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Ubhubhani wexesha lomkhuhlane ubangela phakathi kwe-290,000 kunye ne-650,000 yokufa okunxulumene nesifo sokuphefumla kwihlabathi jikelele ngonyaka. Ilizwe lijongene nobhubhani womkhuhlane omkhulu kobu busika emva kokuphela kobhubhani we-COVID-19. Isitofu sokugonya somkhuhlane yeyona ndlela isebenzayo yokuthintela umkhuhlane, kodwa isitofu sokugonya somkhuhlane wesintu esisekelwe kwinkcubeko yenkukhu ye-embryo ineziphene ezithile, ezifana nokwahluka kwe-immunogenic, ukunciphisa imveliso njalo njalo.

Ukufika kwesitofu sokugonya somkhuhlane we-HA protein gene engineering recombinant kwakhona kunokusombulula iziphene zesitofu sokugonyela i-embryo yenkukhu. Okwangoku, iKomiti yeeNgcebiso yaseMelika kwiZiqhelo zokugonywa (ACIP) incoma idosi ephezulu yokugonya i-recombinant influenza yabantu abadala ≥65 yeminyaka ubudala. Nangona kunjalo, kubantu abangaphantsi kweminyaka engama-65 ubudala, i-ACIP ayicebisi naluphi na uhlobo lwesitofu sokugonya somkhuhlane njengento ephambili ngenxa yokunqongophala kokuthelekisa intloko nentloko phakathi kweentlobo ezahlukeneyo zokugonya.

I-quadrivalent recombinant hemagglutinin (HA) isitofu sokugonya somkhuhlane (RIV4) samkelwe ukuba sithengiswe kumazwe amaninzi ukusukela ngo-2016 kwaye ngoku sesona sitofu sokugonya somkhuhlane esisetyenziswayo. I-RIV4 iveliswa kusetyenziswa iqonga leteknoloji yeprotheyini ephinda-phindayo, elinokoyisa iziphene zemveliso yesitofu engasebenziyo yesitofu esilinganiselweyo kunikezelo lweembumba zeenkukhu. Ngaphezu koko, eli qonga linomjikelezo omfutshane wokuvelisa, lilungele ukutshintshwa kwangethuba kwamagciwane okugonywa kwabaviwa, kwaye inokuphepha ukuguqulwa kokuguqulwa okunokuthi kwenzeke kwinkqubo yokuvelisa iintsholongwane zentsholongwane ezinokuchaphazela umphumo wokukhusela wokugonya ogqityiweyo. U-Karen Midthun, ngoko umlawuli weZiko loPhononongo lweBiologics kunye noPhando kwi-US Food and Drug Administration (FDA), ugqabaze ngelithi “ukufika kogonyo lomkhuhlane oluphinda-phindaneyo kumele ukuqhubela phambili kobuchwepheshe ekuvelisweni kwezitofu zokugonya umkhuhlane… Ukongeza, i-RIV4 iqulethe iprotheyini ye-hemagglutinin ephindwe kathathu kunethamo eliqhelekileyo lokugonya lomkhuhlane, elinamandla okugonya amandla [2]. Izifundo ezikhoyo zibonise ukuba i-RIV4 ikhusela ngakumbi kune-standard-dose yokugonya umkhuhlane kubantu abadala, kwaye ubungqina obugcweleyo bufunekayo ukuthelekisa ezi zimbini kubantu abancinci.

Ngomhla we-14 kuDisemba, i-2023, i-New England Journal of Medicine (NEJM) yapapasha uPhononongo olwenziwe ngu-Amber Hsiao et al., Iziko loFundo lokugonya le-Kaiser Permanente, iNkqubo yezeMpilo ye-KPNC, e-Oakland, e-USA. Uphononongo luphononongo lwehlabathi lokwenyani olusebenzise indlela engacwangciswanga yabemi ukuvavanya isiphumo sokhuseleko se-RIV4 ngokuchasene ne-quadrivalent yedosi yedosi engasebenziyo yokugonya umkhuhlane (SD-IIV4) kubantu abangaphantsi kweminyaka engama-65 ngexesha lonyaka lomkhuhlane ukusuka ku-2018 ukuya ku-2020.

Ngokuxhomekeke kwindawo yenkonzo kunye nobungakanani beziko lezibonelelo ze-KPNC, ziye zabelwa ngokungenamkhethe kwiqela A okanye iQela B (Umfanekiso 1), apho iqela A lafumana i-RIV4 kwiveki yokuqala, iQela B lafumana i-SD-IIV4 kwiveki yokuqala, kwaye ke isibonelelo ngasinye safumana izitofu zokugonya ezimbini ngokutshintshanayo ngeveki de kube sekupheleni kwexesha lomkhuhlane langoku. Isiphelo sokuqala sophononongo sasiyi-PCR-eqinisekisiweyo yeemeko zomkhuhlane, kwaye isiphelo sesibini sasiquka umkhuhlane A, umkhuhlane B, kunye nezibhedlele ezinxulumene nomkhuhlane. Oogqirha kwiziko ngalinye benza iimvavanyo ze-PCR zomkhuhlane ngokokubona kwabo, ngokusekelwe kwinkcazo yekliniki yesigulana, kwaye bafumane ukuxilongwa kwezigulane ezilaliswayo kunye nezigulana zangaphandle, uvavanyo lwebhubhoratri, kunye nolwazi lokugonywa ngeerekhodi zonyango lwe-elektroniki.

Uphononongo lubandakanya abantu abadala abaneminyaka eyi-18 ukuya kwi-64 iminyaka, kunye ne-50 ukuya kwi-64 iminyaka ibe liqela eliphambili elihlalutywayo. Iziphumo zibonise ukuba umphumo okhuselekileyo wokukhusela (rVE) we-RIV4 xa kuthelekiswa ne-SD-IIV4 ngokumelene ne-PCR-confirmed influenza yayingu-15.3% (95% CI, 5.9-23.8) kubantu abaneminyaka eyi-50 ukuya kwi-64 iminyaka. Ukhuseleko olunxulumene nomkhuhlane A lwaluyi-15.7% (95% CI, 6.0-24.5). Akukho siphumo sibalulekileyo sokhuselo esibonakaliswe kumkhuhlane B okanye ukulaliswa okunxulumene nomkhuhlane. Ukongezelela, uhlalutyo lokuhlola lubonise ukuba kubantu abaneminyaka eyi-18-49 iminyaka, zombini i-influenza (rVE, 10.8%; 95% CI, 6.6-14.7) okanye i-influenza A (rVE, 10.2%; 95% CI, 1.4-18.2), i-RIV4-18.2 ibonise ukukhuselwa okungcono kune-RIVSDI.

Ulingo lwangaphambili olungenamkhethe, oluyimfama oluphindwe kabini, olulawulwa kakuhle lubonisa ukuba i-RIV4 inokhuseleko olungcono kune-SD-IIV4 kubantu abaneminyaka eyi-50 nangaphezulu (rVE, 30%; 95% CI, 10 ~ 47) [3]. Olu phononongo luphinda lubonise ngedatha enkulu yehlabathi lokwenyani ukuba izitofu zokugonya zomkhuhlane zibonelela ngokhuseleko olungcono kunezitofu zokugonya ezingasebenziyo zemveli, kwaye izalisekisa ubungqina bokuba i-RIV4 ikwabonelela ngokhuseleko olungcono kubantu abancinci. Uphononongo luhlalutye iziganeko zokusuleleka kwentsholongwane yokuphefumula i-syncytial virus (RSV) kumaqela omabini (usulelo lwe-RSV lufanele lufaniswe kumaqela omabini ngenxa yokuba isitofu sokugonya somkhuhlane asithinteli usulelo lwe-RSV), ngaphandle kwezinye izinto eziphazamisayo, kwaye ziqinisekisa ukomelela kweziphumo ngokuhlalutya kovakalelo oluninzi.

Iqela lenoveli yendlela yoyilo olungenamkhethe olwamkelwe kolu phononongo, ngakumbi ugonyo olutshintshanayo lwesitofu sokugonya kunye nesitofu solawulo rhoqo ngeveki, ilungelelana ngcono izinto eziphazamisayo phakathi kwamaqela amabini. Nangona kunjalo, ngenxa yobunzima boyilo, iimfuno zokwenziwa kophando ziphezulu. Kolu phononongo, unikezelo olungonelanga lwesitofu sokugonya somkhuhlane kwakhona lubangele inani elikhulu labantu ebekufanele ukuba bafumene i-RIV4 bafumana i-SD-IIV4, okubangele umahluko omkhulu kwinani labathathi-nxaxheba phakathi kwamaqela amabini kunye nomngcipheko onokwenzeka wokuthambekela. Ukongeza, uphononongo lwalucetywe kwasekuqaleni ukuba luqhutywe ukusuka ngo-2018 ukuya ku-2021, kwaye ukuvela kwe-COVID-19 kunye nokuthintela kunye nokulawula amanyathelo ayo achaphazele uphononongo kunye nokuqina kobhubhane lomkhuhlane, kubandakanya ukucutha kwexesha lomkhuhlane ka-2019-2020 kunye nokungabikho kwexesha lomkhuhlane ka-2020-2020. Idatha evela kumaxesha amabini kuphela omkhuhlane "ongaqhelekanga" ukusuka ku-2018 ukuya ku-2020 ayafumaneka, ngoko uphando olongezelelweyo luyafuneka ukuvavanya ukuba ezi zinto zifunyanisiweyo zibambe ixesha elide lonyaka, iintlobo ezahlukeneyo ezijikelezayo kunye namacandelo okugonya.

Lilonke, olu phononongo lungqina ngakumbi ukuba ngabanakho ukwenzeka kogonyo lwemfuza oluphinda-phindwayo olusetyenziswa kwindawo yezitofu zokugonya umkhuhlane, kwaye lukwabeka isiseko esiluqilima sobuchwephesha kuphando lwexesha elizayo kunye nophuhliso lwezitofu ezintsha zokugonya umkhuhlane. Iqonga lobuchwephesha lobuchwephesha lobunjineli bezofuzo eliphinda liphinde lisebenze alixhomekekanga kwiimbumba zenkukhu, kwaye lineengenelo zomjikelo omfutshane wemveliso kunye nokuzinza okuphezulu kwemveliso. Nangona kunjalo, xa kuthelekiswa nezitofu zokugonya zomkhuhlane ezingasebenziyo, ayinanzuzo ibalulekileyo ekukhuseleni, kwaye kunzima ukusombulula into yokubaleka komzimba okubangelwa zintsholongwane zomkhuhlane eziguquguqukayo kakhulu ukusuka kwingcambu. Ngokufanayo nezitofu zokugonya zomkhuhlane wesintu, uqikelelo loxinzelelo kunye nokutshintshwa kwe-antigen kuyafuneka minyaka le.

Xa sijongana notshintsho olusakhulayo lomkhuhlane, kusafuneka sinikele ingqalelo ekuphuhlisweni kwezitofu zokugonya umkhuhlane jikelele kwixesha elizayo. Ukuphuhliswa kwesitofu sokugonya somkhuhlane jikelele kufuneka kwandise kancinci umda wokhuseleko kwiintlobo zentsholongwane, kwaye ekugqibeleni kufumaneke ukhuseleko olusebenzayo kuzo zonke iintlobo kwiminyaka eyahlukeneyo. Ngoko ke, kufuneka siqhubeke nokukhuthaza ukuyilwa kwe-immunogen ebanzi esekelwe kwiprotheni ye-HA kwixesha elizayo, kugxininise kwi-NA, enye iprotheni yomhlaba wentsholongwane ye-influenza, njengento ekujoliswe kuyo yokugonya, kwaye igxininise kwiindlela zobuchwepheshe bokugonywa kokuphefumla okunenzuzo ngakumbi ekunyanzeni iimpendulo zokukhusela ezininzi ezibandakanya i-immunity yeselula yendawo (njenge-vaccine ye-nasal spray, i-powder eyomileyo, inhalable). Qhubeka nokukhuthaza uphando lwezitofu zokugonya ze-mRNA, izitofu zokugonya, izincedisi ezintsha kunye namanye amaqonga obugcisa, kwaye uqonde uphuhliso lwezitofu zokugonya zomkhuhlane wehlabathi “ezisabela kulo lonke utshintsho ngaphandle kotshintsho”