{"id":2163,"date":"2021-09-26T18:07:51","date_gmt":"2021-09-26T17:07:51","guid":{"rendered":"https:\/\/slanedeti.sk\/cms\/?p=2163"},"modified":"2021-09-26T18:07:52","modified_gmt":"2021-09-26T17:07:52","slug":"koronavirus-covid-19-tretia-vlna-a-ockovanie","status":"publish","type":"post","link":"https:\/\/slanedeti.sk\/cms\/koronavirus-covid-19-tretia-vlna-a-ockovanie\/2163","title":{"rendered":"Koronav\u00edrus COVID-19 – tretia vlna a o\u010dkovanie"},"content":{"rendered":"\n

V\u00a0decembri 2021 to u\u017e bud\u00fa dva roky od v\u00fdskytu prv\u00fdch ozn\u00e1men\u00fdch pr\u00edpadov nov\u00e9ho koronav\u00edrusu v \u010c\u00edne a pand\u00e9mia, ktor\u00e1 je d\u00f4sledkom jeho masov\u00e9ho roz\u0161\u00edrenia zost\u00e1va v\u00fdznamn\u00fdm zdravotn\u00fdm rizikom a faktorom ovplyv\u0148uj\u00facim chod spolo\u010dnosti. Situ\u00e1ciu sme od za\u010diatku sledovali a sna\u017eili sa prin\u00e1\u0161a\u0165 aktu\u00e1lne inform\u00e1cie, ktor\u00e9 teraz op\u00e4\u0165 dop\u013a\u0148ame, aj s oh\u013eadom na nastupuj\u00facu tretiu vlnu.<\/p>\n\n\n\n

Pozn\u00e1mky k priebehu <\/strong>epid\u00e9mie<\/strong><\/h3>\n\n\n\n

Redakcie prakticky v\u0161etk\u00fdch v\u00fdznamn\u00fdch svetov\u00fdch vedeck\u00fdch \u010dasopisov (ako The Lancet<\/a>, NEJM<\/a>, Nature<\/a> a \u010fal\u0161ie) prijali hne\u010f na za\u010diatku pand\u00e9mie neobvykl\u00e9 rozhodnutie \u2013 vo\u013ene spr\u00edstupni\u0165 v\u0161etky \u010dl\u00e1nky o Covid-19. Hlavn\u00fdm cie\u013eom bolo v kritickej situ\u00e1cii, ke\u010f z\u00e1le\u017e\u00ed na ka\u017edom dni, umo\u017eni\u0165 vedcom a\u00a0zdravotn\u00edkom, \u010do najr\u00fdchlej\u0161\u00ed transfer poznatkov. To napomohlo v overen\u00ed lie\u010debn\u00fdch postupov alebo pri r\u00fdchlom v\u00fdvoji vakc\u00edn. Druh\u00fdm cie\u013eom bolo transparentne informova\u0165 \u0161irok\u00fa verejnos\u0165, napom\u00f4c\u0165 budova\u0165 d\u00f4veru k medic\u00ednskemu v\u00fdskumu a zabr\u00e1ni\u0165 alebo s\u0165a\u017ei\u0165 \u0161\u00edrenie dezinform\u00e1ci\u00ed. T\u00fato skvel\u00fa mo\u017enos\u0165 (\u010di u\u017e priamo v p\u00f4vodn\u00fdch \u010dl\u00e1nkoch alebo prebrat\u00fdch a komunikovan\u00fdch v m\u00e9di\u00e1ch) ve\u013ea \u013eud\u00ed vyu\u017eilo. Z\u00edskali na z\u00e1klade v\u00fdskumu \u0161pi\u010dkov\u00fdch vedcov preh\u013ead, ako sa \u010do naj\u00fa\u010dinnej\u0161ie vyhn\u00fa\u0165 infekcii, alebo si mohli overi\u0165 \u00fadaje o bezpe\u010dnosti a \u00fa\u010dinnosti vakc\u00edn. Na druhej strane, podobne ako v minulosti<\/a>, epid\u00e9mia vyvolala aj mnoho iracion\u00e1lnych reakci\u00ed. Vkladanie n\u00e1dej\u00ed do neoverenej lie\u010dby<\/a> ako je veterin\u00e1rne antiparazitikum ivermekt\u00edn<\/a>, \u010di protesty z\u00fafal\u00fdch, nevzdelan\u00fdch \u013eud\u00ed proti opatreniam prekona\u0165 epid\u00e9miu, \u017eiadnym sp\u00f4sobom nepom\u00f4\u017eu, naopak podporuj\u00fa \u0161\u00edrenie n\u00e1kazy a v\u0161etko s \u0148ou spojen\u00e9 utrpenie. T\u00fato situ\u00e1ciu sa hanebne sna\u017eia zneu\u017ei\u0165 aj niektor\u00ed politici, spochyb\u0148uj\u00faci nie len protiepidemick\u00e9 opatrenia, ale aj o\u010dkovanie. V tejto s\u00favislosti by sme radi pouk\u00e1zali na zauj\u00edmav\u00fd projekt Korona Hra<\/a>, po\u010d\u00edta\u010dovej simul\u00e1cie vytvorenej na z\u00e1klade re\u00e1lnych \u00fadajov, kde ka\u017ed\u00fd (samozrejme s obmedzeniami jednoduchej webovej hry) m\u00f4\u017ee z\u00edska\u0165 z\u00e1kladn\u00fa predstavu o \u201eriaden\u00ed\u201c epid\u00e9mie. \u201eNeintuit\u00edvnos\u0165\u201c epid\u00e9mie znamen\u00e1, \u017ee riadi\u0165 sa verejnou \u010di v\u00e4\u010d\u0161inovou mienkou pri vysoko odborn\u00fdch probl\u00e9moch nie je dobr\u00e1 cesta. Na jej \u00faspe\u0161n\u00e9 zvl\u00e1dnutie potrebuje \u0161t\u00e1t funguj\u00face expertn\u00e9 t\u00edmy, ktor\u00fdch rozhodnutia s\u00fa akceptovan\u00e9 tak politikmi, ako aj verejnos\u0165ou.<\/p>\n\n\n\n

V\u00fdvoj epid\u00e9mie v roku 2021 ur\u010dovali dva hlavn\u00e9 trendy \u2013 n\u00e1stup o\u010dkovania a evol\u00facia nov\u00fdch v\u00edrusov\u00fdch variantov. V\u00fdvoj vakc\u00edn znamenal prielom v priebehu epid\u00e9mie, aj ke\u010f najoptimistickej\u0161ie v\u00edzie<\/a>, \u017ee vakc\u00edny prines\u00fa r\u00fdchly koniec cirkul\u00e1cie v\u00edrusu a koniec covidu v dobre zao\u010dkovan\u00fdch krajin\u00e1ch, sa zatia\u013e nenaplnili. Mo\u017eno by sa tak aj naozaj stalo, ak by sa nevyvinul a neroz\u0161\u00edril infek\u010dn\u00fd delta variant a tento \u010dl\u00e1nok by nevznikol. Ale v\u00fdvoj sa ubral in\u00fdm smerom a v\u00edrus SARS-CoV-2 n\u00e1s op\u00e4\u0165, podobne ako viackr\u00e1t predt\u00fdm, nemilo prekvapil.<\/p>\n\n\n\n

Evol\u00facia variantov<\/strong><\/h3>\n\n\n\n

Vznik mut\u00e1ci\u00ed vo v\u00edrusovej RNA je be\u017en\u00fd biologick\u00fd jav. Jeden viri\u00f3n (v\u00edrusov\u00e1 \u010dastica) je schopn\u00fd nareplikova\u0165 sa po infekci\u00ed bunky aj desa\u0165tis\u00edcn\u00e1sobne \u2013 vytvori\u0165 v infikovanej \u013eudskej bunke 10-tis. k\u00f3pii a bunku usmrti\u0165. Na to, aby sa mut\u00e1cie \u010falej roz\u0161\u00edrili, musia by\u0165 pre v\u00edrus prospe\u0161n\u00e9 – vies\u0165 k vy\u0161\u0161ej infek\u010dnosti, alebo \u00faniku protil\u00e1tkam a imunitn\u00e9mu syst\u00e9mu \u010dloveka (\u201eimmune escape\u201c). Evol\u00facia SARS-CoV-2 mut\u00e1cii je sledovan\u00e1 u\u017e od za\u010diatku epid\u00e9mie. U\u017e vo Wuhane, kde sa v\u00edrus vyskytol prv\u00fdkr\u00e1t, bola zn\u00e1ma jedna mut\u00e1cia a s t\u00fdm ako sa v\u00edrus \u0161\u00edril, sa ich po\u010det zvy\u0161oval. Mut\u00e1cie sa ozna\u010duj\u00fa pod\u013ea toho, na akej poz\u00edcii ved\u00fa k z\u00e1mene v prote\u00ednovom re\u0165azci v\u00edrusu, napr\u00edklad D614G, N501Y (zvy\u0161uj\u00face binding na ACE2 receptor a t\u00fdm infek\u010dnos\u0165), E484K \u201eimmune escape\u201c mut\u00e1cia zabezpe\u010duj\u00faca v\u00edrusu vy\u0161\u0161iu odolnos\u0165 vo\u010di protil\u00e1tkam. Kombin\u00e1ciou viacer\u00fdch mut\u00e1ci\u00ed vznik\u00e1 v\u00edrusov\u00fd variant, varianty m\u00f4\u017eu ma\u0165 niektor\u00e9 mut\u00e1cie spolo\u010dn\u00e9. Najv\u00fdznamnej\u0161ie varianty s\u00fa uveden\u00e9 v\u00a0tabu\u013eke:<\/p>\n\n\n\n

N<\/strong>\u00e1zov (WHO)<\/strong><\/td>In\u00e9 ozna\u010denie<\/strong><\/td>P\u00f4vod<\/strong><\/td>Prv\u00e1 vzorka<\/strong><\/td><\/tr>
Alfa<\/td>B.1.1.7<\/td>UK<\/td>September 2020<\/td><\/tr>
Beta<\/td>B.1.351<\/td>Ju\u017en\u00e1 Afrika<\/td>M\u00e1j 2020<\/td><\/tr>
Gamma<\/td>P.1<\/td>Braz\u00edlia<\/td>November 2020<\/td><\/tr>
Delta<\/td>B.1.617.2<\/td>India<\/td>Okt\u00f3ber 2020<\/td><\/tr><\/tbody><\/table><\/figure>\n\n\n\n

<\/a><\/p>\n\n\n\n

Bol tie\u017e op\u00edsan\u00fd variant \u201edelta plus\u201c, ktor\u00fd m\u00e1 oproti delte navy\u0161e mut\u00e1ciu K417N, ktor\u00e1 je aj v beta variante. Nez\u00e1visl\u00fd (konvergentn\u00fd) vznik mut\u00e1ci\u00ed nazna\u010duje, \u017ee v\u00edrus podlieha aj v\u00fdznamn\u00fdm evolu\u010dn\u00fdm obmedzeniam.<\/p>\n\n\n\n

\"variants<\/a>
Priebeh relat\u00edvneho zast\u00fapenia variantov v Eur\u00f3pe, GISAID<\/a><\/em><\/figcaption><\/figure>\n\n\n\n

<\/p>\n\n\n\n

Evol\u00facia zatia\u013e viedla najm\u00e4 k v\u00fdvoju infek\u010dnej\u0161\u00edch variantov \u2013 p\u00f4vodn\u00fd variant (R0 = 3) bol najprv \u201evytla\u010den\u00fd\u201c alfou (R0 = 4.5) a n\u00e1sledne deltou<\/a> (odhad R0 = 5 a\u017e 9), pri\u010dom delta m\u00e1 aj niektor\u00e9 \u201eimmune escape\u201c vlastnosti. N\u00e1rast reproduk\u010dn\u00e9ho \u010d\u00edsla (R0) z 3, \u010do je hodnota pre stredne infek\u010dn\u00fd v\u00edrus, na hodnotu a\u017e 9 pri delte za menej ako 2 roky je pozoruhodn\u00fd a nepriazniv\u00fd v\u00fdvoj. Ke\u010f\u017ee hodnotu okolo 10 maj\u00fa najinfek\u010dnej\u0161ie zn\u00e1me ochorenia, niektor\u00ed vedci vyslovili predpoklad, \u017ee delta je bl\u00edzko biologick\u00fdch hran\u00edc infek\u010dnosti a\u00a0d\u00fafaj\u00fa, \u017ee u\u017e nepr\u00eddu v\u00fdrazne infek\u010dnej\u0161ie varianty. Na druhej strane ako st\u00fapa po\u010det \u013eud\u00ed, ktor\u00ed covid prekonali a zao\u010dkovali sa a maj\u00fa teda protil\u00e1tky, predpoklad\u00e1 sa, \u017ee evol\u00facia by mohla viac uprednost\u0148ova\u0165 \u201eimmune escape\u201c varianty. Nov\u00e9 varianty bud\u00fa nepochybne vznika\u0165 aj na\u010falej. S\u00fa\u010dasn\u00e1 veda nedok\u00e1\u017ee na molekul\u00e1rnej \u00farovni predpoveda\u0165, ak\u00fd bude ich charakter.<\/p>\n\n\n\n

O\u010dkovanie<\/strong><\/h3>\n\n\n\n

U\u017e v prv\u00fdch t\u00fd\u017ed\u0148och \u0161\u00edrenia SARS-CoV-2 sa viedli \u00favahy o imunite po prekonan\u00ed Covidu, ke\u010f\u017ee t\u00e1to ot\u00e1zka bola z\u00e1sadn\u00e1 tak pre \u013eud\u00ed, \u010do ochorenie prekonali, ako aj pre bud\u00faci v\u00fdvoj epid\u00e9mie. Vtedy bolo mo\u017en\u00e9 vych\u00e1dza\u0165 iba z porovnania s pr\u00edbuzn\u00fdmi v\u00edrusmi. Okrem SARS-CoV-2 sa u \u013eud\u00ed vyskytuj\u00fa tzv. be\u017en\u00e9 koronav\u00edrusy (229E, NL63, OC43, HKU1) a \u00faplne alebo \u010diasto\u010dne eliminovan\u00e9 koronav\u00edrusy SARS-CoV a MERS-CoV, ktor\u00e9 v minulosti sp\u00f4sobili men\u0161ie epid\u00e9mie. U\u00a0\u013eud\u00ed, ktor\u00ed (v rokoch 2002-2004) prekonali SARS, sa zistila pretrv\u00e1vaj\u00faca pr\u00edtomnos\u0165 reakt\u00edvnych T-lymfocytov, na z\u00e1klade \u010doho niektor\u00ed vedci vyslovili predpoklad, \u017ee imunita po SARSe je dlhodob\u00e1 a ke\u010f\u017ee SARS-CoV-2 je k nemu geneticky najpr\u00edbuznej\u0161\u00ed v\u00edrus, bude to podobn\u00e9 aj pri ochoren\u00ed Covid-19. Oproti tomu bolo ale dobre zn\u00e1me, \u017ee be\u017en\u00e9 koronav\u00edrusy vyvol\u00e1vaj\u00fa iba kr\u00e1tkodob\u00fa imunitu, trvaj\u00facu pribli\u017ene rok, preto na druhej strane boli mnoh\u00ed k tvrdeniam o dlhodobej imunite skeptick\u00ed. Pr\u00ed\u010dinou nie je slab\u0161ia imunitn\u00e1 odpove\u010f, ale skuto\u010dnos\u0165, \u017ee tieto koronav\u00edrusy s\u00fa v\u010faka st\u00e1le nov\u00fdm mut\u00e1ci\u00e1m schopn\u00e9 vytv\u00e1ra\u0165 varianty unikaj\u00face imunitn\u00e9mu syst\u00e9mu. Je to podobn\u00fd mechanizmus ako pri chr\u00edpke, u ktorej zvykn\u00fa ka\u017ed\u00fa sez\u00f3nu dominova\u0165 odli\u0161n\u00e9 kmene. O imunite proti SARS-CoV-2 sme sa v\u010faka mno\u017estvu \u0161t\u00fadi\u00ed dozvedeli ve\u013ea inform\u00e1cii, ale t\u00e1to z\u00e1kladn\u00e1 ot\u00e1zka \u2013 ako dlho pretrv\u00e1va imunita po infekcii, alebo o\u010dkovan\u00ed st\u00e1le nie je dostato\u010dne zodpovedan\u00e1.<\/p>\n\n\n\n

Schopnos\u0165 v ur\u010ditej miere unika\u0165 imunitn\u00e9mu syst\u00e9mu (\u013eah\u0161ie infikova\u0165 t\u00fdch \u010do covid-19 prekonali, alebo sa zao\u010dkovali) bola prv\u00fd kr\u00e1t pri novom koronav\u00edruse zisten\u00e1<\/a> pri jeho beta variante. Napriek tomu sa beta variant nikdy v\u00fdrazne neroz\u0161\u00edril mimo Afriku a nesk\u00f4r bol aj tam vytla\u010den\u00fd delta variantom, ktor\u00fd m\u00e1 taktie\u017e \u201eimmune escape\u201c vlastnosti. Z\u00e1rove\u0148 ale plat\u00ed, \u017ee pokles \u00fa\u010dinnosti vakc\u00edn vo\u010di nov\u00fdm variantom je iba mierny. Pod\u013ea \u00fadajov<\/a> z Ve\u013ekej Brit\u00e1nie maj\u00fa mRNA vakc\u00edny vo\u010di delta variantu u plne zao\u010dkovan\u00fdch os\u00f4b \u00fa\u010dinnos\u0165 88\u00a0%, oproti 93.7\u00a0% pri alfa variante. Niektor\u00e9 in\u00e9 \u0161t\u00fadie s\u00edce nazna\u010duj\u00fa aj vy\u0161\u0161\u00ed pokles, pribli\u017ene na \u00farove\u0148 66\u00a0%, ale asi najd\u00f4le\u017eitej\u0161ia je schopnos\u0165 vakc\u00edn predch\u00e1dza\u0165 hospitaliz\u00e1ci\u00e1m a \u00famrtiam. Pod\u013ea americkej CDC vakcin\u00e1cia zni\u017euje riziko hospitaliz\u00e1cie<\/a> 29 n\u00e1sobne. V USA na Covid-19 zomrelo (do za\u010diatku augusta 2021) 1263 zao\u010dkovan\u00fdch \u013eud\u00ed, z celkovo 630 tis. americk\u00fdch obet\u00ed epid\u00e9mie. Anal\u00fdza pacientov, ktor\u00ed sa napriek o\u010dkovaniu ocitli v nemocnici napoved\u00e1 ve\u013ea o tom, kto m\u00e1 vy\u0161\u0161ie riziko, \u017ee ho vakc\u00edna dostato\u010dne neochr\u00e1ni. Ve\u013ek\u00e1 v\u00e4\u010d\u0161ina z nich m\u00e1 nad 65 rokov, \u010dastej\u0161ie s\u00fa zast\u00fapen\u00ed pacienti s rakovinou, HIV, org\u00e1nov\u00fdmi transplant\u00e1ciami, vroden\u00fdmi imunodeficienciami, teda najm\u00e4 t\u00ed, \u010do maj\u00fa oslaben\u00fd imunitn\u00fd syst\u00e9m a vakc\u00edna u nich neviedla k dostato\u010dnej tvorbe protil\u00e1tok. Ochrana t\u00fdchto zranite\u013en\u00fdch skup\u00edn je jedn\u00fdm z\u00a0d\u00f4vodov, pre\u010do niektor\u00e9 krajiny za\u010d\u00ednaj\u00fa pod\u00e1va\u0165 tretiu vakcina\u010dn\u00fa d\u00e1vku.<\/p>\n\n\n\n

S o\u010dkovan\u00edm proti Covidu-19 sa za\u010dalo koncom minul\u00e9ho roka, tak\u017ee t\u00ed \u010do boli o\u010dkovan\u00ed medzi prv\u00fdmi maj\u00fa od prv\u00e9ho podania u\u017e 9-10 mesiacov. Aj p\u00f4vodn\u00fd odhad v\u00fdrobcu hovoril, \u017ee \u00fa\u010dinnos\u0165 vakcin\u00e1cie bude (minim\u00e1lne) jeden rok. V\u0161eobecne sa predpoklad\u00e1, \u017ee po nejakom \u010dase bude potrebn\u00e9 preo\u010dkovanie, \u010do nie je ni\u010d neobvykl\u00e9 ani pri vakc\u00ednach proti in\u00fdm ochoreniam. CDC vydala usmernenie<\/a> oh\u013eadom podania tretej d\u00e1vky, pri\u010dom ju odpor\u00fa\u010da poda\u0165 pacientom s oslabenou imunitou (s rakovinou, u\u017e\u00edvaj\u00facim imunosupres\u00edvnu lie\u010dbu vr\u00e1tane vysok\u00fdch d\u00e1vok kortikosteroidov, s pokro\u010dilou HIV infekciou a vroden\u00fdmi imunodeficienciami). Tretia d\u00e1vka m\u00f4\u017ee predstavova\u0165 benefit pre osoby so stredne z\u00e1va\u017en\u00fdmi imunodeficienciami, ke\u010f organizmus dok\u00e1\u017ee aspo\u0148 v zn\u00ed\u017eenej miere produkova\u0165 protil\u00e1tky. U niektor\u00fdch os\u00f4b so z\u00e1va\u017en\u00fdmi poruchami imunity dve d\u00e1vky negenerovali tvorbu protil\u00e1tok a je pravdepodobn\u00e9, \u017ee v ich pr\u00edpade sa tak nestane ani po tretej d\u00e1vke<\/a>. Preto pre \u013eud\u00ed so z\u00e1va\u017en\u00fdmi poruchami imunity to \u017eia\u013e znamen\u00e1, \u017ee maj\u00fa na\u010falej dodr\u017eiava\u0165 pr\u00edsne opatrenia na ochranu pred infekciou. Taktie\u017e to zd\u00f4raz\u0148uje bioetick\u00fd rozmer o\u010dkovania \u2013 dosiahnutie vysokej zao\u010dkovanosti popul\u00e1cie (skupinovej imunity) je \u017eiad\u00face aj kv\u00f4li ochrane jej naviac zranite\u013en\u00fdch \u010dlenov. V \u010cR<\/a> aj v SR<\/a> bude ma\u0165 n\u00e1rok na podanie tretej d\u00e1vky ka\u017ed\u00fd 8 mesiacov po o\u010dkovan\u00ed druhou d\u00e1vkou. S pod\u00e1van\u00edm tret\u00edch d\u00e1vok sa m\u00e1 za\u010da\u0165 koncom septembra, inform\u00e1cie bud\u00fa e\u0161te upresnen\u00e9. Osoby, ktor\u00e9 bud\u00fa ma\u0165 n\u00e1rok na tretiu d\u00e1vku, bud\u00fa informovan\u00e9 sms spr\u00e1vou. Tretia d\u00e1vka preuk\u00e1zate\u013ene vedie k zv\u00fd\u0161eniu hladiny protil\u00e1tok (ke\u010f\u017ee tie \u010dasom po podan\u00ed druhej d\u00e1vky klesaj\u00fa), ale ak\u00fd presne predstavuje benefit oproti dvom d\u00e1vkam zatia\u013e nie je zn\u00e1me, resp. potvrden\u00e9 vedeck\u00fdmi \u0161t\u00fadiami, ke\u010f\u017ee s preo\u010dkovan\u00edm sa iba za\u010d\u00edna. Eur\u00f3pska liekov\u00e1 agent\u00fara ozn\u00e1mila, \u017ee sa bude danou problematikou zaobera\u0165 a zverejn\u00ed vedeck\u00e9 stanovisko komu odpor\u00fa\u010da podanie tretej d\u00e1vky.<\/p>\n\n\n\n

V s\u00fa\u010dasnosti pod\u00e1van\u00e9 tretie d\u00e1vky s\u00fa rovnak\u00e9 ako dve predch\u00e1dzaj\u00face. Evol\u00faciu SARS-CoV-2 variantov samozrejme sleduj\u00fa aj farmaceutick\u00e9 spolo\u010dnosti a uvedomuj\u00fa si re\u00e1lnu mo\u017enos\u0165, \u017ee ich vakc\u00edny bud\u00fa potrebova\u0165 \u201eupgrade\u201c – teda vlo\u017ei\u0165 do nich mRNA S prote\u00ednu pre aktu\u00e1lne cirkuluj\u00face varianty. Pfizer za\u010dal v auguste s klinick\u00fdm hodnoten\u00edm<\/a> posil\u0148uj\u00facej (tretej) d\u00e1vky proti alfa a beta variantu z\u00e1rove\u0148 (beta a delta variant spolu zdie\u013eaj\u00fa viacero mut\u00e1cii a preto by mala by\u0165 rovnako \u00fa\u010dinn\u00e1 aj proti delte). Preto je mo\u017en\u00e9, \u017ee v doh\u013eadnej dobe bud\u00fa pod\u00e1van\u00e9 tretie d\u00e1vky, ktor\u00e9 bud\u00fa cielenej\u0161ie a e\u0161te \u00fa\u010dinnej\u0161ie proti nov\u0161\u00edm, vysoko infek\u010dn\u00fdm variantom (v s\u00fa\u010dasnosti delta). Pfizer z\u00e1rove\u0148 uskuto\u010d\u0148uje pri p\u00f4vodnej verzii vakc\u00edny pediatrick\u00e9 klinick\u00e9 \u0161t\u00fadie u det\u00ed mlad\u0161\u00edch ako 12 rokov a pl\u00e1nuje v bl\u00edzkej dobe predlo\u017ei\u0165 v\u00fdsledky klinick\u00fdch \u0161t\u00fadi\u00ed na ich kone\u010dn\u00e9 schv\u00e1lenie a roz\u0161\u00edrenie pou\u017eitia vakc\u00edny v tejto vekovej skupine. Z ostatn\u00fdch vakc\u00edn, ktor\u00e9 s\u00fa v pokro\u010dilom \u0161t\u00e1diu<\/a> v\u00fdvoja stoj\u00ed za zmienku Sanofi, ktor\u00e1 ak sa dostane na trh, by bola prvou podjednotkovou (prote\u00ednovou) vakc\u00ednou proti Covidu-19. Pand\u00e9mia z\u00e1rove\u0148 od\u0161tartovala dlhodobej\u0161ie projekty s v\u00edziou (v priebehu nieko\u013ek\u00fdch rokov) prinies\u0165 Covid vakc\u00edny novej gener\u00e1cie \u2013 napr\u00edklad kombinovan\u00fa mRNA vakc\u00ednu proti Covidu a chr\u00edpke<\/a>, alebo vakc\u00edny generuj\u00face \u201e\u0161iroko neutralizuj\u00face protil\u00e1tky\u201c (broadly neutralizing antibodies), ktor\u00e9 by znamenali vysok\u00fa \u00fa\u010dinos\u0165<\/a> vo\u010di v\u0161etk\u00fdm variantom.<\/p>\n\n\n\n

Do za\u010diatku septembra bolo celosvetovo podan\u00fdch viac ako 5 mili\u00e1rd covid vakc\u00edn, tak\u017ee je aj dos\u0165 \u00fadajov o ich bezpe\u010dnosti. Aj ke\u010f ved\u013eaj\u0161ie \u00fa\u010dinky s\u00fa \u010dast\u00e9, nie s\u00fa nijako z\u00e1va\u017en\u00e9 a obzvl\u00e1\u0161\u0165 mRNA vakc\u00edny s\u00fa mimoriadne bezpe\u010dn\u00e9. Najz\u00e1va\u017enej\u0161\u00ed probl\u00e9m s bezpe\u010dnos\u0165ou vakc\u00edn bol vz\u00e1cny v\u00fdskyt krvn\u00fdch zrazen\u00edn<\/a> (tromb\u00f3z) pri adenov\u00edrusov\u00fdch vakc\u00ednach, najm\u00e4 od firmy AstraZeneca, \u010do bol jeden z d\u00f4vodov pre\u010do sa v EU vakc\u00edny tejto firmy prestali pou\u017e\u00edva\u0165. Riziko tromb\u00f3z je mimochodom omnoho vy\u0161\u0161ie pri Covide ako pri vakc\u00edne AstraZeneca.<\/p>\n\n\n\n

\"adverse<\/a><\/figure>\n\n\n\n

Klinick\u00e9 aspekty a v\u00fdskum<\/strong><\/h3>\n\n\n\n

Covid u\u017e prekonalo ve\u013ek\u00e9 mno\u017estvo \u013eud\u00ed a \u010das\u0165 z nich poci\u0165uje niektor\u00e9 pr\u00edznaky ochorenia aj mesiace po nakazen\u00ed a ak\u00fatnom priebehu. Tento stav sa za\u010dal ozna\u010dova\u0165 ako \u201elong covid\u201c alebo postcovidov\u00fd syndr\u00f3m a rozumie sa pod n\u00edm, ak niektor\u00e9 pr\u00edznaky pretrv\u00e1vaj\u00fa dlh\u0161ie ako 3 mesiace. Zatia\u013e \u010do z\u00e1va\u017en\u00fd priebeh ochorenia sa v\u00fdrazne sp\u00e1ja s vy\u0161\u0161\u00edm vekom a pridru\u017een\u00fdmi zdravotn\u00fdmi probl\u00e9mami, long covid je omnoho \u010dastej\u0161\u00ed aj u mlad\u0161\u00edch, predt\u00fdm zdrav\u00fdch \u013eud\u00ed, vr\u00e1tane det\u00ed. Naj\u010dastej\u0161ie s\u00fa dve skupiny pr\u00edznakov, ktor\u00e9 zasahuj\u00fa nervov\u00fd (chronick\u00e1 \u00fanava, depresia, pokles kognit\u00edvnych schopnost\u00ed) a\u00a0d\u00fdchac\u00ed syst\u00e9m (dyspnoe \u2013 d\u00fdchavi\u010dnos\u0165, s\u0165a\u017een\u00e9 d\u00fdchanie), pri\u010dom sa m\u00f4\u017eu ale nemusia vyskytova\u0165 spolo\u010dne. Dyspnoe poci\u0165uje po prekonan\u00ed covidu pribli\u017ene 25\u00a0% \u013eud\u00ed<\/a>, najm\u00e4 t\u00fdch vo vy\u0161\u0161om veku a s \u010fal\u0161\u00edm ochoren\u00edm p\u013e\u00fac<\/a>. U niektor\u00fdch \u013eud\u00ed sa pr\u00edznaky long covidu \u010dasom zmier\u0148uj\u00fa a\u00a0vymizn\u00fa. Je v\u0161ak aj mno\u017estvo tak\u00fdch, ktor\u00ed sa nakazili v prvej vlne (jar 2020) a st\u00e1le maj\u00fa n\u00e1sledkom infekcie zdravotn\u00e9 probl\u00e9my.<\/p>\n\n\n\n

V posledn\u00fdch mesiacoch sme nezaznamenali nov\u00e9 v\u00fdznamn\u00e9 \u0161t\u00fadie venuj\u00face sa \u0161pecificky priebehu covidu pri CF (star\u0161ie s\u00fa uveden\u00e9 v na\u0161om \u010dl\u00e1nku<\/a> z j\u00fana 2020). \u0160t\u00fadie publikovan\u00e9 na prelome rokov 2020 a 2021 nazna\u010duj\u00fa, \u017ee deti s CF zvl\u00e1daj\u00fa covid relat\u00edvne dobre. Mnoh\u00e9 mali asymptomatick\u00fd priebeh, ale \u010das\u0165 sa nevyhla hospitaliz\u00e1cii. Najohrozenej\u0161iu skupinu tvoria CF pacienti<\/a> s transplantovan\u00fdmi org\u00e1nmi, ktor\u00ed s\u00fa najviac ohrozen\u00ed \u0165a\u017ek\u00fdm priebehom a aj rizikom \u00famrtia.<\/p>\n\n\n\n

V pokro\u010dilej\u0161\u00edch \u0161t\u00e1di\u00e1ch klinick\u00e9ho sk\u00fa\u0161ania je aj nieko\u013eko liekov ur\u010den\u00fdch na lie\u010dbu covidu. Za zmienku stoj\u00ed napr\u00edklad antivirotikum favipiravir<\/a>. Schopnos\u0165 RNA v\u00edrusov r\u00fdchlo vytv\u00e1ra\u0165 mut\u00e1cie ale znamen\u00e1, \u017ee spravidla aj r\u00fdchlo vznikaj\u00fa rezistentn\u00e9 kmene. Dobr\u00fdm pr\u00edkladom s\u00fa monoklon\u00e1lne protil\u00e1tky, do ktor\u00fdch sa e\u0161te pred nieko\u013ek\u00fdmi mesiacmi vkladali nemal\u00e9 n\u00e1deje, ale dnes s\u00fa viacer\u00e9 vo\u010di delta variantu ne\u00fa\u010dinn\u00e9 (vr\u00e1tane t\u00fdch, ktor\u00e9 nak\u00fapilo slovensk\u00e9 ministerstvo zdravotn\u00edctva).<\/p>\n\n\n\n

Bud\u00faci <\/strong>v\u00fdvoj<\/strong><\/h3>\n\n\n\n

V \u010dl\u00e1nku<\/a> publikovanom po nev\u00fdraznej prvej vlne sme upozor\u0148ovali, \u017ee (napriek vtedy prevl\u00e1daj\u00facemu n\u00e1zoru) sa epid\u00e9mia z\u010faleka nekon\u010d\u00ed a dan\u00fd \u010das je vhodn\u00e9 vyu\u017ei\u0165 na pr\u00edpravu na jej \u010fal\u0161\u00ed priebeh (\u010do sa minim\u00e1lne v SR nestalo). St\u00e1le nie s\u00fa zodpovedan\u00e9 niektor\u00e9 d\u00f4le\u017eit\u00e9 ot\u00e1zky, ako presn\u00fd charakter \u013eudskej imunity vo\u010di tomuto v\u00edrusu alebo smer jeho evol\u00facie. Preto odhadova\u0165 priebeh epid\u00e9mie na dlh\u0161\u00ed \u010das ako mesiace je neist\u00e9, ak nie nemo\u017en\u00e9. Zhrnieme aspo\u0148 z\u00e1kladn\u00e9 predstavy a mo\u017enosti v\u00fdvoja.<\/p>\n\n\n\n

Nie je \u0165a\u017ek\u00e9 odhadn\u00fa\u0165, \u010do \u010dak\u00e1 Slovensko v najbli\u017e\u0161\u00edch t\u00fd\u017ed\u0148och \u2013 jeho tretia vlna bude kop\u00edrova\u0165 v\u00fdvoj kraj\u00edn so stredne vysokou zao\u010dkovanos\u0165ou. U\u017e v okt\u00f3bri sa d\u00e1 o\u010dak\u00e1va\u0165 pre\u0165a\u017eenie niektor\u00fdch nemocn\u00edc a probl\u00e9my s poskytovan\u00edm neodkladnej zdravotnej starostlivosti. V\u00fdznamn\u00e9 ohnisk\u00e1 bud\u00fa aj na \u0161kol\u00e1ch a v slabo zao\u010dkovan\u00fdch okresoch bud\u00fa \u0161koly viac zatvoren\u00e9 ako otvoren\u00e9. Pod\u013ea niektor\u00fdch odhadov by tretia vlna mohla vrcholi\u0165 niekedy v novembri a do jej konca niekedy po\u010das zimy prinesie \u010fal\u0161ie tis\u00edce m\u0155tvych, s ve\u013ekou prevahou medzi neo\u010dkovan\u00fdmi.<\/p>\n\n\n\n

Omnoho menej jasn\u00e9 je, \u010do nastane po skon\u010den\u00ed tretej vlny a aj medzi expertmi o tom panuj\u00fa iba dohady. V\u0161eobecne sa predpoklad\u00e1, \u017ee koronav\u00edrus sa nepodar\u00ed v doh\u013eadnej dobe eliminova\u0165<\/a>. To nemus\u00ed by\u0165 z\u00e1sadn\u00fd probl\u00e9m. Niektor\u00e9 vysoko zao\u010dkovan\u00e9 krajiny (nad 70\u00a0%) ako Brit\u00e1nia a D\u00e1nsko zru\u0161ili v\u0161etky protiepidemick\u00e9 opatrenia a situ\u00e1cia v ich nemocniciach je zvl\u00e1dnute\u013en\u00e1 (aj ke\u010f nie bezprobl\u00e9mov\u00e1). Viacer\u00e9 krajiny zav\u00e1dzaj\u00fa pre niektor\u00e9 skupiny obyvate\u013eov povinn\u00e9 o\u010dkovanie, ktor\u00e9 bolo v minulosti<\/a> na potla\u010denie epid\u00e9mii \u010dasto nevyhnutn\u00e9.<\/p>\n\n\n\n

Pre \u010fal\u0161\u00ed v\u00fdvoj bude ur\u010duj\u00face najm\u00e4, ak\u00e1 \u010das\u0165 popul\u00e1cie z\u00edska imunitu prekonan\u00edm ochorenia v tretej vlne, \u010di ned\u00f4jde \u010dasom k zn\u00ed\u017eeniu \u00fa\u010dinnosti vakc\u00edn (a ak\u00fd vplyv bude ma\u0165 pod\u00e1vanie tret\u00edch d\u00e1vok) a evol\u00facia nov\u00fdch v\u00edrusov\u00fdch variantov. Vzh\u013eadom na vysok\u00fa infek\u010dnos\u0165 delty by nebolo prekvapuj\u00face, ak by po tretej vlne malo 80 \u2013 90\u00a0% \u013eud\u00ed protil\u00e1tky, \u010do by v najoptimistickej\u0161om pr\u00edpade mohlo vies\u0165 k faktick\u00e9mu koncu epid\u00e9mie, ke\u010f\u017ee v\u00edrus by u\u017e mal probl\u00e9m \u010falej sa \u0161\u00edri\u0165. Najpesimistickej\u0161ia mo\u017enos\u0165 je objavenie sa immune escape variantu, ktor\u00fd by dok\u00e1zal \u00faplne ob\u00eds\u0165 imunitn\u00fd syst\u00e9m, resp. doteraz vytvoren\u00e9 protil\u00e1tky a epid\u00e9mia by sa vlastne za\u010dala odznova. Realistick\u00e9 je \u010daka\u0165 nie\u010do medzi t\u00fdmito mo\u017enos\u0165ami \u2013 nov\u00e9 varianty ur\u010dite vznikn\u00fa, ale s\u00a0existuj\u00facimi biologick\u00fdmi obmedzeniami je ich v\u00fdvoj sk\u00f4r postupn\u00fd a vedci maj\u00fa mo\u017enos\u0165 na ne reagova\u0165 \u00fapravou vakc\u00edn.<\/p>\n","protected":false},"excerpt":{"rendered":"

V decembri 2021 to už budú dva roky od výskytu prvých oznámených prípadov nového koronavírusu v Číne a pandémia, ktorá je dôsledkom jeho masového rozšírenia zostáva významným zdravotným rizikom a faktorom ovplyvňujúcim chod spoločnosti. Situáciu sme od začiatku sledovali a snažili … Continued<\/a><\/p>\n","protected":false},"author":7,"featured_media":2165,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"kt_blocks_editor_width":"","footnotes":""},"categories":[2],"tags":[],"class_list":["post-2163","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-informacie"],"yoast_head":"\nKoronav\u00edrus Covid-19 tretia vlna a o\u010dkovanie<\/title>\n<meta name=\"description\" content=\"\u010co zmen\u00ed trojn\u00e1sobne infek\u010dnej\u0161\u00ed variant COVID-19? 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