香港政府發板決定購置輝瑞及科興武肺病毒疫苗，林鄭月蛾及一眾首長斷言會率先注射，以身展示疫苗的安全性。1319Please respect copyright.ＰＥＮＡＮＡSOzlXyjoMn
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本文章將綜合中國武肺疫苗的現況、簡介疫苗的理念，引據各方科學證據及歷史前例，對文章命題作一簡略探討。1319Please respect copyright.ＰＥＮＡＮＡWZNyKBQhu4
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（圖1）圖中為中國Phase疫苗3臨床研究的地域分佈概覽。依據官方說法，疫苗研發之時乃為中國武肺感染人數貧乏之時，為了探討疫苗效用，中國唯有選址國外將第三期臨床實驗，其人數及地域已詳列在圖中。1319Please respect copyright.ＰＥＮＡＮＡtTcAQJ67h0
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中國現時進入Phase3臨床研究的疫苗公司共有3間，分別為國營CNBG、科興 Sinovac及康希諾Cansino。1319Please respect copyright.ＰＥＮＡＮＡB86GeOhwo8
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其中國營CNBG及科興 Sinovac生產的疫苗均為滅活病毒疫苗，而香港政府則已決定選購科興 Sinovac生產的滅活病毒疫苗，唯政府專家小組已公開向傳媒表明沒有提議政府選購中國疫苗。1319Please respect copyright.ＰＥＮＡＮＡVf9sroyadx
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除香港外，巴西政府在9月時份用上9千萬美金向科興 Sinovac購置4千6百萬枝滅活病毒疫苗，唯香港政府現時並沒有向外公開購置金額。1319Please respect copyright.ＰＥＮＡＮＡ4761akBig1
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（圖2）注射武肺疫苗的主要目的，就是誘導身體產生對抗武肺病毒的抗體。1319Please respect copyright.ＰＥＮＡＮＡBLnz6hv1FA
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疫苗主要功用有三，學界現時的研究相對上側重在第一點。1319Please respect copyright.ＰＥＮＡＮＡHlaAvDGXyM
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一：抗體能夠阻礙病毒進入人體細胞。1319Please respect copyright.ＰＥＮＡＮＡLTz64s4SFy
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二：抗體能夠標記病毒，1319Please respect copyright.ＰＥＮＡＮＡkA3mIn9iG0
指示其他免疫細胞前來消滅病毒。1319Please respect copyright.ＰＥＮＡＮＡZ53wXWHQK3
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三：某情況下，抗體更能夠指示免疫細胞殺滅已受病毒感染的細胞。1319Please respect copyright.ＰＥＮＡＮＡRrR9BQnjaj
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（圖3）用二分法來界定抗體種類的話，能夠阻礙病毒進入細胞的抗體，學界稱之為Neutralization Antibody。1319Please respect copyright.ＰＥＮＡＮＡ7Zqkj7XFkF
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不能夠阻礙病毒進入細胞的抗體，學界則稱之為Non-Neutralization Antibody。1319Please respect copyright.ＰＥＮＡＮＡYh1H43WsGo
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換句話說，抗體並不是越多就越好，要有足夠多數量的Neutralization Antibody才能達到防疫功效。1319Please respect copyright.ＰＥＮＡＮＡ5LRqdyeG8f
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（圖4）用上滅活病毒製作疫苗的話，人體產生的抗體會拼合在病毒不同位置之上。1319Please respect copyright.ＰＥＮＡＮＡKE7bmZ59dk
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若抗體並非拼合在S protein裡頭的關鍵位置上，產生的抗體有較大成數無法阻礙病毒進入細胞，亦即為Non-Neutralization Antibody。1319Please respect copyright.ＰＥＮＡＮＡ3SX3kefAJs
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相反，其他主流疫苗用上不同方式在人體內表達武肺S protein，人體產生的抗體主力針對S protein，較大成數為Neutralization Antibody。1319Please respect copyright.ＰＥＮＡＮＡ8bBg2Bl0AT
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（圖5）滅活病毒疫苗有較大成數會產生Non-Neutralization Antibody，那又如何呢?1319Please respect copyright.ＰＥＮＡＮＡe9dKZs8piW
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在1960年，美國利用滅活病毒製作人類呼吸道合胞病毒 (Respiratory syncytial virus)疫苗。1319Please respect copyright.ＰＥＮＡＮＡfQrXm3pmMJ
80%的兒童注射後出現嚴重呼吸症狀，2名兒童死亡。1319Please respect copyright.ＰＥＮＡＮＡ6yKGPWBEdg
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事後發現，滅活病毒所製作的疫苗所產生的Non-Neutralization Antibody數量對比Neutralization Antibody為多，因此出現名為ADE的症狀，引致注射疫苗的兒童比沒有注射的兒童更容易遭受病毒侵襲以及出現嚴症。1319Please respect copyright.ＰＥＮＡＮＡ2CxVa0YUZQ
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2016年，WHO世衛批准菲律賓為9歲以下的兒童注射以登革熱滅活病毒製作的Dengvaxia疫苗 ，認可其安全性。1319Please respect copyright.ＰＥＮＡＮＡPXZu12dddy
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奈何，2017年疫苗公司發現疫苗會產生名為ADE的症狀，亦即會導致注射疫苗的人士更容易染上登革熱或出現嚴症，下令立即停止注射。1319Please respect copyright.ＰＥＮＡＮＡacdvXAujVj
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那時候已有超過830,000兒童注射疫苗，震驚四方。1319Please respect copyright.ＰＥＮＡＮＡeUnVFhSbJk
2018年9月，「官方」數字為130兒童因注射疫苗而死亡，其中19人體內發現登革熱病毒，引證ADE的存在。1319Please respect copyright.ＰＥＮＡＮＡpPygxVJGZc
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既然擁有1960年ADE的先例，何解50年後菲律賓會再度出現ADE慘劇呢？1319Please respect copyright.ＰＥＮＡＮＡV1s03QtdHH
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其中之一的原因是，ADE無法在動物模型確實呈現，因此非常困難能夠預先作出探討。1319Please respect copyright.ＰＥＮＡＮＡXdnShKCr4u
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現時學界共識是，Neutralization Antibody :Non-Neutralization Antibody比例越高的話，1319Please respect copyright.ＰＥＮＡＮＡJDbfZ0cSMS
ADE產生的機率便越低。1319Please respect copyright.ＰＥＮＡＮＡ26RXYylI76
但非常遺憾的是，亦有個別例子Neutralization Antibody 會引發ADE症狀。1319Please respect copyright.ＰＥＮＡＮＡkLlHcOLUhZ
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會否出現ADE症狀，只有依靠觀察人體臨床研究的結果才能得知，1319Please respect copyright.ＰＥＮＡＮＡAaoW7Q8vj1
這亦是為何第一間踏入臨床第三期研究的Moderna其正式完整報告官方日期為2022年7月，到那時候才會有相對確實資料疫苗會否引起ADE症狀。1319Please respect copyright.ＰＥＮＡＮＡ44TO7VTMuZ
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現時Moderna/輝瑞Pfizer/牛津AstraZeneca的中期第三期報告，無一能夠對ADE的安全性作出探討。1319Please respect copyright.ＰＥＮＡＮＡKs4lXHf07p
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根據現時資料，最壞的ADE情況，將會是注射疫苗後的7-14日產生嚴重過敏免疫反應，肺部無法正常運作窒息而死。1319Please respect copyright.ＰＥＮＡＮＡRbLrBOzSXM
較好的ADE情況，將為注射疫苗後更大機會染上武漢肺炎。1319Please respect copyright.ＰＥＮＡＮＡ7eY0NXPUyY
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在此，讓我們祝褔林鄭及三萬警察在注射疫苗後會出現ADE症狀，亦懇求麵神祝褔林鄭注射疫苗後不會出現ADE症狀。1319Please respect copyright.ＰＥＮＡＮＡNpH1IvGm8w
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ADE症狀延伸閱讀:https://lihkg.com/thread/2161912/page/11319Please respect copyright.ＰＥＮＡＮＡcZDOx1rRqI
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如果想我快啲出文的話，請入去Penana網站科普專欄–薯不揀單俾一個like以及Bookmark，這對我非常之重要。1319Please respect copyright.ＰＥＮＡＮＡmq1lp8t5Xa
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Ref1:https://science.sciencemag.org/content/370/6522/12631319Please respect copyright.ＰＥＮＡＮＡdnVtiQTjVM
Ref2:https://www.nature.com/articles/nm0109-%20%20211319Please respect copyright.ＰＥＮＡＮＡx1vtEkHK1d
Ref3:https://jvi.asm.org/content/jvi/94/17/e01083-20.full.pdf1319Please respect copyright.ＰＥＮＡＮＡABURbUrHww
Ref4:https://www.thelancet.com/journals/laninf/article/PIIS1473-3099(20)30843-4/fulltext1319Please respect copyright.ＰＥＮＡＮＡoZreCHp1gd
Ref5:https://www.sciencemag.org/news/2019/04/dengue-vaccine-fiasco-leads-criminal-charges-researcher-philippines1319Please respect copyright.ＰＥＮＡＮＡ80IY5K13Tz
