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Ogwira ntchito yazaumoyo adayesa kwakukulu pogwiritsa ntchito kuyesa kwa antigen mwachangu pasukulu ina ku France.Chithunzi chojambula: Thomas Samson/AFP/Getty
Pomwe kuchuluka kwa milandu ya coronavirus ku UK kudakwera koyambirira kwa 2021, boma lidalengeza kusintha komwe kungachitike polimbana ndi COVID-19: mamiliyoni a mayeso otsika mtengo, othamanga.Pa Januware 10, idati ilimbikitsa mayesowa mdziko lonse, ngakhale kwa anthu omwe alibe zizindikiro.Mayeso ofananirawa atenga gawo lalikulu pamalingaliro a Purezidenti Joe Biden oti akhale ndi mliri womwe ukukula ku United States.
Mayeso ofulumirawa nthawi zambiri amasakaniza swab ya m'mphuno kapena yapakhosi ndi madzi papepala kuti abweretse zotsatira mkati mwa theka la ola.Mayesowa amatengedwa ngati mayeso opatsirana, osati opatsirana.Amangozindikira kuchuluka kwa ma virus, kotero amaphonya anthu ambiri omwe ali ndi ma virus otsika a SARS-CoV-2.Koma chiyembekezo n’chakuti athandiza kuthetsa mliriwu pozindikira msanga anthu omwe ali ndi kachilomboka, apo ayi akhoza kufalitsa kachilomboka mosadziwa.
Komabe, pamene boma linalengeza za dongosololi, mkangano wokwiya unabuka.Asayansi ena amasangalala ndi njira yoyesera yaku Britain.Ena amati kuyezetsa kumeneku kuphonya matenda ochulukirapo kotero kuti ngati afalikira kwa mamiliyoni, kuvulaza komwe kungabweretse kumaposa kuvulazako.Jon Deeks, yemwe amagwira ntchito yoyesa ndi kuunikira pa yunivesite ya Birmingham ku United Kingdom, akukhulupirira kuti anthu ambiri akhoza kupepukidwa chifukwa cha zotsatira zoipa za mayeso ndi kusintha khalidwe lawo.Ndipo, adati, ngati anthu adziwongolera okha, m'malo modalira akatswiri ophunzitsidwa bwino, mayesowa adzaphonya matenda ambiri.Iye ndi mnzake waku Birmingham a Jac Dinnes (Jac Dinnes) ndi asayansi, ndipo akukhulupirira kuti akufunika zambiri pakuyezetsa mwachangu kwa coronavirus asanayambe kugwiritsidwa ntchito kwambiri.
Koma ofufuza ena posakhalitsa anatsutsa, ponena kuti kuyesako kungayambitse vuto ndilolakwika komanso "kosayankha" (onani go.nature.com/3bcyzfm).Ena mwa iwo ndi Michael Mina, dokotala wa miliri ku Harvard TH Chan School of Public Health ku Boston, Massachusetts, yemwe adati mkanganowu ukuchedwetsa yankho lomwe likufunika kwambiri pa mliriwu.Iye anati: “Tikunenabe kuti tilibe deta yokwanira, koma tili m’kati mwa nkhondo yokhudzana ndi kuchuluka kwa milandu, sitidzakhala oyipa kuposa nthawi ina iliyonse.”
Chinthu chokha chimene asayansi amavomereza n’chakuti pakufunika kulankhulana momveka bwino ponena za kuyesa msanga ndi zomwe zotsatira zake zoipa zimatanthauza.Mina anati: “Kuponya zida kwa anthu amene sadziwa kuzigwiritsa ntchito n’koipa.
Ndizovuta kupeza chidziwitso chodalirika pakuyesa mwachangu, chifukwa-osachepera ku Europe-zogulitsa zitha kugulitsidwa potengera deta ya wopanga popanda kuwunika kodziyimira pawokha.Palibe ndondomeko yoyezera momwe ntchito ikuyendera, kotero ndizovuta kufananiza zoyesa ndikukakamiza dziko lililonse kuti lizitsimikizira.
"Kumeneku ndiye kumadzulo kwachidziwitso," atero a Catharina Boehme, CEO wa Innovative New Diagnostics Foundation (FIND), bungwe lopanda phindu ku Geneva, Switzerland lomwe lawunikanso ndikuyerekeza njira zambiri za COVID -19 Analysis.
Mu February 2020, FIND idayamba ntchito yayikulu yowunika mazana amitundu yoyeserera ya COVID-19 pamayesero okhazikika.Mazikowa amagwira ntchito ndi World Health Organisation (WHO) ndi mabungwe ofufuza padziko lonse lapansi kuyesa mazana a zitsanzo za coronavirus ndikuyerekeza momwe amagwirira ntchito ndi omwe apezeka pogwiritsa ntchito ukadaulo wovuta kwambiri wa polymerase chain reaction (PCR).Tekinolojeyi imayang'ana ma genetic motsatana mu zitsanzo zotengedwa kumphuno kapena kukhosi kwa munthu (nthawi zina malovu).Mayesero otengera PCR amatha kubwereza zambiri za majiniwa kudzera m'machulukitsidwe angapo, kotero amatha kuzindikira kuchuluka kwa parvovirus.Koma zitha kutenga nthawi ndipo zimafuna anthu ophunzitsidwa bwino komanso zida za labotale zodula (onani “Mmene Kuyezetsa kwa COVID-19 Kumagwirira Ntchito”).
Mayeso otsika mtengo, othamanga amatha kugwira ntchito pozindikira mapuloteni ena (omwe amatchedwa ma antigen) pamwamba pa tinthu ta SARS-CoV-2."Mayeso othamanga a antigen"wa samakulitsa zomwe zili muzachitsanzo, kotero kachilomboka kamatha kuzindikirika kokha kachilomboka kakafika pamlingo wambiri m'thupi la munthu - pakhoza kukhala masauzande ambiri a kachilomboka pa mililita imodzi ya zitsanzo.Anthu akakhala opatsirana kwambiri, kachilomboka kamafika pamiyezo imeneyi nthawi yomwe zizindikiro zayamba (onani “Catch COVID-19″).
Dinnes adanena kuti zomwe wopanga amapanga pakuyesa kukhudzika makamaka zimachokera ku mayeso a labotale mwa anthu omwe ali ndi zizindikiro zokhala ndi ma virus ambiri.M'mayesero amenewo, mayesero ambiri ofulumira ankawoneka ovuta kwambiri.(Iwo alinso achindunji kwambiri: sangathe kupereka zotsatira zabodza.) Komabe, zotsatira zenizeni zenizeni zimasonyeza kuti anthu omwe ali ndi ma virus ochepa amasonyeza ntchito zosiyana kwambiri.
Mulingo wa virus pachitsanzo nthawi zambiri umawerengedwa potengera kuchuluka kwa ma PCR amplification omwe amafunikira kuti azindikire kachilomboka.Nthawi zambiri, ngati pafupifupi 25 PCR amplification cycles kapena zochepa zikufunika (zotchedwa cycle threshold, kapena Ct, zofanana kapena zosakwana 25), ndiye kuti mulingo wa kachilombo ka HIV umatengedwa kuti ndi wapamwamba, kusonyeza kuti anthu akhoza kupatsirana-ngakhale zikuwonekeratu ngati anthu ali ndi vuto lopatsirana kapena alibe.
Mu November chaka chatha, boma la Britain linatulutsa zotsatira za maphunziro oyambirira omwe anachitidwa ku Porton Down Science Park ndi Oxford University.Zotsatira zonse zomwe sizinawonedwe ndi anzawo zinasindikizidwa pa intaneti pa January 15. Zotsatirazi zikusonyeza kuti ngakhale kuti mayesero ambiri ofulumira a antigen (kapena "lateral flow") "safika pamlingo wofunikira kuti anthu ambiri atumizidwe," mu Kuyesa kwa labotale, mitundu ina ya anthu 4 inali ndi Ct kapena kutsika 25. Kuwunikanso kwa FIND kwa zida zambiri zoyeserera mwachangu nthawi zambiri kumawonetsanso kuti kukhudzika kwa ma virus ndi 90% kapena kupitilira apo.
Pamene mlingo wa kachilomboka umatsika (ie, mtengo wa Ct ukukwera), kuyezetsa msanga kumayamba kuphonya matenda.Asayansi ku Porton Down anapereka chidwi chapadera ku mayesero a Innova Medical ku Pasadena, California;Boma la Britain lawononga mapaundi opitilira 800 miliyoni ($ 1.1 biliyoni) kuyitanitsa mayesowa, gawo lofunikira la njira yake yochepetsera kufalikira kwa coronavirus.Pa mlingo wa Ct wa 25-28, kukhudzidwa kwa mayesero kumachepetsedwa kufika 88%, ndipo pa mlingo wa Ct wa 28-31, mayeserowo amachepetsedwa mpaka 76% (onani "Kuyesa Kwachangu Kupeza Vuto Lalikulu la Viral").
Mosiyana ndi izi, mu Disembala, Abbott Park, Illinois, Abbott Laboratories adayesa mayeso ofulumira a BinaxNOW ndi zotsatira zoyipa.Kafukufukuyu adayesa anthu opitilira 3,300 ku San Francisco, California, ndipo adapeza kukhudzika kwa 100% kwa zitsanzo zokhala ndi ma Ct ochepera 30 (ngakhale munthu yemwe ali ndi kachilomboka sanawonetse zizindikiro)2.
Komabe, machitidwe osiyanasiyana a PCR amatanthawuza kuti milingo ya Ct silingafanane mosavuta pakati pa ma laboratories, ndipo sizimawonetsa nthawi zonse kuti milingo ya virus mu zitsanzo ndi yofanana.Innova adanena kuti maphunziro aku UK ndi US adagwiritsa ntchito machitidwe osiyanasiyana a PCR, ndikuti kufananitsa kwachindunji pamakina omwewo kungakhale kothandiza.Iwo adalozera ku lipoti la boma la Britain lolembedwa ndi asayansi a Porton Down kumapeto kwa Disembala omwe adayesa mayeso a Innova motsutsana ndi mayeso a Abbott Panbio (ofanana ndi zida za BinaxNOW zogulitsidwa ndi Abbott ku United States).Mu zitsanzo zopitilira 20 zokhala ndi mulingo wa Ct pansi pa 27, zitsanzo zonse zidabweza zotsatira zabwino za 93% (onani go.nature.com/3at82vm).
Poganizira za kuyesa kwa Innova pa anthu masauzande ambiri ku Liverpool, England, malingaliro okhudzana ndi Ct calibration anali ofunikira, omwe amangozindikira magawo awiri mwa atatu a milandu yokhala ndi Ct yochepera 25 (onani go.nature.com) /3tajhkw).Izi zikuwonetsa kuti mayesowa adaphonya gawo limodzi mwa magawo atatu a milandu yomwe imatha kupatsirana.Komabe, akukhulupirira kuti mu labotale yomwe imapanga zitsanzo, mtengo wa Ct wa 25 ndi wofanana ndi kuchuluka kwa kachilombo kocheperako m'ma laboratories ena (mwina ofanana ndi Ct ya 30 kapena kupitilira apo), atero a Iain Buchan, wofufuza za Health. ndi Informatics ku American University.Liverpool, adatsogolera mlanduwu.
Komabe, tsatanetsatane sakudziwika bwino.Dix adati kuyesa kochitidwa ndi University of Birmingham mu Disembala chinali chitsanzo cha momwe kuyezetsa mwachangu kudaphonya matenda.Ophunzira oposa 7,000 asymptomatic kumeneko adayesa mayeso a Innova;2 okha adapezeka ndi HIV.Komabe, ofufuza aku yunivesite atagwiritsa ntchito PCR kuti awonenso 10% ya zitsanzo zoyipa, adapeza ophunzira ena asanu ndi mmodzi omwe ali ndi kachilomboka.Kutengera kuchuluka kwa zitsanzo zonse, mayesowo mwina adaphonya ophunzira 60 omwe ali ndi kachilombo3.
Mina adati ophunzirawa ali ndi kachilombo kocheperako, kotero samapatsirana mwanjira iliyonse.Dix amakhulupirira kuti ngakhale kuti anthu omwe ali ndi kachilombo kakang'ono kameneka akhoza kukhala kumapeto kwa kuchepa kwa matenda, angakhalenso akufalikira kwambiri.Chinanso ndi chakuti ophunzira ena sachita bwino kusonkhanitsa zitsanzo za swab, kotero kuti si tinthu tambiri ta virus timene titha kukhoza mayeso.Akuda nkhawa kuti anthu angakhulupirire molakwika kuti kukhoza mayeso olakwika kungatsimikizire chitetezo chawo - makamaka, kuyesa kofulumira ndi chithunzithunzi chabe chomwe sichingakhale chopatsirana panthawiyo.Deeks adati kunena kuti kuyezetsa kungapangitse kuti malo ogwirira ntchito akhale otetezeka si njira yoyenera yodziwitsira anthu za momwe ntchitoyi ikuyendera.Anati: "Ngati anthu amvetsetsa molakwika zachitetezo, amatha kufalitsa kachilomboka."
Koma Mina ndi ena adati oyendetsa ndege a Liverpool adalangiza anthu kuti asachite izi ndipo adauzidwa kuti atha kufalitsa kachilomboka mtsogolomo.Mina adatsindika kuti kuyesa pafupipafupi (monga kawiri pa sabata) ndiye chinsinsi chothandizira kuyesa kukhala ndi mliri.
Kutanthauzira kwa zotsatira za mayeso sikutengera kulondola kwa mayeso, komanso mwayi woti munthu ali ndi COVID-19.Zimatengera kuchuluka kwa matenda m'dera lawo komanso ngati akuwonetsa zizindikiro.Ngati munthu wochokera kudera lomwe lili ndi mulingo wapamwamba wa COVID-19 ali ndi zizindikilo za matendawa ndikupeza zotsatira zoyipa, zitha kukhala zabodza ndipo ziyenera kufufuzidwa mosamala pogwiritsa ntchito PCR.
Ofufuza amatsutsananso ngati anthu adziyesa okha (kunyumba, kusukulu kapena kuntchito).Kachitidwe ka kuyesako kungasiyane, kutengera momwe woyesa amasonkhanitsira swab ndikusintha chitsanzocho.Mwachitsanzo, pogwiritsa ntchito mayeso a Innova, asayansi a labotale afika pakukhudzidwa pafupifupi 79% pazitsanzo zonse (kuphatikiza zitsanzo zokhala ndi ma virus otsika kwambiri), koma anthu odziphunzitsa okha amangomva 58% (onani "Kuyesa Mwamsanga: Kodi ndi yoyenera kunyumba?") -Deeks amakhulupirira kuti iyi ndi dontho lodetsa nkhawa1.
Komabe, mu Disembala, bungwe loyang'anira mankhwala ku Britain lidavomereza kugwiritsa ntchito ukadaulo woyesera wa Innova m'nyumba kuti azindikire matenda mwa anthu opanda asymptomatic.Mneneri wa DHSC adatsimikiza kuti zizindikiro za mayesowa zidachokera ku National Health Service ya mdziko muno, yopangidwa ndi Unduna wa Zaumoyo ndi Social Care (DHSC), koma idagulidwa ku Innova ndikupangidwa ndi Xiamen Biotechnology Co., Ltd yaku China. mayeso ogwiritsidwa ntchito ndi boma la Britain adawunikidwa mwamphamvu ndi asayansi otsogola aku Britain.Izi zikutanthauza kuti ndi olondola, odalirika, komanso amatha kuzindikira odwala asymptomatic COVID-19. ”Mneneriyo adatero potulutsa mawu.
Kafukufuku waku Germany4 adawonetsa kuti mayeso odzipangira okha amatha kukhala othandiza ngati omwe amachitidwa ndi akatswiri.Kafukufukuyu sanawunikidwe ndi anzawo.Kafukufukuyu adapeza kuti anthu akapukuta mphuno zawo ndikumaliza mayeso osadziwika omwe avomerezedwa ndi WHO, ngakhale anthu nthawi zambiri amapatuka pamalangizo ogwiritsira ntchito, kukhudzika kumakhala kofanana kwambiri ndi komwe akatswiri amapeza.
Ku United States, bungwe la Food and Drug Administration (FDA) lavomereza zilolezo zogwiritsira ntchito mwadzidzidzi kuyesa kwa antigen 13, koma kuyesa kwapanyumba kamodzi kokha kwa Ellume COVID-19 kungagwiritsidwe ntchito kwa anthu asymptomatic.Malinga ndi Ellume, kampani yomwe ili ku Brisbane, ku Australia, mayesowa apeza kachilomboka mwa anthu 11 asymptomatic, ndipo 10 mwa anthuwa adayezetsa ndi PCR.Mu February, boma la US lidalengeza kuti ligula mayeso 8.5 miliyoni.
Maiko/magawo ena omwe alibe zida zokwanira zoyezera PCR, monga India, akhala akugwiritsa ntchito kuyesa kwa antigen kwa miyezi yambiri, kungowonjezera luso lawo loyesa.Chifukwa chokhudzidwa ndi kulondola, makampani ena omwe amayesa PCR angoyamba kuyambitsa njira zina zofulumira pang'ono.Koma boma lomwe lidagwiritsa ntchito kuyesa kwakukulu mwachangu lidati izi zidapambana.Ndi anthu 5.5 miliyoni, Slovakia linali dziko loyamba kuyesa anthu ake onse akuluakulu.Kuyesa kwakukulu kwachepetsa kuchuluka kwa matenda ndi pafupifupi 60% 5.Komabe, mayesowa amachitika limodzi ndi ziletso zokhwima zomwe sizinakhazikitsidwe m'maiko ena komanso thandizo lazachuma la boma kwa anthu omwe ali ndi kachilomboka kuti awathandize kukhala kunyumba.Chifukwa chake, akatswiri amati ngakhale kuphatikiza kuyesa ndi kuletsa kumawoneka kuti kumachepetsa kuchuluka kwa matenda mwachangu kuposa kuletsa kokha, sizikudziwika ngati njirayo ingagwire ntchito kwina.M'mayiko ena, anthu ambiri sangafune kuyezetsa mwachangu, ndipo omwe apezeka ndi kachilomboka amakhala opanda chidwi chodzipatula.Komabe, chifukwa kuyesa kwachangu kwamalonda ndikotsika mtengo kwambiri - $ 5-Mina akuti mizinda ndi mayiko zitha kugula mamiliyoni pang'ono pang'ono zomwe boma lidataya chifukwa cha mliri.
Wogwira ntchito zachipatala mwamsanga anayesa munthu wokwera ndi swab ya m'mphuno pa siteshoni ya sitima ku Mumbai, India.Ngongole yazithunzi: Punit Parajpe / AFP / Getty
Mayeso ofulumira atha kukhala oyenera makamaka pakuwunika kwa asymptomatic kuphatikiza ndende, malo ogona, masukulu ndi mayunivesite, komwe anthu angasonkhane, ndiye kuti mayeso aliwonse omwe angagwire matenda ena owonjezera ndiwothandiza.Koma a Deeks akuchenjeza kuti asagwiritse ntchito mayesowa m'njira yomwe ingasinthe machitidwe a anthu kapena kuwapangitsa kupumula.Mwachitsanzo, anthu anganene kuti zotsatirapo zoipa n’zolimbikitsa kuyendera abale m’nyumba zosungira okalamba.
Pakadali pano, ku United States, njira zazikulu zoyeserera mwachangu zakhazikitsidwa m'masukulu, ndende, ma eyapoti ndi mayunivesite.Mwachitsanzo, kuyambira May, yunivesite ya Arizona ku Tucson yakhala ikugwiritsa ntchito mayeso a Sofia opangidwa ndi Quidel ku San Diego, California kuyesa othamanga ake tsiku ndi tsiku.Kuyambira mu Ogasiti, idayesa ophunzira kamodzi pamwezi (ophunzira ena, makamaka omwe ali m'malo ogona omwe ali ndi miliri, amayesedwa pafupipafupi, kamodzi pa sabata).Pakadali pano, yunivesiteyo yachita mayeso pafupifupi 150,000 ndipo sinanene kuti pachitika milandu ya COVID-19 m'miyezi iwiri yapitayi.
David Harris, wofufuza za stem cell yemwe amayang'anira pulogalamu yayikulu yoyesa ku Arizona, adati mitundu yosiyanasiyana ya mayeso imagwira ntchito zosiyanasiyana: kuyezetsa mwachangu kwa antigen sikuyenera kugwiritsidwa ntchito kuyesa kufalikira kwa kachilomboka pakati pa anthu.Anati: "Mukagwiritsa ntchito ngati PCR, mudzakhala okhudzidwa kwambiri.""Koma zomwe tikuyesera kuchita - kuletsa kufalikira kwa kuyezetsa matenda a antigen, makamaka akagwiritsidwa ntchito kangapo, zikuwoneka kuti zikuyenda bwino.”
Wophunzira waku Oxford University ku UK adayesa mwachangu antigen yoperekedwa ndi yunivesiteyo kenako adawulukira ku United States mu Disembala 2020.
Magulu ambiri ofufuza padziko lonse lapansi akupanga njira zoyesera zofulumira komanso zotsika mtengo.Ena akusintha mayeso a PCR kuti afulumizitse njira yokulitsa, koma ambiri mwa mayesowa amafunikirabe zida zapadera.Njira zina zimadalira njira yotchedwa loop-mediated isothermal amplification kapena LAMP, yomwe ili yachangu kuposa PCR ndipo imafuna zida zochepa.Koma mayesowa sakhala okhudzidwa ngati mayeso otengera PCR.Chaka chatha, ofufuza a ku yunivesite ya Illinois ku Urbana-Champaign adapanga mayeso awo ofulumira: kuyesa kwa PCR komwe kumagwiritsa ntchito malovu m'malo mwa mphuno, kudumpha masitepe okwera mtengo komanso pang'onopang'ono.Mtengo wa mayesowa ndi $10-14, ndipo zotsatira zitha kuperekedwa pasanathe maola 24.Ngakhale yunivesite imadalira ma laboratories omwe ali pamalopo kuti achite PCR, yunivesiteyo imatha kuyang'ana aliyense kawiri pa sabata.Mu Ogasiti chaka chatha, pulogalamu yoyeserera pafupipafupiyi idalola yunivesite kuzindikira kuchuluka kwa matenda am'sukulu ndikuwongolera kwambiri.Pasanathe sabata imodzi, kuchuluka kwa milandu yatsopano kudatsika ndi 65%, ndipo kuyambira pamenepo, yunivesite sinawonenso kuchuluka kofananako.
Boehme adati palibe njira imodzi yoyesera yomwe ingakwaniritse zosowa zonse, koma njira yoyesera yomwe ingazindikiritse anthu omwe ali ndi kachilombo ndiyofunikira kuti chuma chapadziko lonse chikhale chotseguka.Anati: “Mayeso m’mabwalo a ndege, m’malire, m’malo antchito, m’sukulu, m’malo azachipatala—muzochitika zonsezi, kuyezetsa kwachangu kumakhala kwamphamvu chifukwa ndikosavuta kugwiritsa ntchito, kutsika mtengo, komanso kwachangu.”Komabe, adawonjezeranso kuti, mapulogalamu akulu oyesa ayenera kudalira mayeso abwino kwambiri omwe alipo.
Njira yovomerezeka ya EU pano poyesa mayeso a matenda a COVID-19 ndi yofanana ndi njira zina zodziwira matenda, koma nkhawa zokhudzana ndi momwe njira zina zoyezera zimagwirira ntchito zidapangitsa kukhazikitsidwa kwa malangizo atsopano mu Epulo watha.Izi zimafuna opanga kupanga zida zoyesera zomwe zitha kuyezetsa COVID-19 paukadaulo waposachedwa kwambiri.Komabe, popeza kuti zotsatira za kuyezetsa kochitidwa ndi wopanga zingasiyane ndi zomwe zikuchitika m’dziko lenileni, malangizowo amalimbikitsa kuti mayiko amene ali m’bungwelo atsimikizire zimenezi asanayambitse mayesowo.
Boehme adanena kuti, maiko sadzayenera kutsimikizira njira iliyonse yoyezera.Ma Laboratories ndi opanga padziko lonse lapansi adzagwiritsa ntchito njira zofananira (monga zomwe zimapangidwa ndi FIND).Anati: "Chomwe timafunikira ndi njira yoyeserera komanso yowunikira.""Sizidzakhala zosiyana ndi kuyesa mankhwala ndi katemera."
Nthawi yotumiza: Mar-09-2021