上次同大家分享COVID現有的不同治療方案
今日跟大家分享下當一個國家COVID爆發時需要大量接種COVID疫苗時面對的困難和難題
***以下內容只作分享用途,所有臨床診斷的考慮請跟隨個別醫院指引***
首先講講全球最常見較為有效而又打了很多劑的疫苗
Adenovirus vector: AZ and J&J
mRNA: Pfizer-BNT and Moderna
至於另一款疫苗如Novavax或台灣高端由於打的人數不多,就沒有太多數據分享
第一件事要認清的是,由於Delta的出現,疫苗並非神藥,以往大家期望的群體免疫在original或alpha上可能可以達到,但在delta蔓延的今日,似乎有難度。
根據大名鼎鼎的NEJM的研究,兩劑AZ對symptomatic infection的保護率大約為67%、而Pfizer-BNT的保護率大約為88%。不過可惜的是同時間有一些研究,例如牛津大學研究發現當接種疫苗過一段時間後,保護力會漸減,BNT尤其受到時間的影響。
另外,初步數據顯示針對delta,疫苗並不能像alpha或original一樣大幅減少打完疫苗的人的病毒含量。打了疫苗的人的病毒含量跟沒打的相當接近,不過疫苗對防止出現病徵和重症或死亡非常有效,只耐何疫苗來得太遲,delta搶先在世上出現。同時初步數據顯示Delta似乎較alpha/original更大機會出現重症和住院的機會,尤其於年輕人身上,不過這需要更多數據支持。
這代表面對惡名昭彰的Delta,我們不能再依靠打疫苗去保護他人,因為疫苗並不能夠阻止delta asymptomatic transmission。當打完疫苗後的病毒量一樣高時,唯一可以做的便是靠打疫苗保護自己,減低自己感染、住院、重症和死亡風險。
不過當大量接種疫苗時,便會出現一些罕有的副作用,這些副作用醫護人員必須Alert的,而處理這些懷疑的副作用亦對醫療系統造成沉重的負擔。但目前所有大型研究都顯示,疫苗副作用造成對醫療系統的負擔跟任由COVID爆發的社會和醫療成本相比是兩個不同級數的事。
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VITTS - Vaccine-induced immune thrombosis thrombocytopenic syndrome
在adenovirus vector的疫苗身上被發現罕有地會出現這種病症。初步數據是懷疑因為出現platelet factor 4 (PF-4) antibodies,原理跟HITTS (Heparin Induced thrombotic thrombocytopenic syndrome)類似。
VITTS多數會出現Cerebral Venous Sinus或Splanchnic thrombosis,但亦可在一般常見的血栓位置,例如DVT or PE but much less likely
一般臨床上可能會出現劇烈頭痛/腹痛/成因不明的瘀血(Petechiae)等等,較常於第一劑的4-42日內出現,亦較常見於年輕女性身上 機率視乎人種和年齡和研究的地方,歐洲數據為約0.00034%的機會出現。同時驗血報告中亦會發現血小板偏低和D-dimer偏高以及positive anti-PF4。
不過值得注意的是即使病發初期血小板和d-dimer正常都不一定沒有VITTS,個別個案可以於24-48小時後才出現這些features,視乎clinical suspicion, serial review and FBC might be indicated
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心肌炎及心包炎Myocarditis and pericarditis
在mRNA疫苗身上發現的已知罕有副作用,常見炎第二針後的年輕男性(30歲以下)身上,大多於接種第二針後第1-5日後出現,多以心口痛、心悸、暈厥(Syncope)、呼呼短促(SOB)等呈現,病發機率視乎人種、年齡和性別,美國數據為Myocarditis/Pericarditis - 12.6/million = 0.000126% (American Heart Association)
成因未完全了解,但似乎跟免疫系統激活的過程有關(詳情refer AHA report)。大部分患者病情相對輕微,個別患者可能有ECG dynamic changes, ST elevation, troponin rise, mild reduced LvEF on echo,但大部分患者都在短期內出院with full recovery (96% as per AHA)
值得注意的是,myocarditis在歷史上的其他疫苗例如流感、乙肝、天花(small pox)等等都有罕有的機會出現,約10-20 individual/100000 per year
同時感染COVID或其他病毒性感染的話亦可能會出現myocarditis,臨床懷疑的話或需要ECG, troponin, CXR, +/- echo +/- cardiac MRI
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任何醫療選擇都有風險,當一個國家進行社區大型接種時,便需要處理這些問題,英美兩大國的經驗其實為世人提供了好多寶貴實用的資訊,好讓大家不用走冤枉路。
隨著時間的過去,愈來愈多數據和研究讓大家自行分析,多讀書多看研究才不會被任何人誤導,緊記保持批判性思考,無論任何人的高見都別不經消化和思考去接受。
Reference for further reading
1. ATAGI statement ATAGI statement regarding COVID-19 vaccines in the setting of transmission of the Delta variant of concern
https://www.health.gov.au/news/atagi-statement-regarding-covid-19-vaccines-in-the-setting-of-transmission-of-the-delta-variant-of-concern
2. NEJM - Effectiveness of Covid-19 Vaccines against the B.1.617.2 (Delta) Variant
https://www.nejm.org/doi/full/10.1056/NEJMoa2108891
3. Oxford University Studies Preprint - Vaccines still effective against Delta variant of concern, says Oxford-led study of the COVID-19 Infections Survey
https://www.ox.ac.uk/news/2021-08-19-vaccines-still-effective-against-delta-variant-concern-says-oxford-led-study-covid
4. AHA - Myocarditis With COVID-19 mRNA Vaccines
https://www.ahajournals.org/doi/10.1161/CIRCULATIONAHA.121.056135
Photo: internet
同時也有16部Youtube影片,追蹤數超過792的網紅WE5-Shibaland,也在其Youtube影片中提到,Grandpa 噏乜狗 - 不要以貌取狗,要看行為! Grandpa’s Philosophies - Don’t Judge a Dog with the Breed/Appearance, But Behavior instead! ? 懂得珍惜!懂得珍重!每一個人、每一個狗、每一個建築,都有...
「individual photo」的推薦目錄:
individual photo 在 貓行為獸醫師林子軒 Facebook 的精選貼文
往年我對於貓咪戴鈴鐺這件事情,認為可能會讓貓咪因此感到焦慮,或者是鈴鐺聲聽久傷耳,所以抱持著反對立場。但在這幾年相關的研究越來越多,有些事情跟我當初想的不太一樣,所以再次重新跟大家分享一下我的看法:
1.鈴鐺究竟能不能幫助野生動物逃離貓的魔爪?
先說結論,鈴鐺有效,但有其他更安全更有效的產品(如THE CATBIB),然後家貓不要放養,乖乖待在家裡就好不要放出去亂。
相關的研究:
Equipping cats with bells seems to reduce their predation on wild birds and mammals…this practice can be recommended to owners seeking to reduce such predation. (Ruxton, G. 2002)
還有一些類似的研究:
Cats equipped with a bell returned 34% fewer mammals, and 41% fewer birds than those with a plain collar. (Nelson, S. 2005)
2.鈴鐺會造成貓咪聽覺受損或焦慮嗎?
聽覺受損的部分這點有研究,因為噪音導致聽覺功能受損的機制,這方面貓跟人很像,所以有人以貓作為實驗動物做了相關實驗,可參考:
Auditory brainstem responses predict auditory nerve fiber thresholds and frequency selectivity in hearing impaired chinchillas.
如果你懶得看,我直接說結論,答案是”不會”。
由於該研究用的是專門的聲音控制裝置,並沒有使用到鈴鐺,所以這鈴聲是我自己拿分貝計去測的,其平均音量大約是80分貝左右。這個音量要讓聽覺受損的難度,大概就像你在地上撿了一顆石頭想要丟中天上的飛機一樣,有那個可能,但微乎其微。
至於會不會讓長期繫上鈴鐺的貓咪焦慮?
關於這點沒有相關研究,僅知道貓的聽覺頻率比人更廣,音量也是人聽到的四倍(大家有空可以去科教館玩,那邊有一頂貓頭盔可以模擬貓咪聽到的音量,基本上,貓就是可以聽到超細微的聲音)。所以關於這一點,目前無法證實是否有影響,如果有,會有多大的影響?
我是認為,以人的角度能替貓設想到這件事,就是代表你重視動物福利,如果連你都不喜歡那樣的東西長期配戴在自己身上,那幹嘛還給貓戴?
倒是近期有篇比較好玩的研究,主要是在講有一些特定的聲音會引起老年貓的癲癇,可參考:
Levetiracetam in the management of feline audiogenic reflex seizures: a randomised, controlled, open-label study.(Lowrie M, et al. J Feline Med Surg. 2017.)
結論:
雖然鈴鐺沒有這麼萬惡深淵,但以風險考量下,即使是安全項圈也還是有不安全的時候,加上我實在想不到有什麼情況是非得讓貓配戴鈴鐺不可的理由。很多環境上的問題都是我們身為飼主可以努力改善的,所以我認為是不需要沒事找事做,你當你在改車啊?
《附註》
很多人在問什麼樣的聲音會引起貓的癲癇,跟大家分享一下:
The sounds that trigger seizures vary between individual cats, and a huge variety of different sounds were identified as triggers. Some of the more common trigger noises included:
*crinkling tin foil
*a metal spoon clanging in a ceramic feeding bowl
*chinking or tapping of glass
*crinkling of paper or plastic bags
*tapping on a computer keyboard or clicking of a mouse
*clinking of coins or keys
*hammering of a nail
*clicking of an owner’s tongue
至於我個人經驗裡面,這我們家阿橘曾經因為電音舞曲的吵雜聲音發作過。
Photo from: smithsonianmag.com
individual photo 在 WE5 - Shibaland Facebook 的精選貼文
Holiday Today! We’re Here This Afternoon, Sipped A ☕️, Chatted A Bit With The Passerby & Other Customers, They Took Photos With 🐷🐷🐷🐷🐷, Kind Of Our Way Our Living!
Anyways, Met Those Whom Snapping When 🐷🐷🐷🐷🐷🚽💩 & When Am Cleaning After Again Today, Stay Positive, Fighting 👊🏻
放假!半個下午就在這裡閑hea!喝喝咖啡☕️,跟路人、啡客吹吹水、他們跟🐷🐷🐷🐷🐷拍拍照,生活!當然亦有遇上在🐷🐷🐷🐷🐷🚽💩、在我撿💩時拍照的人,若然我不夠正能量便死了💪🏻
.
大家記得戴口罩😷勤洗手🤲🏻🚿留家抗疫💪🏻
Stay Home Stay Safe Stay Healthy Stay Happy!
Wear Mask 😷 Wash Ur Hands 🤲🏻🚿 Stay Home🏠
🤠
懂得珍惜!懂得珍重!每一個人、每一個狗、每一個建築,都有自己的故事!放慢腳步,用身感受,用心欣賞!放鬆心情,多溝通,多連繫,多發掘!一句問候一個交流絶比僅僅拍下一個照片來得實在、珍貴、意義、高尚!
🤠
我們每天都盡心盡力給人分享我們應如何管理狗狗、如何多角度邏輯思考的理念,希望能夠早日人狗共融人人和諧!多尊重,少包容!
🤠
Every Individual, Every Doggie, Every Building, They Do Have Their Own Story! Slow Down Ur Pace, Feel with Heart and Body! Relax, Communicate, Interact, Discover! A Simple Greet and Talk, Comes More Respectful, Meaningful, Treasurable and Decent Rather Than Just Taking a Photo only!
🤠
We Share to People Everyday How Should We Manage Our Puppies, and How to Think Logically at Different Perspectives. Aiming to Achieve Social Harmony in Between Humans and Animals, and Humans among Humans! Show Respect, Rather Than Asking for Tolerance!
😝
*拍照前請先打招呼詢問一下哦
*拍照前請先注意交通安全哦
*狗狗上廁所時請不要拍照哦
*我清理和拿著狗狗便便時請不要拍照哦
*摸狗狗前請先問一下
*我們鼓勵人與人之間應該多聯繫
*打個招呼拍拍照何樂而不為
*PleaseGreetAndAskBeforeYouSnap
*PleasePayAttentionToTrafficBeforeYouSnap
*PleaseDoNotSnapWhenDoggiesPeeAndPoo
*PleaseDoNotSnapWhenAmCleaningAndCarryingTheirPoops
*PleaseAskBeforeYouPat
*WeAreEncouragingHumanEngagement
*NothingToLooseToSayHi
🤠
#WE5 #Shibaland #Shibainus #shibas #ShibaGang #GrandpaDogTraining #Grandpa狗噏 #DogTraining
#OldTownCentral #MutualRespect
#🐷🐷🐷🐷🐷 #WE5ShibaFamily #舊城中環 #多尊重少包容 #文明旅遊 #柴犬 #HKShibas
#多頭飼 #ShibaFamily #ShibaLove #HKShibas
#DiscoverHongKong #DogsofInstagram #DogPhotography
#GrandpaPhotoGraphy
#LoveWillKeepUsTogether #只要不投降就是成功 #不要棄養 #AwesomeHongKong #Canon6D @canonhongkong @hk_dog_owners
individual photo 在 WE5-Shibaland Youtube 的最讚貼文
Grandpa 噏乜狗 - 不要以貌取狗,要看行為!
Grandpa’s Philosophies - Don’t Judge a Dog with the Breed/Appearance, But Behavior instead!
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懂得珍惜!懂得珍重!每一個人、每一個狗、每一個建築,都有自己的故事!放慢腳步,用身感受,用心欣賞!放鬆心情,多溝通,多連繫,多發掘!一句問候一個交流絶比僅僅拍下一個照片來得實在、珍貴、意義、高尚!
?
我們每天都盡心盡力給人分享我們應如何管理狗狗、如何多角度邏輯思考的理念,希望能夠早日人狗共融人人和諧!多尊重,少包容!
?
Every Individual, Every Doggie, Every Building, They Do Have Their Own Story! Slow Down Ur Pace, Feel with Heart and Body! Relax, Communicate, Interact, Discover! A Simple Greet and Talk, Comes More Respectful, Meaningful, Treasurable and Decent Rather Than Just Taking a Photo only!
?
We Share to People Everyday How Should We Manage Our Puppies, and How to Think Logically at Different Perspectives. Aiming to Achieve Social Harmony in Between Humans and Animals, and Humans among Humans! Show Respect, Rather Than Asking for Tolerance!
?
*拍照前請先打招呼詢問一下哦
*拍照前請先注意交通安全哦
*狗狗上廁所時請不要拍照哦
*我清理和拿著狗狗便便時請不要拍照哦
*摸狗狗前請先問一下。
*PleaseGreetAndAskBeforeYouSnap
*PleasePayAttentionToTrafficBeforeYouSnap
*PleaseDoNotSnapWhenDoggiesPeeAndPoo
*PleaseDoNotSnapWhenAmCleaningAndCarryingTheirPoops
*PleaseAskBeforeYouPat
?
individual photo 在 WE5-Shibaland Youtube 的最讚貼文
Grandpa 噏乜狗 - 您有您的自由,但那人家的呢?
Grandpa’s Philosophies - You Have Your Freedom, But How About the Others Then?!
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懂得珍惜!懂得珍重!每一個人、每一個狗、每一個建築,都有自己的故事!放慢腳步,用身感受,用心欣賞!放鬆心情,多溝通,多連繫,多發掘!一句問候一個交流絶比僅僅拍下一個照片來得實在、珍貴、意義、高尚!
?
我們每天都盡心盡力給人分享我們應如何管理狗狗、如何多角度邏輯思考的理念,希望能夠早日人狗共融人人和諧!多尊重,少包容!
?
Every Individual, Every Doggie, Every Building, They Do Have Their Own Story! Slow Down Ur Pace, Feel with Heart and Body! Relax, Communicate, Interact, Discover! A Simple Greet and Talk, Comes More Respectful, Meaningful, Treasurable and Decent Rather Than Just Taking a Photo only!
?
We Share to People Everyday How Should We Manage Our Puppies, and How to Think Logically at Different Perspectives. Aiming to Achieve Social Harmony in Between Humans and Animals, and Humans among Humans! Show Respect, Rather Than Asking for Tolerance!
?
*拍照前請先打招呼詢問一下哦
*拍照前請先注意交通安全哦
*狗狗上廁所時請不要拍照哦
*我清理和拿著狗狗便便時請不要拍照哦
*摸狗狗前請先問一下。
*PleaseGreetAndAskBeforeYouSnap
*PleasePayAttentionToTrafficBeforeYouSnap
*PleaseDoNotSnapWhenDoggiesPeeAndPoo
*PleaseDoNotSnapWhenAmCleaningAndCarryingTheirPoops
*PleaseAskBeforeYouPat
?
#WE5 #Shibaland #Shibainus #shibas #ShibaGang #GrandpaDogTraining #Grandpa狗噏 #DogTraining
#OldTownCentral #MutualRespect
#WeAreEncouragingHumanEngagement
#WE5ShibaFamily #舊城中環 #多尊重少包容 #深度遊 #互相尊重 #文明旅遊 #柴犬
#我們鼓勵人與人之間應該多聯繫 #ShibaFamily #ShibaLove
#DiscoverHongKong #shiba_snap #DogPhotography
#GrandpaPhotoGraphy
#LoveWillKeepUsTogether #只要不投降就是成功
individual photo 在 WE5-Shibaland Youtube 的最佳解答
精神啲!臨時演員都係演員嚟 ☹️?????
?
懂得珍惜!懂得珍重!每一個人、每一個狗、每一個建築,都有自己的故事!放慢腳步,用身感受,用心欣賞!放鬆心情,多溝通,多連繫,多發掘!一句問候一個交流絶比僅僅拍下一個照片來得實在、珍貴、意義、高尚!
?
我們每天都盡心盡力給人分享我們應如何管理狗狗、如何多角度邏輯思考的理念,希望能夠早日人狗共融人人和諧!多尊重,少包容!
?
Every Individual, Every Doggie, Every Building, They Do Have Their Own Story! Slow Down Ur Pace, Feel with Heart and Body! Relax, Communicate, Interact, Discover! A Simple Greet and Talk, Comes More Respectful, Meaningful, Treasurable and Decent Rather Than Just Taking a Photo only!
?
We Share to People Everyday How Should We Manage Our Puppies, and How to Think Logically at Different Perspectives. Aiming to Achieve Social Harmony in Between Humans and Animals, and Humans among Humans! Show Respect, Rather Than Asking for Tolerance!
?
*拍照前請先打招呼詢問一下哦
*拍照前請先注意交通安全哦
*狗狗上廁所時請不要拍照哦
*我清理和拿著狗狗便便時請不要拍照哦
*摸狗狗前請先問一下。
*PleaseGreetAndAskBeforeYouSnap
*PleasePayAttentionToTrafficBeforeYouSnap
*PleaseDoNotSnapWhenDoggiesPeeAndPoo
*PleaseDoNotSnapWhenAmCleaningAndCarryingTheirPoops
*PleaseAskBeforeYouPat
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