在乌拉圭接种疫苗期间失去对大流行的控制

Juan Martín Marqués
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摘要

在疫苗接种期间没有严格执行封锁,疫苗接种率接近每天人口的1%的国家,在实施疫苗接种计划时,观察到病毒传播失去控制或倍增效应。特别是,在乌拉圭,2021年3月至6月期间,疫苗接种率与每天观察到的SARS-CoV-2阳性病例数之间存在明显联系。疫苗接种率在白天出现高峰后,阳性病例出现高峰,并有8天的滞后。通常,10%至20%未检测到的阳性病例被认为是超级传播者,因为尽管症状轻微或没有症状,但病毒载量很高。这些超级传播者或未被发现的阳性病例造成了80%的病毒传播。我们获得的数据使我们能够定义一项队列研究,该研究针对2021年3月开始接种疫苗时连续5天接种疫苗的整个个体。在这个队列中,与预期相比,接种疫苗的个体中检测阳性病例减少了75%。我们有一些额外的数据表明,在疫苗接种率高的4个月里,这些数字保持不变。我们认为,这种减少是由于他们认为自己正在经历疫苗的副作用,没有接受测试,但实际上他们患有COVID。这些未经检测的阳性个体,占每天阳性病例的近5%,可能在不知不觉中成为超级传播者,与采用相同控制措施的未接种疫苗情况相比,接种疫苗期间感染的优势比增加了1.20倍至1.4倍。在此之前,乌拉圭被认为是世界上第一批在一年内不接种疫苗的情况下管理大流行病的国家之一,其卫生政策是“负责任的自由”。然而,在2021年疫苗接种率高的四个月期间,该国在采用相同政策的情况下表现出世界上最严重的疾病水平。
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Loss of control of the pandemic during vaccination in Uruguay
In countries where lockdown was not strictly enforced during vaccination and the vaccination rate was near 1% of the population per day, a loss of control or a multiplying effect in virus spread was observed when the vaccination program was implemented. Particularly, in Uruguay between March and June 2021, there was a clear link between the vaccination rate and the number of positive cases of SARS-CoV-2 observed each day. The peaks in the vaccination rate by day were followed by peaks in positive cases with an 8-day lag. Typically, 10% to 20% non-detected positive cases are considered superspreaders due to their high viral load despite experiencing mild or no symptoms. These superspreaders or undetected positive cases were responsible for 80% of the virus's spread. The data we got access to allow us to define a cohort study for whole individuals being vaccinated during 5 consecutive days during March 2021 when vaccination starts. In this cohort there was a 75% reduction in tested positive cases in vaccinated individuals compared to what was expected. We have some extra data that suggest these number were maintained during the 4 months with high vaccination rate. We propose that this reduction is due to individuals they thought they were experiencing side effects from the vaccine and were not tested, but in fact they had COVID. These non-tested positives individuals, representing nearly 5% of positive cases per day, may have unknowingly become superspreaders, increasing the odds ratio to be infected during vaccination by 1.20x to 1.4x compared to a non-vaccination situation with same control measures applied. Previously, Uruguay had been considered one of the first countries in the world in pandemic management for a year without vaccination, with a particular health politic: “responsible freedom”. However, during a period of four months with high vaccination rate in 2021, the country exhibited the worst levels of disease Worldwide, applying the same politic.
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