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Ma waena o 290,000 a me 650,000 mau maʻi maʻi hanu e pili ana i ka maʻi maʻi ma ka honua holoʻokoʻa i kēlā me kēia makahiki. Ke ʻike nei ka ʻāina i kahi maʻi maʻi maʻi maʻi koʻikoʻi i kēia hoʻoilo ma hope o ka pau ʻana o ka maʻi maʻi COVID-19. ʻO ka lāʻau lapaʻau ke ala maikaʻi loa e pale ai i ka maʻi maʻi maʻi, akā ʻo ka maʻi maʻi influenza maʻamau e pili ana i ka moʻomeheu embryo moa he mau hemahema, e like me ka hoʻololi immunogenic, ka palena hana a pēlā aku.

ʻO ka hiki ʻana mai o ka HA protein gene engineering influenza vaccine hiki ke hoʻopau i nā hemahema o ka lāʻau embryo moa kahiko. I kēia manawa, paipai ka American Advisory Committee on Immunization Practices (ACIP) i ka lāʻau lapaʻau recombinant influenza kiʻekiʻe no nā pākeke ≥65 mau makahiki. Eia nō naʻe, no ka poʻe ma lalo o 65 mau makahiki, ʻaʻole ʻōlelo ʻo ACIP i ka maʻi maʻi maʻi maʻi i kūpono i ka makahiki ma muli o ka nele o ka hoʻohālikelike poʻo a me ke poʻo ma waena o nā ʻano lāʻau lapaʻau like ʻole.

Ua ʻae ʻia ka lāʻau lapaʻau influenza genetically engineered hemagglutinin (HA) quadrivalent recombinant hemagglutinin (RIV4) no ke kūʻai ʻana ma kekahi mau ʻāina mai ka makahiki 2016 a ʻo ia ka lāʻau lapaʻau maʻi maʻi recombinant i hoʻohana ʻia. Hana ʻia ʻo RIV4 me ka hoʻohana ʻana i kahi kahua ʻenehana protein recombinant, hiki ke lanakila i nā hemahema o ka hana kuʻuna maʻamau i hoʻopaʻa ʻia e ka hāʻawi ʻana i nā embryos moa. Eia kekahi, ʻoi aku ka pōkole o ka hana ʻana o kēia kahua, ʻoi aku ka maikaʻi o ka hoʻololi ʻana i nā maʻi maʻi maʻi moho, a hiki ke pale i nā mutations adaptive e hiki mai ana i ke kaʻina hana o nā maʻi viral e hoʻopilikia ai i ka hopena pale o nā lāʻau lapaʻau i pau. Ua ʻōlelo ʻo Karen Midthun, ka luna o ka Center for Biologics Review and Research ma ka US Food and Drug Administration (FDA), "ʻo ka hiki ʻana mai o nā lāʻau lapaʻau recombinant e hōʻike ana i kahi holomua ʻenehana i ka hana ʻana i nā maʻi influenza… Eia kekahi, aia ʻekolu mau manawa ʻoi aku ka nui o ka protein hemagglutinin ma RIV4 ma mua o ka maʻi maʻamau o ka maʻi influenza maʻamau, ʻoi aku ka ikaika o ka immunogenicity [2]. Ua hōʻike ʻia nā haʻawina e kū nei he ʻoi aku ka palekana o ka RIV4 ma mua o ka maʻi maʻi maʻi maʻamau maʻamau i nā poʻe ʻelemakule, a ʻoi aku ka pono o nā hōʻike piha e hoʻohālikelike ai i nā mea ʻelua i ka poʻe ʻōpio.

Ma Kekemapa 14, 2023, ua paʻi ka New England Journal of Medicine (NEJM) i kahi Study na Amber Hsiao et al., Kaiser Permanente Vaccine Study Center, KPNC Health System, Oakland, USA. He noiʻi honua maoli ka haʻawina i hoʻohana i kahi ala helu helu kanaka e loiloi i ka hopena pale o RIV4 e kūʻē i kahi maʻi maʻi maʻi maʻamau quadrivalent-dose inactivated influenza (SD-IIV4) i nā poʻe ma lalo o 65 mau makahiki i loko o ʻelua kau maʻi maʻi mai 2018 a 2020.

Ma muli o ka nui o ka lawelawe a me ka nui o nā hale KPNC, ua hoʻokaʻawale ʻia lākou i ka hui A a i ʻole ka Pūʻulu B (Figure 1), kahi i loaʻa ai i ka hui A RIV4 i ka pule mua, ua loaʻa i ka pūʻulu B ka SD-IIV4 i ka pule mua, a laila loaʻa i kēlā me kēia hale i nā lāʻau lapaʻau ʻelua i kēlā me kēia pule a hiki i ka hopena o ke kau maʻi maʻi i kēia manawa. ʻO ka hopena mua o ka haʻawina ʻo ia nā maʻi maʻi influenza i hoʻopaʻa ʻia e PCR, a ʻo nā helu hope lua e pili ana i ka maʻi influenza A, influenza B, a me nā halemai pili i ka maʻi influenza. Hana nā kauka ma kēlā me kēia hale i nā ho'āʻo PCR influenza e like me ko lākou manaʻo, e pili ana i ka hōʻike ʻana o ka maʻi, a loaʻa i ka maʻi maʻi a me ka maʻi maʻi ma waho, ka hoʻāʻo ʻana i ka maʻi maʻi, a me ka ʻike ma o nā moʻolelo olakino uila.

Hoʻokomo ʻia ka haʻawina i nā pākeke mai 18 a 64 mau makahiki, me 50 a 64 mau makahiki ʻo ia ka pūʻulu makahiki mua i nānā ʻia. Ua hōʻike nā hopena i ka hopena palekana pili (rVE) o RIV4 i hoʻohālikelike ʻia me SD-IIV4 e kūʻē i ka maʻi maʻi i hoʻopaʻa ʻia PCR he 15.3% (95% CI, 5.9-23.8) i nā poʻe 50 a 64 mau makahiki. ʻO ka pale pili i ka maʻi influenza A he 15.7% (95% CI, 6.0-24.5). ʻAʻole i hōʻike ʻia ka hopena palekana pili i ka maʻi maʻi maʻi B a i ʻole nā ​​​​maʻi maʻi maʻi maʻi. Eia kekahi, ua hōʻike ʻia nā noiʻi ʻimi ʻana i ka poʻe 18-49 mau makahiki, no ka maʻi maʻi (rVE, 10.8%; 95% CI, 6.6-14.7) a i ʻole influenza A (rVE, 10.2%; 95% CI, 1.4-18.2).

Ua hōʻike ʻia kahi hoʻokolohua lapaʻau maikaʻi ma mua o ka randomized, double-blind, positive-controlled efficacy clinical trials ua ʻoi aku ka palekana o RIV4 ma mua o SD-IIV4 i nā poʻe 50 mau makahiki a ʻoi aku (rVE, 30%; 95% CI, 10 ~ 47) [3]. Ke hōʻike hou nei kēia haʻawina ma o ka ʻikepili o ka honua maoli e hāʻawi ana nā lāʻau lapaʻau recombinant influenza i ka pale ʻoi aku ka maikaʻi ma mua o nā lāʻau lapaʻau maʻamau i hoʻohana ʻole ʻia, a hoʻokō i nā hōʻike e hāʻawi pū ana ʻo RIV4 i ka pale ʻoi aku ka maikaʻi o ka poʻe ʻōpio. Ua nānā ka haʻawina i ka loaʻa ʻana o ka maʻi respiratory syncytial virus (RSV) ma nā pūʻulu ʻelua (pono e hoʻohālikelike ʻia ka maʻi RSV i nā hui ʻelua no ka mea ʻaʻole pale ka maʻi maʻi influenza i ka maʻi RSV), kāpae ʻia nā mea hoʻohilahila ʻē aʻe, a hōʻoia i ka paʻa o nā hopena ma o nā loiloi sensitivity lehulehu.

ʻO ke ʻano hana hoʻolālā randomized o ka pūʻulu hou i hāpai ʻia i loko o kēia noiʻi ʻana, ʻoi aku ka nui o ka hoʻololi ʻana o ka lāʻau lapaʻau hoʻokolohua a me ke kano hoʻomalu i kēlā me kēia pule, ʻoi aku ka maikaʻi o ke kaulike ʻana i nā mea hoʻopilikia ma waena o nā pūʻulu ʻelua. Eia naʻe, ma muli o ka paʻakikī o ka hoʻolālā, ʻoi aku ka kiʻekiʻe o nā koi no ka hoʻokō noiʻi. I loko o kēia haʻawina, ʻaʻole lawa ka lako o ka lāʻau lapaʻau recombinant influenza i hopena i ka nui o ka poʻe i loaʻa iā RIV4 e loaʻa ana iā SD-IIV4, ka hopena i ka ʻokoʻa nui o ka nui o ka poʻe i komo ma waena o nā pūʻulu ʻelua a me ka hiki ke hoʻohālikelike. Eia kekahi, ua hoʻolālā mua ʻia ke aʻo ʻana e alakaʻi ʻia mai 2018 a 2021, a ʻo ka puka ʻana mai o COVID-19 a me kāna kaohi ʻana a me ka hoʻopaʻa ʻana ua hoʻopilikia i ka noiʻi a me ka ikaika o ka maʻi maʻi maʻi maʻi, me ka pōkole o ka manawa influenza 2019-2020 a me ka haʻalele ʻana o ka makahiki 2020-2021. Loaʻa ka ʻikepili mai ʻelua mau kau maʻi "maʻamau" mai 2018 a i 2020, no laila e pono ai ka noiʻi hou aku e loiloi inā paʻa kēia mau ʻike i nā kau he nui, nā ʻano like ʻole a me nā ʻāpana kano.

ʻO nā mea a pau, ua hōʻoia hou kēia haʻawina i ka hiki ke hoʻohana ʻia i nā lāʻau lapaʻau genetically i hoʻohana ʻia ma ke kahua o nā lāʻau lapaʻau influenza, a ke waiho pū nei i kahi kumu ʻenehana paʻa no ka noiʻi ʻana a me ka hoʻomohala ʻana i nā lāʻau lapaʻau hou. ʻAʻole hilinaʻi ka papa hana ʻenehana ʻenehana recombinant i nā embryos moa, a loaʻa iā ia nā pōmaikaʻi o ka pōkole hana pōkole a me ke kūpaʻa hana kiʻekiʻe. Eia nō naʻe, ke hoʻohālikelike ʻia me nā lāʻau lapaʻau maʻamau i hoʻohana ʻole ʻia, ʻaʻohe ona pōmaikaʻi nui i ka pale ʻana, a he paʻakikī ke hoʻoponopono i ke ʻano o ka pakele ʻana mai nā maʻi maʻi influenza i hoʻololi ʻia mai ke kumu kumu. E like me nā lāʻau lapaʻau kuʻuna maʻi maʻi influenza, koi ʻia ka wānana strain a me ka pani antigen i kēlā me kēia makahiki.

I mua o nā ʻano like ʻole o ka maʻi influenza, pono mākou e makaʻala i ka hoʻomohala ʻana i nā lāʻau lapaʻau maʻi maʻi āpau i ka wā e hiki mai ana. ʻO ka hoʻomohala ʻana i ka maʻi maʻi maʻi maʻi āpau e hoʻonui mālie i ke ʻano o ka pale ʻana i nā maʻi maʻi maʻi, a i ka hopena e loaʻa ai ka pale kūpono i nā maʻi āpau i nā makahiki like ʻole. No laila, pono mākou e hoʻomau i ka hoʻolālā ʻana i ka immunogen ākea ākea e pili ana i ka protein HA i ka wā e hiki mai ana, e nānā i ka NA, kahi ʻano protein ʻē aʻe o ka maʻi maʻi influenza, ma ke ʻano he kī nui o ka maʻi maʻi, a me ka nānā ʻana i nā ala ʻenehana hoʻomaʻemaʻe hanu i ʻoi aku ka maikaʻi i ka hoʻoulu ʻana i nā pane pale lehulehu e pili ana i ka pale kūloko kūloko (e like me ka nasal spray vaccine, inhalable dry powder vaccine). E hoʻomau i ka hoʻolaha ʻana i ka noiʻi ʻana o nā maʻi maʻi mRNA, nā lāʻau lapaʻau, nā adjuvants hou a me nā ʻenehana ʻenehana ʻē aʻe, a ʻike i ka hoʻomohala ʻana o nā maʻi maʻi maʻi maʻi āpau āpau e "pane i nā hoʻololi āpau me ka loli ʻole"