經過五小時開會,巴西Anvisa的委員會批出了科興疫苗和阿斯利康疫苗的緊急使用權。主導Butantan第三期實驗和疫苗生產的聖保羅州長鬆一口氣,立即在綠色佈景板前喚來一位黑人女護士打下科興疫苗「第一針」。Anvisa公開Butantan呈交的最終數據,顯示科興疫苗的有效率為50.39% (IC95:35.26-61.98)。
由於Butantan跟科興簽定保密協議,疫苗數據和研發內情到現在才正式公諸於世,其中提到疫苗所用到的滅活病毒,是從四名來自中國不同地區的患者的血液中分離出來,以作遴選毒株之用,時間最早可追溯至2020年1月尾。重溫一年前的經過:
2019年12月,武漢市長周先旺向北京通報疫情,未獲授權告知社會;
12月31日,中共首度通報武漢爆發疫情,當時稱未發現明顯人傳人現象,未發現醫護感染;
2020年1月1日,武漢政府清洗華南海鮮市場;
1月3日,衛健委下令存有病毒樣本的實驗室銷毀樣本或送到指定機構,華春瑩事後指當日美國獲中方通報武漢疫情;
1月7日,習近平召開會議對防控工作提出要求;
1月11日,病毒基因序列破解一星期後通報世衛,為期8日的湖北兩會正式召開;
1月14日,世衛質疑疫情可能有限度人傳人;
1月18日,周先旺聽信「有限度人傳人」的講法,批准舉辦萬家宴,4萬個家庭參與,造成大爆發;
1月20日,中共透過鍾南山在央視受訪承認醫護感染,確認人傳人發生,政治局常委當晚緊急開會;
1月21日,中共科技部啟動應急科技攻關項目,鍾南山為組長,推動血漿採集,要求五條路線研發疫苗;
1月23日,武漢宣佈封城,超過500萬人聞訊後逃往各省以至全世界,部分人飛往歐洲登上郵輪;
1月28日,譚德塞抵達北京,習近平接見時說是他親自指揮親自部署抗疫,譚德塞稱讚北京透明,武漢疫情可防可控;
1月30日,世衛宣佈武漢肺炎為全球緊急衛生事件。
由1月21日開組到3月16日批准了第一支武肺重組蛋白疫苗進入第一期臨床實驗,不需要兩個月時間。同一日,莫德納mRNA疫苗宣佈直接展開人體試驗。而國藥和科興研發的滅活疫苗,到4月14日才進入第一第二期試驗,現在卻「遲來先上岸」了。而科興拜託巴西聖保羅政府開始第三期試驗的日期,是7月21日。
不要以為委員會5:0表決批准緊急使用權,就等同Anvisa認可了所呈交的數據。Anvisa的評估報告講明:「整項臨床研究沒有提供免疫源性評估結果,所呈交的唯一結果不足以滿足免疫源性評估。」
Anvisa對不完全數據的其餘評價還包括:
Predicted neutralizing antibody assessments:
Not presented the results forseen in the approved clinical study
Predicted binding antibody assessments:
The data presented was referring to a collection. The individual results were presented in a table, without defining which group they were referring into (Placebo or Control)
Evaluation of predicted seroconversion and cellular immunity:
No provided for in the approved clinical study protocol
安全性
Occurrence of requested adverse reactions (local and systemic) within 7 days after
administration of the second dose:
50.8% in the adult group and 36.4% in the group
of the elderly;
Occurrence of unsolicited adverse reactions (local and systemic) up to 7 days
after administration of the second dose:
9.2% in the adult group and 8.1% in the
elderly group.
不良反應方面,報告顯示沒有嚴重不良反應,只有40.1%成人接種位置出現疼痛。而Anvisa不厭其煩地指出了滅活疫苗的另一個關鍵風險,就是抗體依賴增強(ADE)效應,意思是滅活疫苗所誘發的抗體可能會增強病毒的感染能力,令患者的病情加重。中國疾控中心主任高福去年被問到這個問題時對此不置可否,強調「目前新冠疫苗ADE沒有定論」。即是說,需要更多的公測數據才可以確認會否重演登革熱疫苗的滑鐵爐事故。
此外,Anvisa認為科興疫苗的保護期效、注射間隔和劑量多少都是不確定的,老人組的數據也得很少。Anvisa仍然要求Butantan追加數據和澄清,包括5704名受試醫護的有效率和接觸史數據。而整個第三期臨床實驗,亞裔受試者只佔2.5%,其他疫苗都有同樣的通病。
Anvisa在結語不忘戴定頭盔,大意是你們逼我審得這麼倉卒的:「此外,重要的是要注意科興生產的Coronavac仍處於分析中(持續提交),但是有關巴西進行的第三階段研究的文件(有效性和安全性)是在請求臨時授權以供緊急使用之下提交的。」Anvisa再三強調,他們想要的免疫源性數據仍未收到。
還記得之前阿斯利康在巴西的第三期臨床實驗曾經一度中止,全因安慰組死了人嗎?原來科興疫苗的巴西臨床實驗也死過人,還有小產,只是現在才可以透過Anvisa公開:
「73 serious adverse events were reported in 67 study participants. In three of these events the participants evolved to death, but none was related to the product under investigation. Of the 5 reported abortions, only one was assessed as having a causal relationship possible with the product under investigation / placebo. It is noteworthy that the causal relationship of this case is still under discussion between sponsor and clinical center in which the event was reported.」
調查發現事故與產品無關,其中一宗仍在討論,早前都受到保密協議保護。
即管看看香港官方反應,大抵是巴西批准了,他們也鬆一口氣,非常科學。
作者
同時也有10000部Youtube影片,追蹤數超過2,910的網紅コバにゃんチャンネル,也在其Youtube影片中提到,...
causal relationship 在 李木生醫師 Facebook 的最佳貼文
2019的新型冠狀病毒 (武漢肺炎病毒) 已經發生超過8 個月了,最近出生小嬰兒的孕期也已幾乎全部發生於此新型冠狀病毒流行的時代裡。 在這個新的時代,我們偏好在家吃外送,看網路電視 而比較少出門。身為婦產科醫師的我,也一直在了解它對於產婦的影響。有兩點想與大家分享。
首先,懷孕中感染並不會增加武漢肺炎的死亡率。但感染新型冠狀病毒的媽媽可能會經由胎盤垂直感染給小孩。所以孕婦戴口罩,勤洗手與社交距離的重要性再跟大家提醒。很幸運的,目前在台灣我們並沒有這樣的個案出現。
第二點是我覺得比較少人討論到的:維他命D缺乏。在台灣30歲的婦女普遍有三分之一都有維他命D的缺乏。維他命D由食物吸收,但必須靠肝,腎與(陽光照射)皮膚活化(註)。所以在這個大家因為疫情都比較少出門曬太陽的大環境裡,我覺得維他命D缺乏的比例會更高。
維他命D幫助鈣質的吸收,對於骨骼與肌肉的健康有很大的幫助。對於孕婦它甚至可能減少孕期糖尿病或子癲癇症 的風險。但至於有些報告指出維他命D缺乏可能是武漢肺炎死亡率的危險因子,英國國家衛生機構NICE 已經釋疑,認為維他命D缺乏與武漢肺炎死亡率並無因果關聯。
(註) 維他命D3是目前比較被廣泛使用的口服維他命,因其不需要經由身體活化。
==============================
謝謝熱心讀者的詢問,這是本篇文章所採用的醫學文獻。
懷孕與武漢肺炎的死亡率關聯
Ellington S, Strid P, Tong VT, et al. Characteristics of Women of Reproductive Age with Laboratory-Confirmed SARS-CoV-2 Infection by Pregnancy Status — United States, January 22–June 7, 2020. MMWR Morb Mortal Wkly Rep 2020;69:769–775.
2019的新型冠狀病毒由胎盤垂直感染的證據
Vivanti, A.J., Vauloup-Fellous, C., Prevot, S. et al. Transplacental transmission of SARS-CoV-2 infection. Nat Commun 11, 3572 (2020). https://doi.org/10.1038/s41467-020-17436-6
維他命D 降低子癲癇症與孕期糖尿病風險的證據
Palacios C, Kostiuk LK, Peña-Rosas JP. Vitamin D supplementation for women during
pregnancy. Cochrane Database of Systematic Reviews 2019, Issue 7. Art. No.: CD008873.
DOI: 10.1002/14651858.CD008873.pub4
台灣北部人口維他命D缺乏的證據
Lee MJ, Hsu HJ, Wu IW, Sun CY, Ting MK, Lee CC. Vitamin D deficiency in northern Taiwan: a community-based cohort study. BMC Public Health. 2019;19(1):337. Published 2019 Mar 22. doi:10.1186/s12889-019-6657-9
英國國家衛生機構 (國家臨床卓越協會, National Institute of Clincal Excellence, NICE) 對於維他命D與武漢肺炎關聯的看法
https://www.nice.org.uk/advice/es28/chapter/Key-messages Accessed August 23rd, 2020
===============================
It has been more than 8 months since the start of the global pandemic of COVID-19. We are now seeing the ripple reflected in the way we live, even in Taiwan. People prefer to stay home now: they order delivery food instead of going to restaurants, and watch video streaming at home instead of going out. As an obstetrician and gynaecologist, I wondered about its effect on women.
First of all, pregnancy does not increase mortality of SARS-CoV2 virus infection. But it can transmit from mother to child via their placental connection. The virus has recently been found in the placenta of a mother and newborn with COVID-19: proving vertical transmission other than routes such as breastfeeding and/or air droplet transmission. So it is worth reiterating the importance of masking at public spaces and hand hygiene for pregnant women. Luckily, in Taiwan thus far, there has not yet been any cases of vertical transmission.
The second point is less well discussed but may well affect more women. And that is Vitamin D deficiency, which is already common in Taiwan pre-COVID-19 era. Its prevalence is about one third in 30 year-olds. In the COVID-19 era, I suspect the prevalence will increase even further because people prefer staying home. Vitamin D deficiency has also been found to be more common in patients who succumb to COVID-19, although it merely reflects the association between vitamin D deficiency and multiple-comorbidities rather than a causal relationship. However, we already know that vitamin D deficiency in pregnancy can be related to a number of birth-related complications such as gestational diabetes and pre-eclampsia. So it is worthwhile testing for vitamin D levels at the beginning of pregnancy. Vitamin D3 is widely used as a supplement in patients with deficiency, because it does not require activation by sunlight.
causal relationship 在 診所嘔血事件簿 Facebook 的精選貼文
今日個女病人我都唔知佢想點。
佢Office裝修,間多啲房比大粒sss坐。佢同其他小薯搬去另外一個角落坐,係對住一部大嘅影印機。佢話啲碳粉令佢有啲氣管敏感。所以想調返出去。當然問過老細比老細Ban咗。
佢就諗辦法想用醫生紙證明佢唔坐得呢個位。
佢同事好豁達,冇乜唔舒服。叫佢開大個窗同開風扇就得。佢覺得咁樣好唔保障,點都想坐返出面。
但係佢離開咗Office其實氣管都繼續敏感。去到半夜瞓覺前先好返啲。佢又冇其他敏感例如眼痕流眼水或者皮膚痕等等。又話搵個唔知咩人嚟度過,話啲空氣乜乜粒數乜乜指數乜乜冇超標。
坦白講,好難100%證明你一定唔坐得呢一個位。你要有個Strong Causal Relationship先證明到一定係個影印機令到你唔舒服。例如一用影印機你先至氣管敏感。一出Office你就即刻冇事。再返入嚟又再喪咳過。咁就機會大啲。
我叫佢去睇專科證明你有氣管敏感,同埋攞啲藥醫好自己先。之後再睇吓點樣證明一定關個影印機事。證明到人哋咪幫你寫囉。不過人哋收幾多錢你就自己打去問左先,唔慌平。同埋唔使旨意你張醫療咭會有得包。
佢之後轉軚,話其實都唔係好想要個證明。話攞個證明出嚟俾老細睇,唔通想同佢反面咩?都係想攞定先保障自己。
😰😰😰😰
如果你唔係諗住留難老細,咁攞個醫生寫證明做乜嘢?而家老細唔俾你換位,你搵其他人噠佢,其實都係夾佢啦?冇得你隊佢出嚟話佢錯,但係又唔當係反面,跟住又要佢就你返俾你換位。俾你換左個位同埋啲大粒ssss一齊坐你估你有好日子過咩?
Any肥,我都係叫佢睇專科,有病點都要醫嘅。要攞醫生證明就錢你點都要俾。世界上冇得你鍾意點就點,但係又要平靚正。攞醫生證明事小,不過D職場 Politics,佢就真係要諗清楚點樣打呢場仗。
~~~
早個月去友人婚禮,呢個係我見過最正嘅婚禮小禮物~~~啲茶葉超香好唔好~~~ 🤤🤤🤤
喺尖沙咀某間酒店擺酒,服務超級麻麻。佢開大啲個冷氣竟然全台嘅杯杯碟碟都跌滿天花灰。要叫佢哋先至肯換杯碟。仲要冇人自動斟茶斟水斟酒斟汽水。你叫佢斟,佢就淨係斟俾你一個,無意識睇吓你張枱嘅其他人其實係咪已經口乾到傻咗。
causal relationship 在 コバにゃんチャンネル Youtube 的最佳解答
causal relationship 在 大象中醫 Youtube 的精選貼文
causal relationship 在 大象中醫 Youtube 的精選貼文
causal relationship 在 Correlation and Causal Relation - Varsity Tutors 的相關結果
A causal relation between two events exists if the occurrence of the first causes the other. The first event is called the cause and the second event is called ... ... <看更多>
causal relationship 在 causal relationship - 因果關係 - 國家教育研究院雙語詞彙 的相關結果
因果關係, causal relationship. 學術名詞 心理學名詞-兩岸心理學名詞, 因果關係, cause-and-effect relationship ; causality. 學術名詞 社會工作與福利名詞 ... <看更多>
causal relationship 在 Causal Relationship - an overview | ScienceDirect Topics 的相關結果
Causal relationships between variables may consist of direct and indirect effects. Direct causal effects are effects that go directly from one variable to ... ... <看更多>