Center for Infectious Disease Dynamics, Departments of Biology and Entomology, The Pennsylvania State University, University Park, PA 16802
Center for Infectious Disease Dynamics, Departments of Biology and Entomology, The Pennsylvania State University, University Park, PA 16802.
Proc Natl Acad Sci U S A. 2018 Dec 18;115(51):12878-12886. doi: 10.1073/pnas.1717159115. Epub 2018 Dec 17.
Vaccines and antimicrobial drugs both impose strong selection for resistance. Yet only drug resistance is a major challenge for 21st century medicine. Why is drug resistance ubiquitous and not vaccine resistance? Part of the answer is that vaccine resistance is far less likely to evolve than drug resistance. But what happens when vaccine resistance does evolve? We review six putative cases. We find that in contrast to drug resistance, vaccine resistance is harder to detect and harder to confirm and that the mechanistic basis is less well understood. Nevertheless, in the cases we examined, the pronounced health benefits associated with vaccination have largely been sustained. Thus, we contend that vaccine resistance is less of a concern than drug resistance because it is less likely to evolve and when it does, it is less harmful to human and animal health and well-being. Studies of pathogen strains that evolve the capacity to replicate and transmit from vaccinated hosts will enhance our ability to develop next-generation vaccines that minimize the risk of harmful pathogen evolution.
疫苗和抗菌药物都对耐药性产生了强烈的选择作用。然而，只有耐药性是 21 世纪医学的主要挑战。为什么耐药性无处不在，而疫苗耐药性却不是？部分原因是疫苗耐药性的进化远不如药物耐药性那么容易。但是，当疫苗耐药性确实进化时会发生什么呢？我们回顾了六个推测的案例。我们发现，与药物耐药性相比，疫苗耐药性更难检测和确认，其机制基础也不太清楚。然而，在我们研究的案例中，与疫苗接种相关的显著健康益处基本上得到了维持。因此，我们认为疫苗耐药性不像药物耐药性那样令人担忧，因为它不太可能进化，而且即使进化了，对人类和动物的健康和福祉的危害也较小。对能够从接种疫苗的宿主中复制和传播的病原体菌株的研究将提高我们开发最大限度降低有害病原体进化风险的下一代疫苗的能力。
