โฆ Ngingumakadebona wempi yokugoma e-US, futhi namuhla ngizizwa ngiphoqelekile ukukhuluma ngalokho engakubona kuleyo mpi. Izishayamthetho zaphoqeleka ukuthi zishintshe amavoti azo ukuze zihoxise ukukhululwa ekugomeni futhi zihoxise ilungelo elingokomlando lokuvuma izinqubo zezokwelapha. Impi yokugoma iyimpi engcolile, lapho imibono mayelana nokuvikela abasengozini kakhulu isetshenziswa izinkampani ezifanayo zemithi ukuthi ukhokhe u-$2.7 billion ngezijeziso zobugebengu e-US phakathi kuka-2012 no-2015. Imboni yokugoma yenza inzuzo enkulu kakhulu (kulinganiselwa ku-10-40%), izuza emakethe eqinisekiswe uhulumeni, futhi ithola cishe isivikelo sesikweletu esiphelele. Ayikho enye imboni engaqhudelana nalezi zinzuzo. Futhi isifiso esinamandla sale mboni sokukhula nokuqinisekisa imakethe yayo yaseCanada yingakho silapha namuhla.
Ake ngengeze umongo kule ngxoxo ngokuphawula ukuthi ngo-2014, kusho i-NY Times kubiza u-$2200 ukugoma ingane eyodwa ngokugcwele. Ngaleso ntengo, kubiza amaRandi ayizigidi eziyizinkulungwane ezingu-163 ukugoma ngokugcwele yonke ingane yase-US.
Ngicela ukuxolisa zisuka nje ngokusebenzisa kakhulu idatha yase-US? Ngihlinzeka ngolwazi lwaseCanada kanye neNew Brunswick uma lutholakala.
- I-Pharma's Pilgrimage eya eNew Brunswick
Kusukela ngoMashi 2019, abamele abakhiqizi bomgomo abakhulu abathathu eNyakatho Melika: i-GSK, i-Merck ne-Sanofi, sebefikile eNew Brunswick. ukuhlangana nongqongqoshe, abasebenzi bakahulumeni kanye nabashayimthetho. Lokhu akuzenzekelanga. Izinkampani ezenza imithi ziyasebenzisana ukuze zandise ukunqoba okusemthethweni okutholwe e-US. Ukusebenzisa isiphepho sabezindaba phezu kwesimungumungwane, ukuhlolwa kwamawebhusayithi amaningi ahlobene nokugoma, ukusekelwa okusha kwemiyalelo evela izinhlangano zobungcweti ezihlomule embonini enkulu, futhi iphathelene nabaholi beqembu leDemocratic Alliance, ilungelo lokukhululwa ekugonyweni kwezenkolo nefilosofi liye lachithwa yizishayamthetho e-California, New York naseMaine. Endabeni yakamuva yaseNew York, USomlomo we-NY Assembly ubanjwe kukhasethi yevidiyo eyala ilungu lekomidi ukuthi lishintshe ivoti lalo ukuze umthetho wegunya uqhubekele phambili.
Lokhu kwakungelona uhambo oluyize lokuya kwesinye sezifundazwe ezincane kakhulu zaseCanada. Ku-Pharma kuyisango eliya kulo lonke elaseCanada.
Imboni yokugoma ngo-2019 isempambanweni yezindlela.
Ngakolunye uhlangothi, ibhizinisi lokugoma liyachuma. Imithi yokugoma eminingana inikezwe ilayisense emisha, a imboni eqinile-FDA umnyango ojikelezayo sekusunguliwe, futhi izingane zaseNyakatho Melika zithola imithi yokugoma eminingi kunangaphambili. I-Merck, ngokwesibonelo, ibike ukwanda kokuthengisa engxenyeni yesibili ka-2019 I-Gardasil Umuthi wokugomela i-HPV wama-46% (ufinyelela ngaphezu kwezigidigidi ezi-3 zamaRandi ngonyaka) uma kuqhathaniswa nonyaka odlule, nokuthengiswa kwawo kwenyuke ngo-58% I-MMRV (isimungumungwane, umvukuzane, i-rubella kanye ne-varicella) kugonywe. Laba bangabathengisi abakhulu be-Merck 3d kanye no-4th abakhulu. Ukuqubuka kwesimungumungwane e-US kulo nyaka (cishe izehlakalo eziyi-1200) futhi kuqhutshwa abezindaba ukwesaba ukutheleleka kube nomthelela ekuthathweni komgomo.
Ngakolunye uhlangothi, imboni ayifuni ukubhekana nezindleko ezinkulu zokuthuthukisa, ukuhlola kanye nokunikeza amalayisense imigomo emishaโengaphezu kwe-100 yayo esathuthukiswayoโngaphandle kwesiqinisekiso sikahulumeni sokuthi izothengwa.
Imithi yokugoma yenzelwe yonke into esuka induna kuya umdlavuza.
Iziyalezo zomuthi wokugoma ziqinisekisa imakethe yokugoma, manje nasesikhathini esizayo. Imiyalelo ebekwe namuhla izophoqelela ukutholwa kwemithi yokugoma ohlwini oludingekayo njengamanje, kanye neminye imithi yokugoma esazongezwa.
Izinselele Zemboni
Ngo-2019, imboni yokugoma ibhekene nezinselelo zomthetho ezisongelayo.
- a)Ufakazi onguchwepheshe woMnyango Wezobulungiswa wase-US (i-DOJ) ecaleni le-autism yokugoma i-omnibus ka-2007 (okuthinta umphumela wezinkulungwane zezigameko zokulimala okusolwa ngokugoma okuholela ku-autism), Uprofesa wezinzwa u-Andrew Zimmerman, MD usanda kufaka i-afidavithi ethi ubufakazi bakhe bochwepheshe bashintshwa abameli be-DOJ-ukuthi wabatshela ukuthi kwezinye izimo, i-autism ingaba umphumela wokugoma.. Icala okusolwa ukuthi ubufakazi bukaProf Zimmerman bushintshiwe laphumela ekunqatshelweni kwezinzuzo zezinkulungwane zemindeni enezingane ezine-autistic. Kuphinde kwaholela esiphethweni esingesihle eNkantolo Yokugoma yase-US, kuzo zonke izimo ezizayo, ukuthi i-autism ingase ibe umphumela wokugoma. Ngokunokwenzeka izinkulungwane zamacala anqatshiwe kuzodingeka aphinde aquliswe amacala.
- b) Gardasil, umuthi wokugomela i-Merck osetshenziselwa ukuvimbela izifo ze-HPV kanye nomdlavuza obulalayo, ubhekene namacala emhlabeni wonke ngokulimala nokufa kwemizwa. imiphumela engemihle esabalele ebikiwe. Khumbula ukuthi uMerck, umkhiqizi we I-Gardasil, i-MMR, i-varicella neminye imithi yokugoma, ifihle imiphumela emibi eyingozi ye Vioxx cishe iminyaka emihlanu, ukhokha amaRandi ayizigidi eziyizinkulungwane ezingu-4.85 ukuze kulungiswe izicelo zokulimala ezingu-27,000. Usosayensi we-FDA uDavid Graham, MD balinganiselwa ku-39,000 kuye kwangama-61,000 abantu abashonile ngokweqile ngenxa ye-Vioxx.
- c)Udokotela waseDanish kanye nesazi sesayensi yesintu u-Peter Aaby, kanye neqembu aliholayo, sebeneminyaka engama-40 becwaninga ngemithi yokugoma e-Afrika. Ngemva kokuphothula amakhulukhulu ezifundo zokugoma, baphethe ngokuthi umgomo we-DPT ukwanda Ukushona kwezinsana, nge-100% noma ngaphezulu, ezinganeni zase-Afrika. Amanothi eqembu lakhe, "Zonke izifundo zokwethulwa kwe-DTP zithole ukwanda kokushona kwabantu." Ungase ube nesithakazelo kwezakhe inkulumo evule amehlo eNgqungqutheleni yakamuva yeNkululeko Yesayensi eCopenhagen.
Ukuzivikela Okungcono Kakhulu Kuyicala Elihle
Ngokubhekana nalezi zinselelo, ngo-2019 imboni yokugoma yabamba ithuba layo ekuqubukeni kwesimungumungwane e-US isikhathi eside. Umkhankaso we-PR owenziwe ngokungenaphutha owenzelwe imboni usize ukudlula umthetho wokugunyazwa kokugoma e-US, futhi manje imboni iphinda isu eCanada.
Ngemuva kwesifo sesimungumungwane sika-Disneyland sango-2015, kuhlanganiswe nezigidi zamaRandi ezinkokhelweni zokunxenxa kanye neminikelo eqondiswe kwabashayamthetho, izishayamthetho zaseCalifornia zivotele ukuqeda ukukhululwa emithini yokugoma okungeyona eyezokwelapha. Futhi kule nyanga, bacubungula umthethosivivinywa ongaqinisa ukuhlinzekwa kokukhululwa kwezokwelapha.
Omunye wemiphumela ebingalindelekile yegunya lokugoma laseCalifornia kwaba ukuhoxa ngokuphelele kwezingane ezikoleni zikahulumeni. UMnyango Wezempilo Yomphakathi waseCalifornia ubike ukuthi isibalo sezingane zasenkulisa ezifunda emakhaya, ezingagonyiwe sinyuke sisuka ku-2,000 saya cishe ku-7,000 phakathi kuka-2016 no-2018., kulandela igunya laseCalifornia lokugoma.
Ingabe i-New Brunswick ilungiselelwe ukuncipha okukhulu kwenani lezingane ezifunda esikoleni sikahulumeni?
- Uqinisekisiwe ukuthi "Imithi yokugoma iphephile futhi iyasebenza."
Inendandatho eqinisekisayo, kodwa ayidlulisi lutho. Eqinisweni, umgomo ngamunye uhluke kakhulu komunye nomunye. Ngokuvamile, kukhona esikwaziyo (kodwa akwanele) mayelana nenzuzo, kodwa okuncane nje mayelana nokulimala kwemithi yokugoma eyahlukene. Ngokusho kwe Isikhungo Sezokwelapha, "Inqubo yokulindela, ukuthola, kanye nokulinganisa izingozi zezehlakalo ezimbi ezingavamile ngemva kokugonywa iletha inselele enkulu." Njengezidakamizwa, ngayinye isetshenziswa ngokufanelekile lapho inzuzo idlula ingozi. Ngenxa yokuthi imigomo inikezwa abantu abanempilo ukuze kuvinjelwe izifo, kufanele iphephe nakakhulu kunemithi.
Ukusebenza kokuqala kwemithi yokugoma eyahlukene yezingane isukela cishe ku-40% kuya ku-93%. Ukungavikeleki kuyancipha ngokuhamba kwesikhathi.
Kunenkinga enkulu enhliziyweni yokuhlolwa kokuphepha komgomo: ulwazi lwezehlakalo ezimbi lufihlwe imfihlo, lugodlwe odokotela kanye nomphakathi yizikhungo zezempilo zomphakathi. Imiphumela engathandeki iyabhucungwa noma yenziwe amanga ize ibonakale yamukelekile. Ngoba lokhu kunzima ukukukholwa, ngizokunikeza izibonelo ezi-3 ezibalulekile zokukhohlisa idatha ye-CDC.
- UThomas Verstraeten wayengudokotela osemncane kunhlangano ye-CDC okwathi ngo-1999 wafunda ubudlelwano bezibalo phakathi kwamanani anqwabelene ezingane ezisanda kuzalwa ze-thimerosal (i-mercury) ezatholwa emithini yokugoma kanye nezifo zemizwa. Imiphumela yakheโokuhlanganisa nokuthi izingane ezichayeke emazingeni aphezulu e-mercury emithini yokugoma ngemva kokuzalwa zaba nezinga eliphindwe ka-7 izinga le-autism njengezingane ezingavezwangaโyaphazamisa kangangokuthi i-CDC yabiza umhlangano wangasese wochwepheshe bokugoma ukuze baxoxe futhi bayilawule. Azikho izintatheli noma amalungu omphakathi avunyelwe, kodwa a ikhophi yombhalo womhlangano kwaputshuka. (Ngikunikeze i-abstract engashicilelwe etholwe yi-FOIA ebonisa enye idatha ye-Verstraeten ngaphambi kokuthi ibhucushwe ukuze kususwe umphumela we-mercury. iphepha elishicilelwe ngo-2003 uthi, "Azikho izinhlangano ezibalulekile ezingaguquki ezitholakele phakathi kwe-thimerosal (i-mercury) equkethe imigomo nemiphumela ye-neurodevelopmental." Ngikunike futhi a incwadi evela kudokotela uCongressman Bill Weldon eya kuDkt. Julie Gerberding, umqondisi we-CDC mayelana nalokhu kukhohlisa kwedatha. Indaba ayixazululiwe. Kamuva i-Merck yatholakala ukuthi idukise umphakathi ngokuthi iyisuse nini i-thimerosal emithini yokugoma izinsana.
- UDkt. William Thompson uvumile ukuthi iqembu lakhe lososayensi be-CDC laliqondiswe ukuthi licekele phansi imininingwane ocwaningweni lwalo exhumanisa ukugonywa kwe-MMR kwabesilisa abamnyama nokukhuphuka kwamazinga e-autism.. Iqembu lihlangane egumbini lenkomfa, lafaka yonke imininingwane ekhombisa lo mphumela emgqomeni kadoti. UThompson wagcina ikhophi ngasese, wayenza yatholakala kuCongressman Bill Posey. I iphepha elishicilelwewenqabe noma yikuphi ukuxhumana kwe-autism. UKhongolose uPosey ucele ukuthi kuphenywe, kodwa akukho osekwenzekile. Ifilimu I-Vaxxed imayelana nalolu daba.
- U-Poul Thorson wayengudokotela, umsebenzi we-CDC futhi kamuva waba usonkontileka we-CDC bobabili abakhohlisa idatha ye-Danish ukuze basuse imiphumela emibi ye-thimerosal, futhi bantshontshe izimali ku-CDC.UThorson okwamanje useMnyango Wezempilo Nezinkonzo Zabantu' uhlu lwababaleki ebulungiswa.
Naphezu kobufakazi obuqinile bokungaziphathi kahle kwesayensi kulawa macala e-3 CDC, amaphepha ashicilelwe kumajenali wezokwelapha aphezulu anale datha eshintshiwe awakaze ahoxiswe ezincwadini zezokwelapha. Kunalokho, bahlinzeka ngosekelo oluyisisekelo lokuphepha komgomo we-MMR kanye ne-mercury emithini yokugoma. Amaphepha omgunyathi angcolisa izincwadi zezokwelapha, okwenza kube nzima ukubona imiphumela emibi yangempela yemithi yokugoma.
Kusukela ngo-1995, lapho iCongress iqasha i-CDC Foundation, imali engaphezu kwezigidi ezingu-800 zamaRandi inikelwe ku-CDC ngale moto yeSisekelo. Health Canada, I-Merck, i-Pfizer, i-Novartis nezinye izinkampani zokugoma zinikela ku-CDC Foundation, ngezinye izikhathi ukuze xhasa izinhlelo ezikhulisa ukuthengisa. OwayenguMqondisi we-CDC uGerberding waba nguMongameli we-Merck Vaccines ngemuva kokushiya i-CDC. Izingxabano zezimali ze-CDC mayelana nokuphepha komgomo kudala zabhalwa.
Isayensi yokuphepha komgomo
Kunzima kakhulu ukuxhumanisa ukusabela okubi nokugoma ngaphandle uma kwenzeka maduzane ngemva kwalokho. Ngokuvamile, ukusabela okubi ngemva kwesikhathi kubonakala kuphela njengokubangelwa imithi yokugoma uma kwenzeka izikhathi eziningi kunokulindelekile.
I-National Academy of Sciences yaqokwa yiCongress ngo-1863 ukuze inikeze iseluleko sochwepheshe kuhulumeni. ICongress icele i-National Academy of Sciences' Institute of Medicine ukuthi yenze uchungechunge lwezifundo zokuphepha zomgomo ukuze zazise inqubomgomo yokugoma.
Ngo-2011, i-US National Academy of Sciences' Institute of Medicine wahlola ubufakazi ngesizathu somuthi wokugoma emithini yokugoma eyi-8 kanye nezinhlanganisela zomuthi wokugoma ezingaba ngu-158 ezingaba khona. Ezimweni eziningi (85%) zamacala, ngolimi olusetshenziswa i-Academy, "ubufakazi babunganele ukwamukela noma ukwenqaba ubuhlobo obuyimbangela." Isayensi ayizinzile.
UMongameli uKen Shine we-Institute of Medicine/National Academy of Medicine wabhala, e-US Uhlelo Lukazwelonke Lokugoma Umbiko Wonyaka ka-2013:
โNakuba zimbalwa izinkinga zempilo ezihlotshaniswa ngokusobala nemithi yokugoma futhi ezinye izinhlangano ezibekayo zinganqatshwa ngokusekelwe ebufakazini, ezimweni eziningi ubufakazi babunganele ukwamukela noma ukwenqaba ubudlelwano obuyimbangela... isikhathi. Ngenxa yokushoda kweziphetho eziqinile mayelana nemiphumela engemihle engase ibe khona yomuthi wokugoma, ukutshalwa kwezimali okuqhubekayo nokukhethiwe ku-epidemiologic kanye nolunye uphenyo ngezingozi zokugoma kuzodingekaโฆ Mayelana okungcono kakhulu umuntu angakwenza ukulinganisa, ngokusekelwe ebufakazini, amathuba okuthi imvamisa yesehlakalo esibi ingaphansi kwezinga elishiwo, eliphansi. Lokhu kungase kwanele kudokotela okala impilo yomphakathi kanye nenzuzo yezempilo yomuntu siqu ngokumelene nengozi ephansi kakhulu, kodwa akwanele ukwanelisa umzali oqaphile.
Ukuxhumana okuqhubekayo, okusobala, nokuvulelekayo nakho kuyisithako esibalulekile ohlelweni lokuphepha lokugoma oluyimpumelelo. Lokhu kusho okungaphezu kochwepheshe abachaza izinzuzo nobungozi kubazali nemindeni. Kusho ukulalela ngokucophelela izinkathazo nokungabaza, ukuhlala ngokweqiniso emandleni obufakazi ngaphandle kwehaba noma ukuhlanekezela amaqiniso, kanye nokubika ngokugcwele nangokungakhethi ngophenyo oluphusile ngokwesayensi lwezehlakalo ezingezinhle ezingaba khona."
Ngo-2019 imimoya yayishintshile e-Academy of Medicine. Umongameli omusha, uVictor Dzau, yena kanye nabanye bephaneli bakhe abeluleki abangcoliswe ukungqubuzana kwezezimali okungadalulwanga, ukuchithile ukukhathazeka kukamanduleli wakhe mayelana nokushoda kobufakazi bokuphepha komgomo, wasayina umcako omfushane: "Umsebenzi wethu ukuqinisekisile ukuthi isayensi icacile - imigomo iphephe kakhulu."
Manje siyazi ukuthi i-National Academies of Sciences' Institute of Medicine/National Academy of Medicine ithole izigidi zamadola ezinkampanini zezidakamizwa ezinentshisekelo emsebenzini wayo. I-Merck inikeze phakathi kuka-$5 no-$10 wezigidi zamaRandi; I-AstraZeneca, Bristol Myers Squibb, GlaxoSmithKline, Johnson noJohnson, Eli Lilly, Novartis, Pfizer, Sanofi-Aventis, kanye ne-United Therapeutics ngamunye banikeze phakathi kuka-$1 no-$5 m.isigidi.
Ulwazi lwemiphumela emibi ngenxa yomgomo owodwa, inhlanganisela yemithi yokugoma, noma inani lemithi yokugoma luhlala lufiphele.
Odokotela baseCanada bahlola impilo yezingane ngemva kokugonywa kwazo izinyanga ezingu-12 neziyi-18. Bathole ukuvakashelwa kwegumbi lezimo eziphuthumayo okweqile kwengane eyodwa kwezingu-168 ezigonywe ezinyangeni eziyi-12 ngomgomo we-MMR, okwenzeka phakathi kwesonto elilodwa namabili kamuva. Baphetha ngokuthi, โKunezingozi eziphakeme kakhulu zokuvakashela igumbi lezimo eziphuthumayo cishe isonto elilodwa kuya kwamabili kulandela ukugonywa kwezinyanga eziyi-12 neziyi-18. Ucwaningo lwesikhathi esizayo kufanele luhlole ukuthi lezi zenzakalo zingabikezelwa noma zivinjwe yini.โ
Amacala ayi-1300 e-narcolepsy abangelwa umkhuhlane wezingulube wango-2009 I-Pandemrix ukugoma. Lo mphumela wawukwazi ukuxhunyaniswa nomgomo ngoba izigidi zabantu zagonywa kanyekanye, i-narcolepsy eyavela yayinzima futhi idinga ukunakekelwa okujulile kodokotela, izinga le-narcolepsy laliphindwe izikhathi ezingu-10-16 kunalokho obekulindelekile, futhi ukugadwa komgomo kwakukade kubhekwe. ukwanda ukuze kuhlolwe imigomo emisha yobhubhane. Abantu baseCanada bathole umgomo ofanayo (I-Arepanrix) kodwa yakhiqizwa endaweni ehlukile, futhi ngenhlanhla yodwa inguqulo yaseCanada ayizange ibangele i-narcolepsy.
- Ngabe iNew Brunswick ibhekene nenkinga yesifo esingavinjelwa ngokugoma?
Impendulo ithi cha. Futhi uma bekunenkinga, uBill 39 ubungeke ulinde ukuthi uqale ukusebenza kuze kube ngu-2021.
Isimungumungwane. Kusukela ngo-Agasti 3, ICanada yaba namacala angama-84 esimungumungwane ngo-2019, Futhi abekho abantu ababulawa yisimungumungwane kusukela ngo-2014. Ngokumangalisayo, kunikezwe i-hoopla yabezindaba phezu kwesimungumungwane, kuphela abathathu baseMelika babulawa yisimungumungwane eminyakeni engu-20 edlule. Ingane yokugcina yaseMelika yashona ngo-2003, eneminyaka engu-14 ubudala ngemva kokufakelwa komnkantsha.
Ngo-2011 ubhubhane lwesimungumungwane eQuebec, lapho ngaphezu kwama-95% abantu bagonyiwe, ama-50% alabo abahlaselwa yisimungumungwane bathole imithamo emi-2 yomgomo wesimungumungwane.. Ngemuva kobhubhane lwesimungumungwane eDisneyland, kwatholakala ukuthi Izigameko zesimungumungwane ezingama-73 (38% zalezo ezithayishwe yi-CDC) zidalwe ngamagciwane aphuma emuthini wokugomela isimungumungwane.
I-Pertussis. I-Canada ilinganisa ukufa komuntu oyedwa ngenxa yokukhwehlela njalo ngonyaka. Ziningi izehlakalo, eziningi azitholakali futhi azibikwa. Abanye balinganisela iziguli zase-US eziyisigidi zokukhwehlela njalo ngonyaka. Lokhu kungenxa yokuthi ukuvikelwa komgomo kuncipha ngokushesha. Ngaphezu kuka-80% wezifo zokukhwehlela zenzeke ezinganeni ezigonywe ngokugcwele ocwaningweni lwakamuva.
I-Diphtheria. Nakhu icala elilodwa le-diphtheria njalo eminyakeni emibili e-US.
Umumbu. I-Canada ibike Izimungumungu eziyi-180 ngonyaka kusukela ngo-2011-2013. Ukuqubuka kwama-mumps kuwumphumela wokuncipha kokuzivikela okubangelwa umgomo. "Imininingwane evela ocwaningweni lokuqubuka kwezifo ikhombise ukuthi amathuba okuba nomvukuzane anyuke ngo-10 kuya ku-27% unyaka ngamunye ngemuva kokugoma."
I-Rubella. Konke okwakamuva Amacala e-rubella ase-US wonke angenwe kwamanye amazwe.
IPolio. Ayikho uvendle eCanada. I Icala lokugcina uvendle (lemvelo) eCanada lenzeka ngo-1977. Kube nezigameko ezi-3 ezibikiwe e-US kusukela ngo-2005, zonke zivela ezinhlotsheni zokugomela uvendle. Emhlabeni wonke, kunezigameko eziningi ezintsha zevendle ngenxa yezinhlobo zokugoma eziye zaba nobudlova kunangenxa yamagciwane asendle uvendle. Ngonyaka odlule, amagciwane atholakala ekugomeni akhubaza izingane eziyi-105 emhlabeni wonke; igciwane lasendle nje 33.
Imithi yokugoma equkethe amagciwane aphilayo, njenge-MMR, i-Varicella, novendle ingangena, ilimaze futhi ayivamisile ukubulala owamukelayo, ikakhulukazi uma ingane inokuntuleka kokuzivikela komzimba okungaziwa.. Kunezixwayiso ezibanzi ku- Ishidi lemininingwane yomgomo we-MMR engikunikeze yona, mayelana nokuthi ubani okufanele hhayi thola umgomo.
Nakuba kungavamile ukuvunywa, ukugoma akuyona inqubo yokulinganisa konke. Ngokusho kweMayo Clinic, "Ukusabela kwe-antibody emgomeni wesimungumungwane kuyahlukahluka kakhulu kubantu." Abesifazane banokusabela okubi kakhulu kunabesilisa. Ubulili nobuhlanga bunomthelela ekuphenduleni. Njengoba kwenza ifa. Imindeni eye yabhekana nokusabela okubucayi kokugoma ilungile ukuthi ikhathazeke ngeminye imigomo kanye nokuphepha kokugoma kwezelamani, ngoba umndeni wayo cishe usengozini engaphezu kwesilinganiso sokusabela. Okungabikwanga ukuthi izingane eziningi ezingagonyiwe zona ngokwazo ziyiqembu elisengozini, futhi akufanele zigonywe. Nokho, awekho amazinga akhona odokotela abangawasebenzisa ukuze banqume ubungozi bokugoma ezinganeni eziningi. Ngakho-ke ukukhululwa kwezokwelashwa kumele kuthuthukiswe, futhi ngokuvamile kunzima ukukuthola.
- Ukuzivikela Komhlambi kubukela phansi amazinga aphezulu okwehluleka kokugoma
Ubhubhane lwesimungumungwane eQuebec engilushilo lubonisa ukuthi ngisho nezinga lokugoma elingaphezu kuka-95% alizange likuvimbele ukuqubuka kwesimungumungwane esikhulu. Izilinganiso zokungavikeleki komhlambi zisekelwe kumodeli yezibalo, futhi ziyizilinganiso kuphela. Isizathu esenza ukuthi u-50% wesimungumungwane kwenzeke ezinganeni ezigonyiwe ukwehluleka komgomo wokuqala noma wesibili. Ukwehluleka komgomo oyinhloko kusho ukuthi umgomo awuzange ukhiqize amasosha omzimba, kanti ukwehluleka kwesibili kusho ukuthi ukuzivikela komzimba kwalahleka ngokuhamba kwesikhathi.
Emithini eminingi yokugoma, ukwehluleka okuyisisekelo nesesibili akunakwa, ngenxa yokuthi izingane azichayeke kokuningi kwalezi zifo. Izifo izingane ezichayeka kuzo i-pertussis kanye nomkhuhlane, bese kuba sobala ukwehluleka kokugomaโngoba izimo eziningi ze-pertussis kanye nomkhuhlane omningi zenzeka ezinganeni ezigonywe ngokugcwele.
- Ingabe izingane ezingagonyiwe zifaka izingane ezingenakuzivikela ezifweni engozini?
Iqiniso liwukuthi izingane ezingenaso isifo sokuzivikela ezifweni azibulawa izifo ezingavinjelwa ngokugoma, futhi bambalwa abazitholayo, ngaphandle komkhuhlane, i-pertussis kanye ne-varicellaโngoba imigomo yalezi zifo ezi-3 inikeza ukuzivikela okulinganiselwe.
Bangaphansi koyedwa waseMelika oyedwa abafa minyaka yonke ngenxa yesimungumungwane, umvukuzane, irubella, uvendle, noma i-diphtheria. Ngokwesilinganiso, oyedwa waseCanada ubulawa ukukhwehlela (pertussis). Izingane eziyishumi zaseCanada zibulawa umkhuhlane. Ingane eyodwa yaseMelika ifa minyaka yonke ngenxa ye-varicella (ichickenpox).
Ubheka ukufa kwezingane eziyi-11 ngonyaka eCanada. Ingabe ukugoma yonke ingane ngokugcwele ngokumelene nokukhwehlela, i-varicella kanye nomkhuhlane kungavimbela lokhu kufa? Khumbula, iziguli eziningi zokukhwehlela kanye ne-varicella zigonywe ngokugcwele. Futhi nakuba ukuvikeleka okukhiqizwa ezinganeni ezincane ekudutshulweni komkhuhlane kuhluka minyaka yonke, ngokuvamile kungaphansi kwama-50%.
Ukuzivikela komhlambi akukwazi ukufezwa ngokukhwehlela noma umkhuhlane ngoba awukho umuthi wokugoma owanele. Ukuzivikela komgomo we-Pertussis kuncipha ngokushesha kangangokuthi ukuvikelwa okuncane kusele ngemva kweminyaka engu-3-4. Ukudluliselwa kwabanye kungenzeka ngaphambi kokuthi uqaphele ukuthi ukwenzile Umkhuhlane or ingxabano.
Ngisho noma i-100% yabantu baseCanada igonyiwe, lezi zifo zizoqhubeka nokujikeleza phakathi kwabantu abagonyiwe kanye nenani labantu abangagonyiwe.
I-Varicella ayikwazi ukuqedwa kokubili ngoba umgomo awulungile (85% ukusebenza kahle), ukwehla kwenzeka, nangenxa yokuthi igciwane lihlala emzimbeni wakho unomphela ngemva kokugonywa noma ukutheleleka. Iningi lezingane ezingavikelekile ezithuthukisa izifo ze-varicella zenza kanjalo zisuka kumagciwane asevele ehlala emizimbeni yazo. Isimangalo sokuthi ukukhululwa emithini yokugoma kubeka izingane ezingenaso amandla omzimba engcupheni sasungulwa amafemu e-PR, abukho ubufakazi baso. Eqinisweni, izingane ezingenaso i-immunocompromised zinjalo engozini eyengeziwe yokuchithwa kwamagciwane aphilayo emithini yokugoma ngezinye izingane ezisanda kugonywa.
- Ukungavikeleki okwanele kwabantu kubonakala kukhona
Nakuba amanani okugoma abikwe eNew Brunswick ephansi, amanani okukhululwa okungezona ezokwelashwa nawo aphansi: 2%. Incazelo engcono kakhulu yokuntuleka kwezifo eziwumshayabhuqe naphezu kwamazinga arekhodiwe aphansi okugoma ukugcinwa kwamarekhodi okwanele.
E-Maine, enezibalo zabantu ezifanayo, izilinganiso zokugoma zomuthi wokugoma ngamunye odingekayo cishe zingama-95%. Amazinga okukhululwa ayahluka ngomuthi wokugoma. I-1% kuphela yezingane zase-US ezingatholi mgomo. Kufika ku-25% bathola eminye, kodwa hhayi yonke imithi yokugoma etholakalayo.
- Ingabe kufanele sikhathazeke ngekhwalithi yomgomo kanye nemvelaphi?
Imithi yokugoma iyisayensi yezinto eziphilayo. Ngokusho kwe-FDA, "Iningi lezinto eziphilayo ziyingxube eyinkimbinkimbi engabonakali kalula noma ephawulekayo.โ Ukuhumusha: imithi yokugoma iqukethe izinto ezingaziwa, ezingaziwa ngisho nayi-FDA kanye ne-Public Health Agency of Canada. Lokhu kubenza kube nzima ukulawula. I-FDA ithembele kubakhiqizi bomuthi wokugoma ukuthi banikeze idatha enembile mayelana nesinyathelo ngasinye senqubo yokukhiqiza. Uma kwenzeka inkinga ngesikhathi sokukhiqiza, i-FDA ilindele ukutshelwa futhi ilindele ukuthi umenzi akhumbule imithi eminingi yokugoma ethintekile uma kunesidingo. Ngikunikeze ulwazi lokukhumbula imigomo emi-5 noma ezinye izinkinga e-Canada kusukela ngo-2012.
https://healthycanadians.gc.ca/recall-alert-rappel-avis/hc-sc/2018/66674a-eng.php
https://www.healthycanadians.gc.ca/recall-alert-rappel-avis/hc-sc/2012/15083a-eng.php
https://www.healthycanadians.gc.ca/recall-alert-rappel-avis/hc-sc/2012/15001a-eng.php
https://www.healthycanadians.gc.ca/recall-alert-rappel-avis/hc-sc/2012/15834a-eng.php
https://www.healthycanadians.gc.ca/recall-alert-rappel-avis/hc-sc/2012/15096a-eng.php
Ikhwalithi yokukhiqizwa izidakamizwa ibilokhu incipha. Izidakamizwa ezingaphezu kuka-80% ezithengiswa e-US zikhiqizwa phesheya kwezilwandle, ikakhulukazi eNdiya naseChina.
I-FDA ivamise ukuhlela kabusha ulwazi mayelana nezindawo lapho kukhiqizwa khona izithako zokugoma. Nginomuzwa wokuthi okwamanje, imikhiqizo yokugoma yase-US yenziwa eYurophu naseNyakatho Melika.
Kodwa-ke, i-World Health Organization inohlelo lokugunyaza (noma โukufanelekaโ) imithi yokugoma eyenziwa emazweni angathuthukile ukuze ithengiswe emazweni ngamazweโ ngokujwayelekile kwamanye amazwe angathuthukile.
Izinkampani ezinkulu zemithi yamazwe ngamazwe, njenge-Sanofi, enezindawo zokukhiqiza imithi yokugoma kokubili eNdiya futhi China, akhiqiza imithi yokugoma emazweni angathuthukile. I-China ne-India inabakhiqizi bemithi yokugoma abangaphezu kwama-20. Cishe kuyindaba yesikhathi kuphela ngaphambi kokuba imithi yokugoma ekhiqizwa emazweni aziwa ngokungaqapheli ngokwanele kukahulumeni kwemithi isetshenziswe e-Canada nase-US.
I-China yathola umuthi wokugoma ama-scandals ngo-2016 futhi ngo-2018:
NgoJulayi, iChina yabhekana โnenhlekelele embi kakhulu yezempilo yomphakathi eminyakeni edluleโ njengoba kwasho yiSouth China Morning Post. Umkhiqizi wokugoma waseShayina i-Changsheng Biotechnology itholwe inerekhodi lokukhiqiza nokuhlola futhi yashintsha ngokungafanele imingcele yenqubo kanye nezinto zokusebenza phakathi nokukhiqizwa kwayo kwemithi yokugomela amarabi enziwe iqhwa. Ngaphezu kwalokho, imigomo esezingeni eliphansi ye-diphtheria, pertussis, kanye ne-tetanus (DPT) ekhiqizwe yi-Changsheng Biotechnology yanikezwa izingane zaseShayina ezingu-215,184; kanye nemithi yokugomela ye-DPT esezingeni eliphansi engu-400,520 ekhiqizwe yi-Wuhan Institute of Biological Products ithengiswe e-Hebei naseChongqing. NgoJulayi 25, umlawuli wezidakamizwa waseChina wethule uphenyo kubo bonke abakhiqizi bemithi yokugoma ezweni lonke. Abantu abayishumi nanhlanu baseChangsheng Biotechnology, okuhlanganisa nosihlalo, baboshwe yiziphathimandla zaseChina.
Lesi sihlava sakamuva sokugoma silandela ochungechungeni lwezinkinga zokudla nezidakamizwa mbumbulu nezisezingeni eliphansi e-China. Ngenxa yalokho, abazali abaningi baye baphelelwa ukholo ohlelweni lokugoma.โ
- Umkhuhlane, kanye I-Fluadukugoma
I-Influenza yisifo esihlasela i-3-20% yabantu ngonyaka. Kade bengu Bangu-6515 ababike ukufa komkhuhlane e-US ngo-2017, phakathi nokugqashuka okubi kakhulu kweshumi leminyaka. I-CDC isebenzisa amamodeli ezibalo ukuze linganisela ukufa komkhuhlane, futhi izilinganiso zihlanganisa ukufa okuvela kwezinye izimo zenhliziyo namaphaphu, kubantu ababenomkhuhlane. Lezi zilinganiso ngokuvamile zisukela ekufeni kwabantu abangu-30-50,000 ngonyaka, okuhlobene nomkhuhlane. Amaphesenti angamashumi ayisishiyagalolunye okufa komkhuhlane kwenzeka kulabo abangaphezu kweminyaka engama-65. Ngenkathi iningi labantu abaneminyaka engaphezu kwengama-65 lithola imigomo yaminyaka yonke yomkhuhlane e-US, leli qembu lobudala mancane amathuba okuthi lithuthuke ekugomeni, uma liqhathaniswa nabantu abasha. Sekukonke, umuthi wokugomela umkhuhlane ukusebenza okumaphakathi okungaba ngu-40%, Ngokwe-CDC.
Unyaka ngamunye, imithi yokugomela umkhuhlane isanda kwenziwa ukuthi iqukathe izinhlobo ezivelele ezibikezelwe ngaleyo sizini. Ngenxa yesidingo sokwenza imikhiqizo ehlukene unyaka ngamunye, futhi kwenziwe ukuthi itholakale ngokushesha ngesikhathi somkhuhlane ngamunye, ayihlolwa ngezinga elifanayo neminye imithi yokugoma. Izivivinyo zemitholampilo zokuhlola ukuphepha azidingeki ezinguqukweni zaminyaka yonke zemithi yokugomela umkhuhlane. Izilingo ezisebenzayo azinakwenzeka ngaphambi kokusetshenziswa ngobuningi. Imithi yokugomela umkhuhlane yaminyaka yonke โifakwe kukhokho,โ nakuba ihlolwa ukuthi ayinamaphutha yini.
Ngo 2009, umuthi wokugomela i-GSK womkhuhlane wobhubhane ubangele izehlakalo eziyi-1300 ze-narcolepsy eYurophu, ikakhulukazi entsheni nasebancane abadala. I-European Medicines Agency yehlulekile ukuxwayisa umphakathi ngale nkinga ngesikhathi esifanele, okuholela ekusetshenzisweni isikhathi eside komgomo oyinkinga.
Izizathu okungenzeka ukuthi kwenzeke lokhu zihlanganisa umnyango ojikelezayo phakathi kwabakhiqizi bemithi yokugoma nabalawuli, ukuhlolwa okufushanisiwe kokuphepha kwemithi yokugomela umkhuhlane, kanye nokuvikelwa kwesibopho esinikezwa abakhiqizi ngohulumeni. Isiqephu sinikeza isexwayiso sokuthi okubalulekile kuqala kwabalawuli kungase kungabi yinhlalakahle yomphakathi ngaso sonke isikhathi.
The Ukusabela kwabadala emithini yokugomela umkhuhlane kubi kakhulu. Kuzanywa amasu amabili okuthuthukisa ukungatheleleki komgomo kuleli qembu lobudala. Owokuqala ubandakanya ukusebenzisa ukugxila okuphezulu kwama-antigen emithini yokugoma. Okwesibili kuhilela ukusebenzisa ama-adjuvants anoveli, okuyizinto ezinikeza ukuvuselela okukhulayo kumasosha omzimba. Ngokunokwenzeka lokhu kungathuthukisa ukungatheleleki, kepha kungandisa ukuvuvukala kanye nezifo ze-autoimmune.
The I-Fluad umgomo ukuphela komgomo womkhuhlane e-Canada nase-US oqukethe inoveli, i-immune-boosting adjuvant. I-adjuvant ibizwa nge-MF59 C1. Ikhiqizwe yinkampani yase-Italy ekuqaleni, umuthi wokugomela umkhuhlane oqukethe i-adjuvant wawunikezwe ilayisense labadala kuphela, e-Italy, ngo-1997. Awuzange unikezwe ilayisense e-US kuze kube ngu-2015, kubadala kuphela, mhlawumbe ngenxa yokuthi babengenakubhekana nezinkinga ezivela e-US. ukuvuselela amasosha omzimba okwengeziwe. Angikwazanga ukuthola izincwadi ezingachemile ku-MF59 adjuvant noma i- I-Fluad umgomo, njengoba lonke ucwaningo luxhaswe abakhiqizi balo (uSclavo, kwase kuba uChiron, kwase kuba nguNovartis, manje osesequirus).
UFluad unikezwe ilayisensi yabadala eCanada ngo-2011 Iphepha leqiniso likahulumeni wase-Ontario emgomeni ikwenza kucace ukuthi ngo-2016 bekungakaziwa ukuthi ukugqugquzelwa komzimba okweqile kunikeza isivikelo esithuthukisiwe kumkhuhlane:
"Uhamba kahle kanjani I-Fluadยฎ umgomo uvikela umkhuhlane? Imithi yokugomela umkhuhlane may kunciphisa ukulaliswa kanye nokufa kwabantu abadala. Ngokusho kwe-monograph yomkhiqizo, I-Fluadยฎ ikhiqiza ukusabela okuphezulu kokuzivikela komzimba kubantu asebekhulile uma iqhathaniswa neminye imigomo yomkhuhlane ngaphandle kwe-adjuvant. Ukusabela okuphezulu kokuzivikela komzimba kungase kubonise lokho I-Fluadยฎ isebenza kangcono kunemithi yokugoma enganakiwe, nakuba lokhu kungaziwa ngokuqinisekile.โ
Futhi akwaziwa ukuthi uphephe kangakanani umgomo we-adjuvant. Ibanga ukusabela kwasendaweni okungaba ngu-15% ngaphezulu kunemithi yokugomela umkhuhlane ongahlosiwe, kodwa asazi ukuthi ingabe ubangela ukusabela okubi kakhulu, noma ukuqala kamuva, ukusabela okubi.
I-FluWatch ibika ukuthi izingane ezingu-10 zaseCanada zibulawe umkhuhlane ngesizini edlule, eziyi-8 ezineminyaka engu-2-4 ubudala. Izingane eziyisishiyagalolunye zashona ngesizini edlule. I-Canada kanye ne-US batusa imithi yokugomela umkhuhlane minyaka yonke kuzo zonke izingane ezifanelekile ezineminyaka engaphezu kwezinyanga eziyisi-6, kuyilapho iningi laseYurophu likwenza. hhayi batusa umuthi wokugomela umkhuhlane ezinganeni ezinempilo. Izingane ezincane kakhulu zikhiqiza ukusabela okungekuhle kwamasosha omzimba emithini yamanje yokugomela umkhuhlane. Kodwa bambalwa ababulawa yilesi sifo.
IKomidi Likazwelonke Lokweluleka laseCanada Lezokugoma labuyekeza izincwadi eziphathelene nokusetshenziswa kwe I-Fluad, imigomo ye-MF59-adjuvanted kumasana nasezinganeni ezincane ngo-2015. Kusukela ku-Executive Summary yombiko wabo:
โUkusabela okunamandla akuvamile, kodwa izifundo ezimbalwa ezibuyekeziwe bezincane kakhulu ukuthi zingahlonza izehlakalo ezimbi kakhulu kodwa ezingavamile. Ikakhulukazi, ulwazi lokuphepha lukhawulelwe ku-ATIV (imithi yokugomela i-adjuvanted trivalent influenza) ezinganeni ezine-immunodeficiencies nezinye izifo ezingamahlalakhona...
Kukhona idatha eyanele yokuhlola ukuthi ingabe i-ATIV (umuthi wokugomela umkhuhlane) iyasebenza kakhulu kune-UTIV (umuthi wokugomela umkhuhlane ongenadjuvanted) noma i-LAIV (umuthi wokugomela umkhuhlane onciphile) ekusebenzeni noma ukwenza ukuhlaziya ukwaziswa kwenzuzo yengcuphe.โ
Ababuyekezi baphinde baphawula ukuthi i-European Medicines Agency (EMA) yehlulekile ukunikeza ilayisense lomgomo wezingane zase-Europe ngo-2012. Umbiko we-EMA ithole inani lezinkinga ngohlolo olulodwa olubalulekile lomtholampilo lwe I-Fluad ezinganeni. Ngaphezu kwalokho, umbiko we-EMA uthi, "Uhlelo lokusebenza lwamanje, nakuba luhlobene nomkhiqizo owasungulwa eminyakeni engaphezu kwengu-15 edlule futhi wagunyazwa ukusetshenziswa kwabadala, luhlanganisa ucwaningo olulodwa kuphela olukhuluma ngokusebenza komgomo womtholampilo." Umbiko uyaphetha, โIbhalansi yobungozi benzuzo iyonke ye I-Fluad Pediatric inegetive.โ
Naphezu a) ukuntuleka kobufakazi benzuzo, b) ulwazi olulinganiselwe kanye c) nolwazi lokuphepha olungathembekile, d) ukwenqatshwa eYurophu, futhi e) abukho ubufakazi banoma yiliphi elinye izwe elilusebenzisela izingane, f) ingasaphathwa eyokusetshenziswa ezinganeni-ngo-2015 I-Public Health Agency of Canada (PHAC) inelayisensi I-fluid yezingane ukuze isetshenziswe ezinsaneni nasezinsaneni ezineminyaka engu-6 kuya eminyakeni emi-2.
Kubonakala sengathi izingane ezincane zaseCanada ziye zakhethwa ukuba zibe izingulube ezingaqaphile ocwaningweni olukhulu lokuvuselela amasosha omzimba walo mgomo wenoveli osetshenziswayo.
Yayicabangani i-PHAC? Ingabe izingane zaseCanada zizosebenza njengezifundo zokuhlolwa, ngaphandle kolwazi lwabazali bazo, emithini yokugoma eyengeziwe ezikhethelwe zona isikhungo sezempilo somphakathi?
Uma ukukhululwa ekugomeni kususwa, kungavikelwa kanjani ezikhulwini zezempilo zomphakathi ukwethembeka kwakhe okuyinhloko kungase kungabi emphakathini?
Izikhulu zezempilo zomphakathi zisebenzisa imithombo yezindaba, ochwepheshe bezokwelapha kanye nezinyathelo zikahulumeni ukukhuthaza, ukukhuthaza nokugoma nge-cajole. Ukuziphatha kwabo ne I-fluid yezingane umuthi wokugoma ukhombisile ukuthi akumele banikezwe amandla okuphoqa.
I-ZNetwork ixhaswa kuphela ngokuphana kwabafundi bayo.
Nikela