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Miliri yachimfine ya nyengo imayambitsa pakati pa 290,000 ndi 650,000 imfa zokhudzana ndi matenda opuma padziko lonse chaka chilichonse. Dzikoli likukumana ndi mliri woopsa wa chimfine m'nyengo yozizira ikatha mliri wa COVID-19. Katemera wa chimfine ndi njira yothandiza kwambiri yopewera chimfine, koma katemera wa chimfine wochokera ku chikhalidwe cha nkhuku ali ndi zofooka zina, monga kusintha kwa immunogenic, kuchepetsa kupanga ndi zina zotero.

Kubwera kwa recombinant HA mapuloteni jini engineering fuluwenza katemera akhoza kuthetsa vuto la chikhalidwe nkhuku mluza katemera. Pakadali pano, Komiti Yolangizira yaku America pa Katemera wa Katemera (ACIP) imalimbikitsa katemera wa fuluwenza wowonjezera mlingo waukulu kwa akuluakulu ≥65 zakubadwa. Komabe, kwa anthu ochepera zaka 65, ACIP sichimalangiza katemera wa chimfine wa msinkhu uliwonse ngati chinthu chofunika kwambiri chifukwa chosowa kufananitsa mutu ndi mutu pakati pa mitundu yosiyanasiyana ya katemera.

The quadrivalent recombinant hemagglutinin (HA) genetically engineered influenza vaccine (RIV4) wavomerezedwa kuti azigulitsidwa m'maiko angapo kuyambira 2016 ndipo pakali pano ndiye katemera wa chimfine wogwiritsiridwa ntchito. RIV4 imapangidwa pogwiritsa ntchito nsanja yaukadaulo yophatikizanso mapuloteni, yomwe imatha kuthana ndi zofooka za katemera wanthawi zonse wosatsegulidwa ndi kuperekedwa kwa mazira a nkhuku. Komanso, nsanja ili ndi lalifupi kupanga mkombero, n'zothandiza kwambiri m'malo mwake wa mitundu katemera ofuna, ndipo akhoza kupewa kusintha masinthidwe amene angachitike popanga ndondomeko ya tizilombo ta tizilombo toyambitsa matenda amene angakhudze zoteteza zotsatira anamaliza katemera. Karen Midthun, yemwe anali mkulu wa Center for Biologics Review and Research ku US Food and Drug Administration (FDA), ananena kuti "kubwera kwa katemera wa chimfine ophatikizananso kumaimira kupita patsogolo kwaukadaulo popanga katemera wa fuluwenza ... Kuphatikiza apo, RIV4 imakhala ndi mapuloteni a hemagglutinin kuwirikiza katatu kuposa katemera wamba wamba, omwe ali ndi chitetezo champhamvu chamthupi [2]. Kafukufuku amene alipo asonyeza kuti RIV4 ndi yoteteza kwambiri kuposa katemera wa chimfine wamba mu okalamba, ndipo umboni wochuluka ukufunika kuti ufanane ndi awiri mwa anthu ang'onoang'ono.

Pa Disembala 14, 2023, New England Journal of Medicine (NEJM) idasindikiza Kafukufuku wa Amber Hsiao et al., Kaiser Permanente Vaccine Study Center, KPNC Health System, Oakland, USA. Kafukufukuyu ndi kafukufuku wapadziko lonse lapansi yemwe adagwiritsa ntchito njira yosasinthika ya anthu kuti awone momwe chitetezo cha RIV4 chimayendera motsutsana ndi katemera wa quadrivalent standard-dose inactivated influenza vaccine (SD-IIV4) mwa anthu osakwana zaka 65 pazaka ziwiri za fuluwenza kuyambira 2018 mpaka 2020.

Kutengera dera lautumiki ndi kukula kwa malo a maofesi a KPNC, adatumizidwa mwachisawawa ku gulu A kapena Gulu B (Chithunzi 1), pomwe gulu A lidalandira RIV4 sabata yoyamba, Gulu B lidalandira SD-IIV4 sabata yoyamba, kenako malo aliwonse adalandira katemerayu mosinthana mlungu uliwonse mpaka kumapeto kwa nyengo ya chimfine. Mapeto oyambirira a phunziroli anali milandu ya chimfine yotsimikiziridwa ndi PCR, ndipo mapeto achiwiri anali fuluwenza A, fuluwenza B, ndi zipatala zokhudzana ndi chimfine. Madokotala pa malo aliwonse kuchita mayeso fuluwenza PCR pa nzeru zawo, zochokera chipatala ulaliki wa wodwalayo, ndi kupeza inpatient ndi outpatient matenda, zasayansi kuyezetsa, ndi katemera zambiri kudzera zolemba pakompyuta mankhwala.

Kafukufukuyu adaphatikizapo akuluakulu azaka zapakati pa 18 mpaka 64, omwe ali ndi zaka 50 mpaka 64 kukhala gulu lazaka zoyambirira zomwe adawunikidwa. Zotsatira zake zidawonetsa kuti chitetezo chachibale (rVE) cha RIV4 poyerekeza ndi SD-IIV4 motsutsana ndi chimfine chotsimikizika cha PCR chinali 15.3% (95% CI, 5.9-23.8) mwa anthu azaka zapakati pa 50 mpaka 64. Chitetezo chachibale ku chimfine A chinali 15.7% (95% CI, 6.0-24.5). Palibe zowerengera zofunikira wachibale zoteteza zomwe zidawonetsedwa pa chimfine B kapena zipatala zokhudzana ndi chimfine. Kuphatikiza apo, kusanthula kofufuza kunawonetsa kuti mwa anthu azaka za 18-49, onse a chimfine (rVE, 10.8%; 95% CI, 6.6-14.7) kapena fuluwenza A (rVE, 10.2%; 95% CI, 1.4-18.2), RIV4-18.2, RIV4.

Mayesero am'mbuyomu osasinthika, akhungu awiri, oyendetsedwa bwino adawonetsa kuti RIV4 inali ndi chitetezo chabwino kuposa SD-IIV4 mwa anthu azaka 50 kapena kuposerapo (rVE, 30%; 95% CI, 10 ~ 47) [3]. Kafukufukuyu akuwonetsanso kudzera pazambiri zenizeni zapadziko lonse lapansi kuti katemera wa chimfine ophatikizananso amapereka chitetezo chabwinoko kuposa akatemera anthawi zonse osagwiritsidwa ntchito, ndipo amakwaniritsa umboni wakuti RIV4 imaperekanso chitetezo chabwinoko mwa anthu achichepere. Kafukufukuyu adasanthula kuchuluka kwa matenda a kupuma kwa syncytial virus (RSV) m'magulu onsewa (matenda a RSV ayenera kufananizidwa m'magulu onsewa chifukwa katemera wa chimfine samalepheretsa matenda a RSV), osaphatikizanso zinthu zina zosokoneza, ndikutsimikizira kulimba kwa zotsatira zake kudzera mu kusanthula kwamaganizidwe angapo.

Gulu lachisawawa la kamangidwe kameneka lomwe linagwiritsidwa ntchito mu kafukufukuyu, makamaka katemera wosinthira wa katemera woyesera komanso katemera wowongolera mlungu uliwonse, amalinganiza bwino zinthu zosokoneza pakati pa magulu awiriwa. Komabe, chifukwa cha zovuta za kapangidwe kake, zofunikira pakufufuza ndi zapamwamba. Mu kafukufukuyu, kusakwanira kokwanira kwa katemera wa chimfine wophatikizananso kudapangitsa kuti anthu ambiri omwe amayenera kulandira RIV4 alandire SD-IIV4, zomwe zidapangitsa kusiyana kwakukulu kwa chiwerengero cha omwe atenga nawo mbali pakati pa magulu awiriwa komanso chiopsezo chotengera kukondera. Kuphatikiza apo, kafukufukuyu adakonzedweratu kuti azichitika kuyambira 2018 mpaka 2021, ndipo kuwonekera kwa COVID-19 ndi njira zake zopewera ndi zowongolera zakhudzanso kafukufukuyu komanso kukula kwa mliri wa chimfine, kuphatikiza kufupikitsa nyengo ya chimfine ya 2019-2020 komanso kusowa kwa 2019-2020 fuluwenza. Zambiri zochokera munyengo ziwiri "zosazolowereka" za chimfine kuyambira 2018 mpaka 2020 zilipo, kotero kuti kafukufuku wochulukirapo akufunika kuti awone ngati zomwe zapezedwazi zikugwirabe nyengo zingapo, mitundu yosiyanasiyana yozungulira komanso zida za katemera.

Zonsezi, phunziroli linanso akutsimikizira kuthekera kwa recombinant chibadwa injiniya katemera ntchito m'munda wa katemera fuluwenza, komanso kuyika olimba luso maziko a kafukufuku m'tsogolo ndi chitukuko cha nzeru katemera fuluwenza. The recombinant majini uinjiniya katemera luso nsanja sizidalira nkhuku mazira, ndipo ali ndi ubwino wa yochepa kupanga mkombero ndi mkulu kupanga bata. Komabe, poyerekeza ndi chikhalidwe inactivated fuluwenza katemera, alibe kwambiri phindu chitetezo, ndipo n'zovuta kuthetsa chitetezo kuthawa chodabwitsa chifukwa kwambiri mutated fuluwenza mavairasi ku muzu. Mofanana ndi katemera wa chimfine, kuneneratu za zovuta ndi kusintha kwa antigen kumafunika chaka chilichonse.

Pamaso pa akutuluka mitundu ya chimfine, tiyenerabe kulabadira chitukuko cha universal fuluwenza katemera m`tsogolo. Kukula kwa katemera wa chimfine wapadziko lonse kuyenera kukulitsa pang'onopang'ono kuchuluka kwa chitetezo ku ma virus, ndipo pamapeto pake kutetezedwa ku zovuta zonse zaka zosiyanasiyana. Choncho, tiyenera kupitiriza kulimbikitsa mapangidwe yotakata sipekitiramu immunogen zochokera HA mapuloteni m`tsogolo, kuganizira NA, china padziko puloteni wa fuluwenza HIV, monga chandamale chachikulu katemera, ndi kuganizira njira luso kupuma Katemera kuti ndi opindulitsa kwambiri pochititsa Mipikisano dimensional zotetezera mayankho kuphatikizapo m`deralo ma chitetezo (monga mphuno kutsitsi katemera etc., youma katemera). Pitirizani kulimbikitsa kafukufuku wa katemera wa mRNA, katemera wonyamula katundu, zowonjezera zatsopano ndi njira zina zamakono, ndikuzindikira chitukuko cha katemera wa chimfine wapadziko lonse omwe "amayankha kusintha kulikonse popanda kusintha"