Young Megan, Crook Harry, Scott Janet, Edison Paul
Faculty of Medicine, Imperial College London, London, UK.
Centre for Virus Research, University of Glasgow, Glasgow, UK.
BMJ Med. 2022 Apr 1;1(1):e000040. doi: 10.1136/bmjmed-2021-000040. eCollection 2022.
As of 25 January 2022, over 349 million individuals have received a confirmed diagnosis of covid-19, with over 5.59 million confirmed deaths associated with the SARS-CoV-2 virus. The covid-19 pandemic has prompted an extensive global effort to study the molecular evolution of the virus and develop vaccines to prevent its spread. Although rigorous determination of SARS-CoV-2 infectivity remains elusive, owing to the continuous evolution of the virus, steps have been made to understand its genome, structure, and emerging genetic mutations. The SARS-CoV-2 genome is composed of several open reading frames and structural proteins, including the spike protein, which is essential for entry into host cells. As of 25 January 2022, the World Health Organization has reported five variants of concern, two variants of interest, and three variants under monitoring. Additional sublineages have since been identified, and are being monitored. The mutations harboured in these variants confer an increased transmissibility, severity of disease, and escape from neutralising antibodies compared with the primary strain. The current vaccine strategy, including booster doses, provides protection from severe disease. As of 24 January 2022, 33 vaccines have been approved for use in 197 countries. In this review, we discuss the genetics, structure, and transmission methods of SARS-CoV-2 and its variants, highlighting how mutations provide enhanced abilities to spread and inflict disease. This review also outlines the vaccines currently in use around the world, providing evidence for every vaccine's immunogenicity and effectiveness.
截至2022年1月25日,超过3.49亿人被确诊感染新冠病毒,与严重急性呼吸综合征冠状病毒2(SARS-CoV-2)病毒相关的确诊死亡人数超过559万。新冠疫情促使全球展开广泛努力,以研究该病毒的分子进化并开发预防其传播的疫苗。尽管由于病毒的不断进化,对SARS-CoV-2传染性的严格测定仍然难以实现,但在了解其基因组、结构和新出现的基因突变方面已取得了进展。SARS-CoV-2基因组由几个开放阅读框和结构蛋白组成,包括刺突蛋白,它对于进入宿主细胞至关重要。截至2022年1月25日,世界卫生组织已报告了5种值得关注的变异株、2种感兴趣的变异株和3种正在监测的变异株。此后又发现了其他亚谱系,并正在进行监测。与原始毒株相比,这些变异株中含有的突变使其传播性、疾病严重程度增加,并能逃避中和抗体。目前的疫苗策略,包括加强针,可提供针对重症的保护。截至2022年1月24日,已有33种疫苗在197个国家获得批准使用。在本综述中,我们讨论了SARS-CoV-2及其变异株的遗传学、结构和传播方式,强调了突变如何增强其传播和致病能力。本综述还概述了目前在世界各地使用的疫苗,提供了每种疫苗免疫原性和有效性的证据。