amakuru

Icyorezo cyigihe cyibicurane gitera impfu ziterwa nindwara zubuhumekero hagati ya 290.000 na 650.000 buri mwaka. Igihugu kirimo icyorezo cyibicurane gikomeye muriyi mezi y'imbeho nyuma y’icyorezo cya COVID-19 kirangiye. Urukingo rw'ibicurane ni bwo buryo bwiza bwo kwirinda ibicurane, ariko urukingo rwa grippe gakondo rushingiye ku muco w'isoro ry'inkoko rufite utunenge tumwe na tumwe, nko guhindagurika kwa immunogene, kugabanya umusaruro n'ibindi.

Kuza kwa recombinant HA protein gene injeniyeri ibicurane birashobora gukemura inenge yinkingo gakondo yinkoko. Kugeza ubu, Komite Ngishwanama y'Abanyamerika ishinzwe gukingira (ACIP) irasaba urukingo rw’ibicurane by’ibicurane byinshi ku bantu bakuru ≥65. Icyakora, kubantu bari munsi yimyaka 65, ACIP ntabwo isaba urukingo rwibicurane rukwiranye nimyaka nkibyingenzi kubera kutagereranya imitwe hagati yubwoko butandukanye bwinkingo.

Urukingo rwa quadrivalent recombinant hemagglutinin (HA) urukingo rwa grippe yakozwe na genetique (RIV4) rwemejwe ko rwamamaza ibicuruzwa mu bihugu byinshi kuva mu 2016 kandi kuri ubu ni urukingo rw’ibicurane by’ibicurane bikoreshwa. RIV4 ikorwa hifashishijwe uburyo bwa tekinoroji ya poroteyine ya recombinant, ishobora gutsinda ibitagenda neza by’inkingo gakondo zidakingirwa zigarukira ku gutanga insoro z’inkoko. Byongeye kandi, uru rubuga rufite igihe gito cyo gukora, rufasha cyane gusimbuza igihe cy’urukingo rw’abakandida ku gihe, kandi rushobora kwirinda ihinduka ry’imihindagurikire y’imihindagurikire y'ikirere rishobora kubaho mu gihe cyo gukora virusi ishobora kwanduza inkingo zirangiye. Karen Midthun, icyo gihe wari umuyobozi w'ikigo gishinzwe isuzuma n’ubushakashatsi ku binyabuzima mu kigo cy’Amerika gishinzwe ibiryo n’ibiyobyabwenge (FDA), yagize ati: “kuza kwa nkingo z’ibicurane by’ibicurane byerekana iterambere ry’ikoranabuhanga mu gukora inkingo z’ibicurane… Ibi bitanga amahirwe yo gutangiza vuba umusaruro w’inkingo mu gihe habaye icyorezo“ [1]. Byongeye kandi, RIV4 irimo poroteyine ya hemagglutinine inshuro eshatu kurusha urukingo rusanzwe rw’ibicurane by’ibicurane, rufite ubudahangarwa bukomeye [2]. Ubushakashatsi buriho bwerekanye ko RIV4 irinda cyane urukingo rw’ibicurane bisanzwe ku bantu bakuze, kandi hakenewe ibimenyetso byinshi byuzuye kugira ngo ugereranye byombi mu baturage bakiri bato.

Ku ya 14 Ukuboza 2023, Ikinyamakuru cy’ubuvuzi cya New England (NEJM) cyasohoye Ubushakashatsi bwakozwe na Amber Hsiao n'abandi, Ikigo cy’inyigisho z’inkingo za Kaiser Permanente, Sisitemu y’ubuzima ya KPNC, Oakland, muri Amerika. Ubu bushakashatsi n’ubushakashatsi bwakozwe ku isi bwakoresheje uburyo bwateganijwe bw’abaturage kugira ngo hamenyekane ingaruka zo gukingira RIV4 n’urukingo rw’ibicurane by’ibicurane (SD-IIV4) ku bantu bari munsi y’imyaka 65 mu bihe bibiri by’ibicurane kuva 2018 kugeza 2020.

Bitewe n'akarere ka serivisi n'ubunini bw'ibikoresho bya KPNC, bahawe amahirwe ku itsinda A cyangwa Itsinda B (Ishusho 1), aho itsinda A ryakiriye RIV4 mu cyumweru cya mbere, Itsinda B ryakiriye SD-IIV4 mu cyumweru cya mbere, hanyuma buri kigo cyakira inkingo ebyiri buri cyumweru kugeza igihe cy'ibicurane kirangiye. Iherezo ry’ibanze ry’ubushakashatsi ni indwara y’ibicurane yemejwe na PCR, naho iherezo rya kabiri ryarimo ibicurane A, ibicurane B, n’ibitaro by’ibicurane. Abaganga bo muri buri kigo bakora ibizamini bya grippe PCR ku bushake bwabo, bashingiye ku ivuriro ry’umurwayi, kandi bakabona indwara z’indwara n’indwara, gupima laboratoire, hamwe n’inkingo bakoresheje inyandiko z’ubuvuzi.

Ubushakashatsi bwarimo abantu bakuru bafite hagati yimyaka 18 na 64, hamwe nimyaka 50 kugeza 64 niyo matsinda yambere yasesenguwe. Ibisubizo byagaragaje ko ingaruka zo gukingira (rVE) za RIV4 ugereranije na SD-IIV4 kurwanya ibicurane byemejwe na PCR yari 15.3% (95% CI, 5.9-23.8) ku bantu bafite hagati y’imyaka 50 na 64. Kurinda ibicurane A byari 15.7% (95% CI, 6.0-24.5). Nta mibare ifatika yo gukingira yagaragaye ku bicurane B cyangwa mu bitaro bijyanye na grippe. Byongeye kandi, isesengura ry’ubushakashatsi ryerekanye ko mu bantu bafite hagati y’imyaka 18-49, haba kuri grippe (rVE, 10.8%; 95% CI, 6.6-14.7) cyangwa ibicurane A (rVE, 10.2%; 95% CI, 1.4-18.2), RIV4 yerekanye uburinzi bwiza kuruta SD-IIV4.

Igeragezwa ryambere ryateguwe, rihumye-rihumye, ryagenzuwe neza nubuvuzi bwerekanaga ko RIV4 yari ifite uburinzi bwiza kuruta SD-IIV4 kubantu bafite imyaka 50 nayirenga (rVE, 30%; 95% CI, 10 ~ 47) [3]. Ubu bushakashatsi bwongeye kwerekana binyuze mu makuru manini-nyayo ku isi yerekana ko inkingo z’ibicurane zongera gutanga uburinzi bwiza kuruta inkingo gakondo zidakozwe, kandi zikuzuza ibimenyetso byerekana ko RIV4 itanga uburinzi bwiza ku baturage bakiri bato. Ubushakashatsi bwasesenguye ubwandu bwa virusi y’ubuhumekero (RSV) bwanduye mu matsinda yombi (ubwandu bwa RSV bugomba kugereranywa muri ayo matsinda yombi kuko urukingo rw’ibicurane rutarinda kwandura RSV), ukuyemo izindi mpamvu ziteye urujijo, kandi rugenzura imbaraga z’ibisubizo hakoreshejwe isesengura ryinshi.

Itsinda rishya ryashushanyije uburyo bwo gushushanya bwakoreshejwe muri ubu bushakashatsi, cyane cyane urukingo rusimburanya urukingo rw’igeragezwa hamwe n’urukingo rwo kugenzura buri cyumweru, rwarushijeho guhuza ibintu bivanga hagati yaya matsinda yombi. Ariko, bitewe nuburyo bugoye bwo gushushanya, ibisabwa kugirango ubushakashatsi bukorwe. Muri ubu bushakashatsi, gutanga urukingo rw’ibicurane bidahagije byatumye abantu benshi bagombye kubona RIV4 bahabwa SD-IIV4, bigatuma habaho itandukaniro rinini mu mubare w’abitabira ayo matsinda yombi kandi hashobora kubaho kubogama. Byongeye kandi, ubushakashatsi bwari buteganijwe gukorwa mbere ya 2018 kugeza 2021, kandi havutse COVID-19 hamwe n’ingamba zo gukumira no kugenzura byagize ingaruka ku bushakashatsi ndetse n’uburemere bw’icyorezo cy’ibicurane, harimo no kugabanya igihe cy’ibicurane cya 2019-2020 ndetse no mu gihe cy’ibicurane 2020-2021. Imibare yo mu bihe bibiri gusa "bidasanzwe" ibicurane kuva 2018 kugeza 2020 irahari, bityo hakenewe ubushakashatsi bwinshi kugirango harebwe niba ibyo byagaragaye bikurikirana mu bihe byinshi, ibice bitandukanye bikwirakwizwa hamwe ninkingo.

Muri rusange, ubu bushakashatsi burerekana kandi ko bishoboka ko inkingo zakozwe na genoside zakozwe mu rwego rw’inkingo z’ibicurane, kandi zikanashyiraho urufatiro rukomeye rwa tekiniki mu bushakashatsi no guteza imbere inkingo z’ibicurane. Urubuga rwa tekinoroji ya recombinant yubukorikori ntabwo rushingiye ku nsoro z’inkoko, kandi rufite ibyiza byo kuzenguruka umusaruro muke no kongera umusaruro mwinshi. Nyamara, ugereranije ninkingo za grippe zidakora zidakorwa, nta nyungu nini zifite mu kurinda, kandi biragoye gukemura ikibazo cyo guhunga ubudahangarwa cyatewe na virusi y’ibicurane ihindagurika cyane bivuye ku ntandaro. Kimwe ninkingo za grippe gakondo, buri mwaka birasabwa guhanura no gusimbuza antigen.

Mu guhangana n’ibicurane by’ibicurane, dukwiye gukomeza kwita ku iterambere ry’inkingo z’ibicurane ku isi hose. Iterambere ry’urukingo rw’ibicurane ku isi hose rigomba kwagura buhoro buhoro uburyo bwo kwirinda virusi, kandi amaherezo rikagera ku burinzi bunoze bwo kwirinda indwara zose mu myaka itandukanye. Tugomba rero gukomeza guteza imbere igishushanyo mbonera cy’ubudahangarwa bushingiye kuri poroteyine ya HA mu gihe kiri imbere, twibanda kuri NA, indi poroteyine yo hejuru ya virusi ya grippe, nk’intego nyamukuru y’inkingo, kandi twibande ku nzira y’ikoranabuhanga ry’ikingira ry’ubuhumekero rifite akamaro kanini mu gutanga ibisubizo by’uburinzi butandukanye harimo n’ubudahangarwa bw’uturemangingo twaho (nk’urukingo rw’ibiti byangiza, n'ibindi). Komeza guteza imbere ubushakashatsi bwinkingo za mRNA, urukingo rwabatwara, imiti mishya hamwe nizindi mbuga za tekiniki, kandi umenye iterambere ry’inkingo nziza y’ibicurane “isubiza impinduka zose nta gihinduka”