar wanda aka yi wa alurar riga kafi.
Binciken ya kuma duba asibitocin Covid; takwas suna cikin rukunin da aka yi wa allurar, kuma ɗaya daga cikin Covid-murmurewa. Waɗannan lambobin suna nuna haɗarin dangi na 8 (95% CI: 1-65). Babu mace-mace a cikin ko wanne rukuni, yana nuna cewa duka alluran rigakafi da rigakafi na halitta suna ba da kyakkyawar kariya daga mace-mace.
Wannan shi ne madaidaiciya kuma ingantaccen binciken ƙungiyar annoba mai sauƙin fahimta da fassara. Marubutan sun yi magana da babban tushen son zuciya ta hanyar daidaitawa. Wata yuwuwar son zuciya da ba su magance ba (kamar yadda yake da ƙalubale a yi) ita ce waɗanda ke da kafin Covid na iya yiwuwa a iya fallasa su a baya ta hanyar aiki ko wasu ayyuka. Tun da an fi bayyana su a baya, ƙila kuma an fi fallasa su a lokacin da ake biyo baya. Hakan zai haifar da rashin la'akari da haɗarin dangi don neman rigakafin. Hakanan ana iya samun rarrabuwar kawuna idan wasu daga cikin waɗanda aka yi wa allurar ba da saninsu ba suna da Covid. Hakan kuma zai haifar da rashin kima.
Nazarin CDC
Nazarin CDC bai ƙirƙiri ƙungiyar mutane da za su bi na tsawon lokaci ba. Madadin haka, sun gano mutanen da ke asibiti da alamun Covid-kamar, sannan sun kimanta nawa ne daga cikinsu suka gwada inganci da mara kyau ga Covid. Daga cikin wadanda aka yi wa allurar, 5% sun gwada inganci, yayin da ya kasance kashi 9% a cikin wadanda aka murmure daga Covid. Menene ma'anar wannan?
Kodayake marubutan ba su ambace shi ba, sun ɗauki a de a zahiri shine zane-sarrafawa. Duk da yake ba shi da ƙarfi kamar binciken ƙungiyar, wannan ingantaccen ƙirar cuta ce. Na farko binciken don nuna cewa shan taba yana ƙara haɗarin ciwon huhu na huhu ya yi amfani da zane-zane mai kulawa. Sun kwatanta marasa lafiya da ke asibiti tare da ciwon huhu na huhu kuma sun sami karin masu shan taba a cikin wannan rukunin idan aka kwatanta da marasa lafiya marasa ciwon daji, waɗanda suka yi aiki a matsayin masu sarrafawa. Lura cewa da sun iyakance ƙungiyar kulawa ga mutanen da ke fama da ciwon zuciya, da sun amsa wata tambaya ta daban: ko shan taba shine babban haɗari ga ciwon huhu fiye da ciwon zuciya. Tun da shan taba yana da haɗari ga cututtuka guda biyu, irin wannan ƙididdigar haɗarin zai bambanta da wanda suka samo.
A cikin binciken CDC akan rigakafi na Covid, shari'o'in sune wadanda aka kwantar da su a asibiti don cutar Covid, suna da alamun alamun Covid-kamar da gwaji mai inganci. Hakan ya dace. Ya kamata abubuwan sarrafawa su zama samfurin wakilci daga yawan mutanen da masu cutar Covid suka fito. Abin takaici, ba haka lamarin yake ba tunda mutanen Covid-negative masu alamun alamun Covid-kamar, kamar ciwon huhu, sun kasance sun tsufa kuma suna da rauni tare da cututtuka. Hakanan ana iya yi musu allurar.
A ce muna son sanin ko shirin rigakafin ya kai ba kawai tsofaffi ba har ma da raunana masu fama da cututtuka. A wannan yanayin, za mu iya gudanar da binciken ƙungiyar da aka daidaita shekaru don tantance ko waɗanda aka yi wa alurar riga kafi za a iya kwantar da su a asibiti don matsalolin da ba na Covid ba kamar ciwon huhu. Wannan zai zama nazari mai ban sha'awa da za a yi.
Matsalar ita ce binciken CDC ba ya amsa tambayar kai tsaye na ko allurar rigakafi ko murmurewa Covid ya fi kyau a rage haɗarin cutar Covid mai zuwa, ko kuma ƙaddamar da allurar rigakafin ta kai ga gaci. Maimakon haka, yana tambayar wanene daga cikin waɗannan biyun ya fi girman tasiri. Yana ba da amsa ko allurar rigakafi ko murmurewa Covid ya fi alaƙa da asibiti na Covid ko kuma idan yana da alaƙa da sauran asibitocin nau'in numfashi.
Mu duba lambobin. Daga cikin shari'o'in 413 (watau masu cutar Covid-324), 89 an yi musu allurar rigakafi, yayin da 6,004 suka murmure daga Covid-931. Wannan ba yana nufin cewa waɗanda aka yi wa alurar riga kafi suna cikin haɗari mafi girma tun da ana iya samun ƙarin su. Don sanya waɗannan lambobi a cikin mahallin, muna buƙatar sanin adadin nawa a cikin al'umman baya da aka yi wa allurar rigakafin Covid-murmure. Binciken baya samarwa ko amfani da waɗannan lambobin, kodayake ana samun su daga aƙalla wasu abokan hulɗar bayanai, gami da HealthPartners da Kaiser Permanente. Madadin haka, suna amfani da marasa lafiya na Covid-negative tare da alamun Covid kamar alamun su azaman rukunin kulawa, wanda akwai 1.77 da aka yiwa alurar riga kafi, kuma 5.49 Covid-murmurewa. Tare da waɗannan lambobi a hannu, za mu iya ƙididdige ƙimar rashin daidaituwa na 95 (ba a ruwaito a cikin takarda ba). Bayan gyare-gyare na covariate, rabon rashin daidaituwa ya zama 2.75 (10.99% CI: XNUMX-XNUMX).
Yin watsi da covariates don wannan lokacin, za mu kalli lambobin da ba a daidaita su dalla-dalla don dalilai masu ma'ana. Takardar ba ta ba da rahoton adadin mutanen da aka yi wa allurar rigakafi da Covid-murmure da ke cikin jama'a da ke cikin haɗarin asibiti tare da alamun Covid-kamar ba. Idan akwai 931,000 Covid-murmurewa da 6,004,000 alurar riga kafi (87%), to adadin daidai yake da na abubuwan sarrafawa, kuma sakamakon yana da inganci. Idan, a maimakon haka, akwai (a ce) 931,000 Covid-murmure da 3,003,000 da aka yi wa alurar riga kafi (76%), to, rabon rashin daidaituwa zai zama 0.89 maimakon 1.77. Babu wata hanyar da za a iya sanin gaskiya ba tare da waɗancan adadin yawan jama'a ba sai dai idan mutum yana shirye ya ɗauka cewa waɗanda ke kwance a asibiti don alamun Covid-kamar ba tare da samun Covid wakilan asalin asalin ba ne, wanda da alama ba za su kasance ba.
Tare da yawan jama'a don ayyana ƙungiyar ƙungiya, dole ne mutum ya daidaita don shekaru da sauran ƙungiyoyi kamar a cikin binciken Isra'ila. Wasu na iya yin gardama cewa marasa lafiya marasa lafiya na asibiti na Covid waɗanda ke da alamun Covid-kamar ƙungiyar kulawa ce ta dace saboda suna ba da ƙarin samfurin wakilci na yawan jama'ar da ke cikin haɗarin asibiti na Covid. Wannan na iya zama wani ɓangare na gaskiya idan aka kwatanta da binciken da ba a daidaita ba, amma hujjar ba daidai ba ce kamar yadda ba ta magance mahimmin batun da ya dace da tambayar likita da ake yi ba. Akwai dangantaka tsakanin allurar rigakafi/murmurewa da kuma asibiti na Covid da dangantaka tsakanin allurar rigakafi/murmurewa da kuma rashin asibiti na Covid. Maimakon kimanta na farko, wanda ke da matukar sha'awar manufofin kiwon lafiya, binciken CDC yana kimanta bambanci tsakanin su biyun, wanda ba shi da ban sha'awa musamman.
Nazarin CDC yana daidaitawa ga masu haɗaka kamar shekaru, amma hanyar ba ta warware wannan muhimmin al'amari na ƙididdiga ba kuma yana iya ƙara tsananta shi. Mutane masu rauni sun fi yin allurar rigakafi, yayin da mutane masu aiki suka fi iya samun murmurewa daga Covid, kuma babu ɗayan waɗannan da aka gyara da kyau. Tare da nazarin bambancin, akwai kuma ƙarin ruɗani wanda dole ne a daidaita shi don: duka ruɗewar da ke da alaƙa da fallasa da kuma asibitocin Covid da rikice-rikice masu alaƙa da fallasa da kuma asibitocin da ba na Covid. Wannan yana ƙara yuwuwar sakamako na son zuciya.
Duk da yake ba shine babbar matsalar ba, akwai wata hujja mai ban sha'awa game da takarda. gyare-gyaren haɗin gwiwa yawanci zai canza ƙididdige ma'auni kaɗan, amma baƙon abu ne don ganin canji mai girma kamar na 1.77 zuwa 5.49 wanda aka lura a cikin binciken CDC. Ta yaya za a iya bayyana wannan? Dole ne saboda wasu covariates sun bambanta sosai tsakanin shari'o'i da sarrafawa. Akwai akalla guda biyu daga cikinsu. Yayin da kashi 78% na wadanda aka yi wa allurar sun girmi shekaru 65, kashi 55% na wadanda aka dawo da su Covid-65 sun kasa da shekaru 96. Ko da abin da ya fi dacewa shi ne cewa kashi 69% na wadanda aka yi wa allurar an kwantar da su a asibiti a lokacin bazara na Yuni zuwa Agusta, yayin da XNUMX% na Covid-murmure an kwantar da su a cikin hunturu da watanni na bazara daga Janairu zuwa Mayu. Irin waɗannan bambance-bambancen da ba su daidaita ba galibi ana daidaita su don amfani da daidaitawa kamar yadda yake a cikin binciken Isra'ila.
Kwararrun cututtukan cututtukan galibi suna dogara ne akan nazarin sarrafa shari'a lokacin da babu bayanai ga ƙungiyar baki ɗaya. Misali, a cikin cututtukan cututtukan abinci masu gina jiki, masu bincike sukan kwatanta halayen cin abinci na marasa lafiya tare da cutar sha'awa da samfurin wakilcin kulawar lafiya. Bin dabi'un cin abinci na ƙungiyar na tsawon lokaci yana da rashin ƙarfi da tsada sosai, don haka binciken sarrafa shari'a na tushen tambayoyin ya fi dacewa. Don wannan binciken rigakafin, babu wani dalili na binciken sarrafa shari'a tunda ana samun bayanan ƙungiyar daga abokan hulɗar bayanan CDC da yawa. Abin mamaki ne cewa CDC ta zaɓi wannan ƙirar sarrafa shari'ar maimakon ƙarancin ƙira na ƙungiyar da marubutan Isra'ila suka zaɓa. Irin wannan bincike zai amsa tambayar sha'awa kuma yana iya ba da sakamako daban-daban fiye da binciken Isra'ila.
Ya kamata a yi rigakafin Covid-murmure?
Binciken na Isra'ila ya kuma kwatanta Covid-murmure tare da kuma ba tare da maganin ba. Dukansu ƙungiyoyin biyu suna da ƙarancin haɗarin Covid, amma waɗanda aka yi wa alurar riga kafi suna da ƙarancin 35% na haɗarin cututtukan cututtuka (95% CI: 65% ƙasa zuwa 25% mafi girma), wanda zai iya zama alamar cewa akwai kuma ƙarancin haɗarin asibiti. Duk da yake ba su da mahimmanci a kididdiga, alluran rigakafi na iya ba da ƙarin kariya sama da riga mai ƙarfi daga rigakafi na halitta. Idan an tabbatar da wasu binciken, to, tambaya ce ta fa'idodi da kasada, kuma yin la'akari da mummunan halayen rigakafin rigakafi. Ga mai haɗari mai haɗari, raguwa 35% babbar fa'ida ce, kodayake ƙasa da ingancin maganin ga waɗanda ba su da Covid. Ga mai ƙarancin haɗari, wanda ya haɗa da yawancin mutanen da ke da rigakafi na dabi'a, raguwar haɗari 35% ya fi tabo dangane da cikakkiyar haɗari.
A matsayin misali na wannan ra'ayi, hadaddun yau da kullun wanda ya rage haɗarin cutar kansa da kashi 35% zai zama maganin mu'ujiza mai girma da mahimmanci wanda kowa ya kamata ya sha koda kuwa yana da muni. A gefe guda kuma, na'urar tafiya mai ban tsoro da ta rage haɗarin mutuwa ta hanyar walƙiya da kashi 35 cikin XNUMX ba zai yi kyau ba. Hadarin ya riga ya ragu ba tare da na'urar ba. Wannan misalin yana misalta mahimmancin ba wai kawai duba haɗarin dangi ba amma har ma da cikakkar haɗarin da ake iya dangantawa.
karshe
Game da Covid-murmure, akwai manyan batutuwan kiwon lafiyar jama'a guda biyu. 1. Shin wanda Covid-ya murmure zai amfana daga yin allurar ma? 2. Shin ya kamata a sami fasfo na rigakafi da umarni da ke buƙatar a yi musu allurar don yin aiki da shiga cikin al'umma?
Binciken CDC bai magance tambaya ta farko ba, yayin da binciken na Isra'ila ya nuna ƙaramin fa'ida amma ba ta da fa'ida sosai wajen rage cutar Covid-19. Nazari na gaba da fatan za su yi ƙarin haske kan wannan batu.
Dangane da ingantacciyar shaida daga binciken Isra'ila, waɗanda aka murmure daga Covid suna da rigakafi mai ƙarfi da dorewa daga cutar Covid fiye da wanda aka yi wa alurar riga kafi. Don haka, babu wani dalili na hana su ayyukan da aka ba su izinin yin allurar. Hasali ma, nuna wariya ne.
Yawancin wadanda aka murmure daga Covid an fallasa su ga kwayar cutar a matsayin ma'aikata masu mahimmanci yayin girman cutar kafin a sami alluran rigakafin. Sun sa sauran al’umma su tashi tsaye, da sarrafa abinci, da kai kaya, da sauke jiragen ruwa, da diban shara, da aikin ‘yan sanda, da kula da harkokin wutar lantarki, da kashe gobara, da kula da tsofaffi da marasa lafiya, da dama.
Yanzu ana korar su kuma an cire su duk da cewa suna da kariya mai ƙarfi fiye da allurar rigakafin aiki-daga-gida da ke korar su.
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Martin Kulldorff masanin cututtukan cututtuka ne kuma masanin halittu. Shi Farfesa ne na Magunguna a Jami'ar Harvard (a kan hutu) kuma Fellow a Kwalejin Kimiyya da 'Yanci. Bincikensa ya mayar da hankali kan barkewar cututtuka da kuma lura da rigakafin rigakafi da amincin magunguna, wanda ya samar da SaTScan, TreeScan, da software na RSequential kyauta. Co-Marubucin Babban Sanarwa na Barrington.
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