{"id":90114,"date":"2020-04-30T07:01:25","date_gmt":"2020-04-30T07:01:25","guid":{"rendered":"https:\/\/raed.academy\/?p=90114"},"modified":"2020-05-01T19:08:13","modified_gmt":"2020-05-01T19:08:13","slug":"el-llarg-i-incert-cami-cap-a-la-vacuna","status":"publish","type":"post","link":"https:\/\/raed.academy\/ca\/el-llarg-i-incert-cami-cap-a-la-vacuna\/","title":{"rendered":"El llarg i incert cam\u00ed cap a la vacuna"},"content":{"rendered":"

Jos\u00e9 Esparza<\/strong><\/em>
\nProfessor de l’Institut de Virologia Humana de la Facultat de Medicina de la Universitat de Maryland, ex-president de la Global Virus Network, investigador de l’Institut Rober Koch, conseller de l’Organitzaci\u00f3 Mundial de la Salut (OMS) i acad\u00e8mic de l’Acad\u00e8mia de Ci\u00e8ncies d’Am\u00e8rica Llatina <\/em><\/p>\n

Conversa mantinguda amb Francisco Kerdel<\/strong><\/a>, acad\u00e8mic corresponent de la Reial Acad\u00e8mia Europea de Doctors-Barcelona 1914 (RAED)
\n<\/em><\/p>\n

Crec que nom\u00e9s hi ha tres maneres de controlar aquesta epid\u00e8mia. La primera \u00e9s quan es cre\u00ef una immunitat de ramat, potser quan s’infectin prop del 60-70% de les persones. La segona manera \u00e9s amb un vacuna. I la tercera \u00e9s amb totes dues. Les falses expectatives sobre una vacuna es deriven de la promesa de Donald Trump<\/strong> sobre que una vacuna es desenvoluparia en 12-18 mesos. Mai vaig pensar que aix\u00f2 fos possible si se segueixen les regles, ja que caldrien almenys dos anys si tot surt b\u00e9, que rarament passa. Avui he vist un v\u00eddeo de Bill Gates<\/strong> que expressa la mateixa preocupaci\u00f3.<\/p>\n

Quins s\u00f3n els problemes?<\/p>\n

No sabem si la infecci\u00f3 amb el SARS-CoV-2 resulta en la inducci\u00f3 d’immunitat protectora. Aix\u00f2 \u00e9s formalment cert perqu\u00e8 l’epid\u00e8mia tan sols t\u00e9 quatre mesos i no hi ha hagut temps per demostrar-ho. Per\u00f2 si el virus es comporta com tots els altres virus jo diria que ha de induir immunitat postinfecci\u00f3. Aquesta immunitat existeix despr\u00e9s de la infecci\u00f3 amb els quatre coronavirus humans benignes que produeixen refredats comuns, amb el SARS i el MERS i amb diversos coronavirus que produeixen malalties en animals dom\u00e8stics. En aquests casos el que s\u00ed \u00e9s cert \u00e9s que la immunitat protectora \u00e9s de curta durada, de dos a tres anys.<\/p>\n

Alguns pacients que es recuperen tenen baixos nivells d’anticossos, per\u00f2 aix\u00f2 no \u00e9s estrany. L’important \u00e9s que tinguin c\u00e8l\u00b7lules B de mem\u00f2ria que r\u00e0pidament comencin a produir anticossos quan detectin el virus. Fins i tot en casos com el VIH que provoca la sida les persones infectades produeixen anticossos neutralitzants per\u00f2 el virus r\u00e0pidament muta i s’escapa. Els coronavirus s\u00f3n for\u00e7a estables gen\u00e8ticament.<\/p>\n

\"Jos\u00e9

Jos\u00e9 Esparza<\/p><\/div>\n

Hi ha uns casos sospitosos de reinfecci\u00f3, per\u00f2 no s’ha demostrat que sigui a causa de reactivaci\u00f3. Fins i tot si hi ha reinfecci\u00f3 s’esperaria que no causar\u00e0 malaltia.<\/p>\n

Tenim diversos (potser molts) candidats a vacuna. S\u00f3n productes de laboratori que creiem poden induir anticossos i fins i tot immunitat cel\u00b7lular. Hi ha prop de 70 candidats en diferents estadis de desenvolupament usant diferents plataformes: virus inactivats, vectors virals, prote\u00efnes recombinants, ARN i ADN, etc. Alguns d’aquests candidats ja han mostrar induir anticossos en animals de laboratori i almenys dos han demostrat protegir micos.<\/p>\n

Ara cal conduir proves cl\u00edniques en humans. Aquestes proves generalment es fan en tres fases. La fase I es fa amb prop de 50 persones sanes per demostrar que la vacuna no causa efectes secundaris. Aix\u00f2 pren generalment un any. La fase II necessita centenars de persones per definir dosi i obtenir m\u00e9s informaci\u00f3 sobre seguretat i immunogenicitat. Aquestes proves poden durar un altre any. La fase III \u00e9s per demostrar que la vacuna prev\u00e9 la infecci\u00f3 i\/o malaltia. Requereix centenars o milers de persones a risc de contraure la infecci\u00f3. Si la incid\u00e8ncia de la infecci\u00f3 \u00e9s alta, la mida de mostra \u00e9s menor. S\u00f3n proves en doble cec on per raons \u00e8tiques tots, inclusivament el grup control, han de prendre mesures per evitar la infecci\u00f3. Aquestes proves poden durar entre un i dos anys depenent de la incid\u00e8ncia de la infecci\u00f3.<\/p>\n

En realitat, moltes vegades es combinen les fases I i II per obtenir m\u00e9s r\u00e0pidament “proof of concept” que la vacuna protegeix (fase IIb). Ja hi ha un parell de vacunes en fase I i Adrian Hill<\/strong>, a Oxford<\/strong>, ha anunciat que molt aviat iniciar\u00e0 una prova en 1.000 persones que b\u00e0sicament combina les tres fases en una. \u00c9s arriscat.<\/p>\n

Quins riscos pot haver?<\/p>\n

El major risc te\u00f2ric \u00e9s que els anticossos indu\u00efts per la vacuna en comptes de protegir exacerbin la malaltia si la persona vacunada s’infecta. Aix\u00f2 es podria deure a un fenomen ben conegut (Antibody Dependent Enhancement) que es coneix amb d’altres vacunes i que ja es va observar amb vacunes experimentals de SARS a animals. Aquest \u00e9s el risc m\u00e9s alt i una vacuna no ha de mostrar-ho despr\u00e9s d’un temps apropiat de seguiment (probablement almenys un any).<\/p>\n

Si els resultats s\u00f3n positius, quan estaria disponible la vacuna?<\/p>\n

Caldria fabricar en grans quantitats i alguns processos no s\u00f3n f\u00e0cils de portar d’una escala de laboratori a una industrial. La ind\u00fastria farmac\u00e8utica espera fins a tenir una prova de concepte abans d’iniciar la construcci\u00f3 de les plantes, que costen molts milions. No obstant aix\u00f2, J&J<\/strong> ha anunciat que comen\u00e7aran la fabricaci\u00f3 de la planta si el seu producte funciona (que no s’ha comen\u00e7at a provar en humans). D’altra banda, les plantes s\u00f3n diferents per a cada tipus de vacunes. L’\u00fanica cosa que seria est\u00e0ndard s\u00f3n les plantes per a l’ompliment de vials del producte final.<\/p>\n

Quantes dosis caldrien? Tampoc no est\u00e0 clar, perqu\u00e8 vacunar a set mil milions de persones no \u00e9s factible. Es podria vacunar les persones de m\u00e9s alt risc, per\u00f2 potser es necessiti m\u00e9s recerca i potser alguna modificaci\u00f3 de la vacuna per a les persones de m\u00e9s de 60 anys.<\/p>\n

En conclusi\u00f3, jo crec que una vacuna \u00e9s possible i que es podrien escur\u00e7ar els temps, per\u00f2 hi ha moltes inc\u00f2gnites que resoldre i aix\u00f2 prendr\u00e0 temps.<\/p>\n

En qualsevol cas observo -amb sorpresa- que ning\u00fa, o gaireb\u00e9 ning\u00fa, posa en dubte que aviat sorgir\u00e0 una vacuna efectiva i duradora per combatre amb resultats positius la pand\u00e8mia del coronavirus, quan no tenim suficient evid\u00e8ncia que el virus confereixi immunitat duradora als que ha afectat.<\/p>\n

 <\/p>\n","protected":false},"excerpt":{"rendered":"

Jos\u00e9 Esparza Professor de l’Institut de Virologia Humana de la Facultat de Medicina de la Universitat de Maryland, ex-president de la Global Virus Network, investigador de l’Institut Rober Koch, conseller de l’Organitzaci\u00f3 Mundial de la Salut (OMS) i acad\u00e8mic de l’Acad\u00e8mia de Ci\u00e8ncies d’Am\u00e8rica Llatina Conversa mantinguda amb Francisco Kerdel, acad\u00e8mic corresponent de la Reial […]<\/p>\n","protected":false},"author":12,"featured_media":84005,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_et_pb_use_builder":"","_et_pb_old_content":"","_et_gb_content_width":"","footnotes":""},"categories":[268,273],"tags":[],"class_list":["post-90114","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-coronavirus-des-del-coneixement","category-salut","et-has-post-format-content","et_post_format-et-post-format-standard"],"yoast_head":"\nEl llarg i incert cam\u00ed cap a la vacuna - Reial Acad\u00e8mia Europea de Doctors<\/title>\n<meta name=\"description\" content=\"La infecci\u00f3 per coronavirus resulta en la inducci\u00f3 d'immunitat protectora? 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