美国肝脏研究协会专家小组共识声明:预防肝病患者感染 2019 年冠状病毒病的疫苗。
American Association for the Study of Liver Diseases Expert Panel Consensus Statement: Vaccines to Prevent Coronavirus Disease 2019 Infection in Patients With Liver Disease.
机构信息
Elson S. Floyd College of MedicineWashington State UniversitySpokaneWAUSA.
University of PennsylvaniaPhiladelphiaPAUSA.
出版信息
Hepatology. 2021 Aug;74(2):1049-1064. doi: 10.1002/hep.31751.
The aim of this document is to provide a concise scientific review of the currently available COVID-19 vaccines and those in development, including mRNA, adenoviral vectors, and recombinant protein approaches. The anticipated use of COVID-19 vaccines in patients with chronic liver disease (CLD) and liver transplant (LT) recipients is reviewed and practical guidance is provided for health care providers involved in the care of patients with liver disease and LT about vaccine prioritization and administration. The Pfizer and Moderna mRNA COVID-19 vaccines are associated with a 94%-95% vaccine efficacy compared to placebo against COVID-19. Local site reactions of pain and tenderness were reported in 70%-90% of clinical trial participants, and systemic reactions of fever and fatigue were reported in 40%-70% of participants, but these reactions were generally mild and self-limited and occurred more frequently in younger persons. Severe hypersensitivity reactions related to the mRNA COVID-19 vaccines are rare and more commonly observed in women and persons with a history of previous drug reactions for unclear reasons. Because patients with advanced liver disease and immunosuppressed patients were excluded from the vaccine licensing trials, additional data regarding the safety and efficacy of COVID-19 vaccines are eagerly awaited in these and other subgroups. Remarkably safe and highly effective mRNA COVID-19 vaccines are now available for widespread use and should be given to all adult patients with CLD and LT recipients. The online companion document located at https://www.aasld.org/about-aasld/covid-19-resources will be updated as additional data become available regarding the safety and efficacy of other COVID-19 vaccines in development.
本文件旨在对目前可用的 COVID-19 疫苗和正在开发的疫苗进行简明的科学综述,包括 mRNA、腺病毒载体和重组蛋白方法。综述了 COVID-19 疫苗在慢性肝病 (CLD) 患者和肝移植 (LT) 受者中的预期用途,并为参与肝病和 LT 患者护理的医疗保健提供者提供了疫苗优先接种和管理的实用指南。与安慰剂相比,辉瑞和 Moderna 的 mRNA COVID-19 疫苗在预防 COVID-19 方面的有效性分别为 94%-95%。临床试验参与者中有 70%-90%报告了疼痛和压痛的局部反应,40%-70%报告了发热和疲劳的全身反应,但这些反应通常较轻且为自限性,且在年轻人中更常见。与 mRNA COVID-19 疫苗相关的严重超敏反应罕见,更常见于女性和原因不明的既往药物反应史者。由于 ADVANCE 肝疾病和免疫抑制患者被排除在疫苗许可试验之外,因此迫切需要在这些和其他亚组中获得有关 COVID-19 疫苗安全性和有效性的额外数据。目前已有安全性高、有效性强的 mRNA COVID-19 疫苗可供广泛使用,应给予所有 CLD 成年患者和 LT 受者。位于 https://www.aasld.org/about-aasld/covid-19-resources 的在线配套文件将随着其他正在开发的 COVID-19 疫苗安全性和有效性的更多数据更新。