Revaccination cannot be avoided. Where should the residents of Russia put a comma?

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Revaccination cannot be avoided. Where should the residents of Russia put a comma?
Revaccination cannot be avoided. Where should the residents of Russia put a comma?
Anonim

Russia was the first in the world to declare the need for re-vaccination: no other state has yet gone so far. Why did we do it, but the West did not? When will they start revaccinating there too? Is it necessary to do this at all or is it enough to monitor antibodies? Finally, what happens to the strongest outbreak of a new strain of coronavirus in our country, and when will it all end? Let's figure it out in more detail.

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First, about the big picture. In our country - as in others a little earlier - the base strain of the coronavirus by the Indian one (aka "delta") was displaced. If the person infected with the basic coronavirus, on average, managed to transmit the infection to a couple of three people, then in the case of the Indian, the figure increased to four to five people. This indicator is also called the basic reproductive number, and in the "delta" it is extremely high - at the level of natural smallpox.

It was due to this doubling of the rate of spread of the coronavirus that it did not show any decline, despite the rather high summer temperatures. Indeed, in the norm, diseases transmitted by airborne droplets are carried worse in the summer - this is exactly what happened with the basic coronavirus (as with a cold or flu before it). But when the base reproductive number doubled, the delta was far more infectious than the flu and the common cold. And even contagious enough to flare up in summer. It is logical when you consider that the strain originated in India: it is quite hot there, and the virus had to change in order to successfully spread.

The same changes became the reason why Russia was the first in the world to declare the inevitability of revaccination (and it has already begun in Moscow). Below we answer ten questions about her and the future of the epidemic.

Why do you need to be revaccinated - after all, the developers of Sputnik and Pfizer had hoped that their vaccine would last for two years?

Until recently, scientific work showed: immunity from a high-quality anti-coronavirus vaccine will be long-lived. Yes, IgG antibodies that neutralize coronavirus leave the blood of the vaccinated (and recovered) after about six months. However, there are "memory cells" that are able to quickly, literally in three days, establish a "mass production" of such antibodies if the body again encounters the same virus.

It was on this basis that many in Russia and abroad hoped that the Covid-19 vaccine would work for years, or even for life.

Alas, the Indian strain, the notorious "delta", has destroyed all hope. The fact is that for the full activation of cellular immunity, it is necessary that a lot of target virus enter the blood. The original strain of SARS-CoV-2 over time "tore from the inside" the human cell where it settled, destroying its membrane - as a result of which it entered the bloodstream and caused a cellular response.

Alexander Gintsburg explains why revaccination is needed:

"The immunity that is determined by memory cells, in the case of the Indian strain, actually does not help us very much."

The Indian strain of coronavirus does not break the cell membrane. To get into our other cells, he dissolves the "window" in the cell already "colonized" by him, and then - and the "window" in the shell of the neighboring, not yet colonized. As a result, the virus actually creates multinucleated human cells (syncytia). Healthy people practically do not have such cells.In this strategy, the "Indian" ("delta") is basically protected from meeting the immune cells: he is under the cover of the human cell membrane, using it as a "human shield".

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This means that a person does not have enough cellular immunity to protect himself from the "delta": a high level of antibodies neutralizing the coronavirus is needed. Then they will intercept the "delta" even before it begins the process of colonizing our cells. However, six months after vaccination - it doesn't matter whether Sputnik or Pfizer - antibodies in many people are waning. Therefore, you need to revaccinate.

What to vaccinate for - maybe it is enough to monitor antibodies? And by the way, what should they be in order not to get sick?

Well, we understood why with a new strain of coronavirus, cellular memory is less useful and why you need to have a high level of antibodies. But why necessarily revaccinate? Isn't it easier to take periodic antibody tests, and while they are high, do not go for a second vaccination?

Oddly enough, this is more difficult. For example, with antibodies of at least 200 for Diasorin, it will be difficult for you to get sick. But what if you came to donate blood for antibodies, and Diasorin's tests ran out? You will take the Roche test, and if yours is above 100, you are unlikely to be taken by the Delta or even the South African strain (beta). But what if there was a third test at all? Where do you get all these values, for each of the possible tests? By the way, manufacturers change them from time to time, as well as the scale.

If you wish, you can manually shovel tons of empirical data from the telegram chats of the "popular vaccination" and from the experience of other people find out which antibody values ​​for which test will protect you. In practice, it takes a hell of a lot of time - we know for sure, since we have been doing this for several months.

Neither the state, nor the majority of citizens in general can afford to delve into the topic like that. Moreover: most do not need it.

After all, a decent quantitative test for antibodies costs from 1,500 rubles, and the Sputnik kit costs less than 900 rubles. You will not get any harm from booster vaccinations, even if you have a very high antibody titer at the time of booster vaccination. Therefore, from a health and economic standpoint, it is cheaper to prick everyone - and not bother with tests.

Ideally, a quantitative antibody test is needed - though only one: 42 days after the first Sputnik vaccination. If he does not show you antibodies - that is, you will be one of the 2% who are unlucky - it is better to try to negotiate a revaccination. If you refer to zero indicators, then there is a chance to convince the local medical commission. The experience of participants in telegram chats of national vaccination shows that those who did not receive antibodies during the first two vaccinations still receive antibodies during revaccination.

Why did the West not announce that revaccination is needed?

Of course, the question can be asked: why then revaccination was not yet recommended in the West? There are two answers. First, they recommend it - only after Russia. In the West, the situation with the "delta" is simply not as acute as in our country: a much larger part of the population is vaccinated there. Therefore, the number of deaths from the "delta" in a typical Western country is not more than a thousand per day, as in Russia (contrary to the data of the headquarters, yes), but dozens.

Secondly, one must understand that the situation in the West is not quite like ours. There is no shortage of vaccines in Russia. We have so few people willing to get vaccinated that the authorities and business are forcing them to get vaccinated. At the beginning of this July, we still injected fewer Sputnik kits than we produced as of March 17, 2021. That is, we are still mastering what the factories did 3.5 months ago.

Of course, the Ministry of Health, with an unwavering hand, allows revaccination. After all, vaccines, in fact, have a limited shelf life: if you do not inject what was done in winter this summer, the drug will have to be thrown away.

In the West, anti-vaccination savagery is still much weaker than in Russia, which is quite funny, because it is from there that anti-vaccination came to us.However, not for the first time: communism has also come to us, but there have never been millions of human victims from it, as in Russia, in the West. But we digress: the point is that because of the smaller number of anti-vaccinators abroad, people are vaccinated more massively.

Consequently, if Western countries now announce revaccinations every six months, they will have a sharp shortage of vaccines, especially the most highly effective ones. One must think that when their production grows to the required extent, revaccination will be allowed outside of Russia as well.

Isn't Sputnik disposable, as the “experts” from the Internet say? How can they be revaccinated?

We know very well that we will be asked this question, so we will answer it in advance. No, Sputnik is not disposable, as Irina Yakutenko, Ilya Yasny and many other people who our media present to readers as “experts on the topic of coronavirus” have argued. The drug, as the developers have repeatedly noted, is suitable for an unlimited number of revaccinations.

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The reason is that the adenovirus vector, which is injected with Sputnik, does not create long-term antibody immunity in our body. After 56 days, this immunity to it passes - and you can be revaccinated.

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In addition, it is not injected into the blood, where antibodies circulate, but intramuscularly, where the probability of binding by antibodies is sharply lower. Therefore, as it is easy to see in the graph above, after revaccination with Sputnik, the level of antibodies becomes even higher than after the first vaccination, that is, you are protected even more than 91.4%.

Or maybe it is better to revaccinate with "KoviVac" or "EpiVacKorona" - what if the "experts" from the Internet are still right, and "Sputnik" is disposable?

Practice shows that there are always people for whom the opinion of vaccine developers is nothing, but the opinion of experts from the Internet is everything. Therefore, we will answer them in advance. No, there is no point in being revaccinated with KoviVac. This is a whole-virion vaccine that introduces a "killed" coronavirus into the body, and its Wuhan version. Already against the basic strain of coronavirus, such vaccines are not very effective - from 50% to 70%, depending on the age cohort. Therefore, those who vaccinated large parts of the population of Chile and Mongolia with the whole-virion Chinese vaccine recently saw outbreaks of morbidity and mortality from Covid-19. And even the developers of "KoviVac" themselves honestly talk about their offspring: "But it would be presumptuous on our part to expect a better result than they [foreign whole-virion vaccines] have."

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From the "delta" whole-virion vaccines will be even less effective: this variant of SARS-CoV-2, recall, bypasses cellular immunity due to the fact that it does not destroy the human cell colonized by the virus.

That is, having been re-vaccinated with KoviVac, you will receive much weaker protection than if you are revaccinated with Sputnik. He has protection against "delta" - about 90%, only slightly lower than against the base strain. Why didn’t his defense fall, while KoviVac’s defense would fall?

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Because we have been monitoring telegram chats of volunteers for months, where they exchanged data on antibodies. To summarize: about half of the antibodies injected with KoviVac have low antibodies, and the other half have just low antibodies. "CoviVac" should give cellular immunity, but, as we have already shown above, there is not so much sense from it with the "delta" as with the base strain. Considering that "delta" almost displaced this very basic strain, the choice for revaccination is obvious.

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The situation with EpiVacCorona is even worse. It just doesn't work, why - we analyzed it in detail here. It is impossible to revaccinate with it, as well as to be vaccinated. The use of this drug in Russia is a grave crime for everyone involved in its admission to the market. As a result of this crime, thousands or even tens of thousands of people can die. We do not know how those people sleep at night who are allowed to inject others with it.

After all, the fact that EpiVacCorona does not work is not a secret for anyone.The head of the Gamaleya Center, Alexander Gintsburg, quite transparently hinted in this regard: “As for the case when a person was previously vaccinated with another vaccine, I would not want to talk about this topic. I presented my point of view on this matter to the Ministry of Health. I can only be responsible for Sputnik-V. I will not comment on the rest of the vaccines. Contact the Ministry of Health, let it be on his conscience."

Let's be honest: you can't envy the conscience of the Ministry of Health. If, of course, he has it, which cannot be said in the case of EpiWakCorona.

A former employee of the Gamaleya Center says that human cells are dying from Sputnik. Is it not dangerous for them to be revaccinated?

Another argument of anti-vaccine users is the blog posts of Oleg Medyannikov. A former employee of the Gamaleya Center, who moved to the West long ago and recently discovered a talent for scientific popularization - so far, however, reduced to stories about the dangers of Sputnik, developed by his former colleagues, with whom he had an ugly conflict many years ago.

The essence of Medyannikov's ideas is that Sputnik's adenovirus vectors doom every cell in which they settle to death. They say that the immune cells begin to hunt for the cell infected with the adenovirus vector and destroy it. As a result, each injection by Sputnik carries the risk of losing up to 100 billion cells.

Medyannikov is wrong: in fact, adenovirus vectors in human cells completely disappear in two weeks. All this time, they are protected by the cell membrane and do not produce new adenoviruses, since the Sputnik developers cut out the genes responsible for reproduction from them. As a result, from the outside, the cell looks completely innocent and the immune system does not hunt for it.

We wrote in more detail about Medyannikov's other mistakes here. We also explained there why this man harbored a deep personal grudge against the Gamaleya Center, which explains his scientifically strange attempt to criticize Sputnik.

Do I need a vaccination if the vaccinated are sick? After all, they say that Sputnik is ineffective against the Indian strain

With mass vaccination, some of the vaccinated inevitably fall ill with a mild form: the effectiveness of Sputnik, according to clinical trials, is 91.4%, which means that 8.6% still get sick. In Russia, 23 million are vaccinated. Consequently, more than 1.9 million of them can become infected.

Interestingly, 8.6% is a number that is close to the sum of the 2% of those vaccinated who do not receive antibodies, and those 8% who receive little antibodies. Most likely, they are mostly sick. If, after vaccination, you have antibodies in the region of 200 according to Diasorin, the likelihood of even a mild form of the disease is small.

This is confirmed by the data on patients with Covid-19. Approximately one in seven is fully vaccinated against it in Russia, but only one out of 200 people with covid is vaccinated today. It turns out that the protection against the vaccine is quite consistent with the declared one.

But the main thing is not even this, but the fact that you will survive. As we already wrote, the risk of dying from covid after vaccination with a decent drug is reduced a thousand times. Most likely, this only happens to those who, for some reason, did not develop antibodies after vaccination. If this is your case and there were no antibodies at all, it is worth demanding the convening of a medical commission and re-vaccination. There are some chances of achieving it.

Finally, the last: "Sputnik" fully protects both from the Indian strain, and from all known today in principle. The stories about the drop in efficiency by 2, 6 times, which went around all social networks, are the result of a misunderstanding of the words of the developer of this vaccine, Logunov. He only stated about "a slight decrease in the activity of sera - this is approximately 2, 6 times in relation to the Sputnik-V vaccine." The decrease in efficiency was speculated by the media and their audience in social networks. The activity of the serum is determined by neutralizing the coronavirus, which is used to infect a culture of human cells in the laboratory.The figure "2.6 times" means that it neutralizes the "delta" when diluted, which is 2.6 times lower than in the case of neutralizing the base variant SARS-CoV-2.

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In the real organism of the vaccinated - in contrast to this experiment in the laboratory - the level of antibodies changes quickly. Immune cells stimulate synthesis if there are not enough of them. As a result, a really critical decrease is when the blood serum neutralizes the new strain 10 times worse than the base strain. 2, 6 times - very little.

By the way, the same Logunov correctly notes that for the Pfizer vaccine (the most effective of the Western ones), this blood serum figure drops four to five times relative to the base strain of coronavirus. In other words, those vaccinated by Sputnik are actually better protected from delta than any other vaccine recipient in the world.

Could new strains appear that will even “break through” Sputnik? It is possible. If there are the majority of unvaccinated people around, something similar may appear in a few years. However, the process of modifying Sputnik for a new strain will not take longer than developing its current version. We remind you that they did it in just two weeks.

If the vaccine works, why did we have so little vaccination before the compulsory measures?

The answer is simple: it has always been this way. Russia is a whole world of remarkably stable cultural traditions. Even Catherine II tried to introduce smallpox vaccination and quickly found out that without huge monetary incentives, no one wants to be vaccinated, although this seriously reduced the chances of dying from smallpox. In the 1830s, the state tried to introduce potatoes with the same "success." In those same years, it also waged a quarantine fight against cholera. Alexander Pushkin honestly described how he passed one of these quarantine outposts for a bribe, which clearly illustrated that savagery in relation to epidemiological measures in our country is an ancient tradition, consecrated for centuries, even among its so-called educated class. That we all saw in the current epidemic.

Something changed only under the USSR: Lenin simply introduced compulsory vaccination and did not ask anyone. Such mechanisms worked flawlessly: in 1960, after the introduction of smallpox into the country, we vaccinated 9.5 million in a month and a half. There is nothing like such figures with the coronavirus, because the current state is made of a different material.

Is there a chance that semi-compulsory vaccination in Russia will crush the epidemic?

Recently, the state began to put pressure on business so that service workers were vaccinated at least 60%. It's better than nothing. But we do not think that such measures will be enough. There are simply not enough service workers. Therefore, the entire adult population will not be able to vaccinate this way. Without this, the unvaccinated will forever remain bioreactors for growing all new strains. In five years, the unvaccinated with insufficient good health will die out, and the coronavirus will move into the category of seasonal diseases such as influenza, knocking out only the weakest (and not a deadly threat that takes away every hundredth sick person, as it is today).

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The situation with vaccinations in Russia resembles the situation with the rules of the road. Imagine that compliance with them would be like vaccination against coronavirus today - mandatory for only 60% of service workers. And everyone else can drive drunk without the slightest threat of punishment and violate any prohibitions.

Do you think it would be possible in such a country to safely go on the road?

It will be the same with vaccinations. Until it affects the majority of the population - and with revaccination - there will be no end to the coronavirus epidemic in Russia. Therefore, the most realistic thing is not to wait for it, but simply to graft. At least for you personally, the epidemic will cease to be a deadly threat.

A vaccine for children will appear in the fall. But is it necessary to vaccinate them?

By September 15, Sputnik's developers will make the so-called intranasal vaccine for children.In fact, this is the same vaccine, just instead of a needle, there will be a spray nozzle at the end of the syringe. Drops with adenovirus-vector will not get into the blood, but onto the nasal and pharyngeal mucosa. There, they will begin to produce the S-protein of the coronavirus and create a stable immune system.

Such a drug has a huge plus before an intramuscular injection: it creates a barrier to infection by airborne droplets. The modern "Sputnik" trains the immune system to hunt for the virus already in the blood, and the intranasal one can simply prevent it from entering the bloodstream.

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Is it worth vaccinating children if their Covid-19 is mild? We would say yes. In Nature Medicine recently published a study that most people who recovered from 16 to 30 years old had serious post-ovarian consequences even six months after the illness. Moreover, these are not only harmless violations of tastes and smells, but also problems with concentration and memory. For some schoolchildren, memory is useful: they still study sometimes.

Strictly speaking, such an intranasal vaccine would be useful for adults - and for revaccination too. It is much better to have a barrier against illness at the entrance to the body (in the upper respiratory tract) than to meet the virus already inside. The Moscow authorities even claim that they will be able to obtain such a version of Sputnik-Light for their city: if they succeeded, it would be an ideal version of revaccination. However, for some reason, the Ministry of Health has not yet approved such a vaccine for adults.

The Ministry of Health never sets out the most pressing questions about the epidemic to the population, so we do not know why it did not approve it. Perhaps we will never know. But if anything, you have been warned in advance.

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