Coronavirus vaccines may not work in some people. It’s because of their underlying conditions.

冠狀病毒疫苗可能對某些人不起作用。因為他們有潛在的疾病。

Early research shows that 15 to 80 percent of people with certain medical conditions, such as specific blood cancers or organ transplants, are generating few antibodies after receiving coronavirus vaccines.

早期研究表明，15%到80%患有某些疾病的人，比如特定的血癌或器官移植，在接受冠狀病毒疫苗后產生的抗體很少。
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By Ariana Eunjung Cha
May 18, 2021 at 8:00 p.m. GMT+8
Maria Hoffman feels as though she has been left behind. Her adopted hometown of Charleston, S.C., is hopping — with restaurants and bars fully open, park concerts in full swing and maskless friends reuniting with hugs on streets.

瑪麗亞·霍夫曼覺得自己好像被留下了。她定居的家鄉(xiāng)南卡羅來納州查爾斯頓（Charleston，S.C.）正在跳動——餐館和酒吧已全面開放，公園音樂會如火如荼地舉行，沒戴口罩的朋友們在街上擁抱團聚。

Hoffman, 39, is fully vaccinated and eager to rejoin the world. But as a kidney transplant patient, she is hesitant to participate for fear of becoming infected. “Risk is very different for people in my situation,” she said. “I am 100 percent acting like I am not immunized.”

39歲的霍夫曼已經接種了疫苗，渴望重返世界。但作為一名腎移植患者，她不敢參與，因為害怕被感染?！皩τ谖以谶@種情況下，風險是完全不同的，”她說我百分之百表現得好像我沒有接種疫苗。”

The state worker is among millions of immunocompromised Americans, about 3 to 4 percent of the U.S. population, for whom the shots may not work fully, or at all, and who are unsure of their place in a country that is increasingly opening up. Emerging research shows that 15 to 80 percent of those with certain conditions, such as specific blood cancers or who have had organ transplants, are generating few antibodies.

這名國家工作人員是數百萬免疫功能低下的美國人中的一員，約占美國人口的3%至4%，對他們來說，注射可能無法完全奏效，或者根本無法奏效，他們不確定自己在一個日益開放的國家中的位置。新的研究表明，15%到80%的患有某些疾病的人，比如特定的血癌或接受過器官移植的人，產生的抗體很少。

Federal health officials’ decision last week to rescind almost all masking and distancing recommendations for those who are fully vaccinated only added to the sense of fear, isolation and confusion for those with immune issues. On Twitter and other social media platforms, many such patients expressed frustration that the change might leave them with less — not more — freedom as their risk of infection grows as more of their neighbors and co-workers ditch their masks.

聯邦衛(wèi)生官員上周決定撤銷針對那些完全接種疫苗的人的口罩和距離建議，這會增加那些有免疫問題的人的恐懼感、孤立感和困惑感。在Twitter和其他社交媒體平臺上，許多這樣的患者表示沮喪，因為隨著越來越多的鄰居和同事扔掉口罩，他們感染的風險越來越大，這種改變可能會讓他們的自由更少，而不是更多。

Hoffman, who has been advised by her doctors to act as though she never got the shots, recounted how she visited a grocery store Thursday but became anxious and left after a maskless man struck up a conversation.

醫(yī)生建議霍夫曼要像從來沒有打過針似的生活。霍夫曼講述了她星期四去一家雜貨店，但在一個沒戴口罩的男人搭話后，她感到焦慮，于是離開了。

“I wear my mask out of respect for others, and for those who are sick,” she said. “If you aren’t wearing a mask, we can’t make you now.”

她說：“我戴口罩是為了尊重別人，也為了那些生病的人?！比绻銢]有戴口罩，我們不能強迫你?！?/b>

Vaccine makers excluded immunocompromised people from their clinical trials in an understandable rush to develop a way to protect as many people as quickly as possible. As a result, there’s limited information about how this group is reacting to the shots, as well as to the loosening of Centers for Disease Control and Prevention restrictions.

疫苗生產商將免疫功能低下的人排除在臨床試驗之外，這是可以理解的，他們急于開發(fā)一種能夠盡快保護盡可能多的人的方法。因此，關于這一群體對疫苗注射以及疾病控制和預防中心放寬限制的反應的信息有限。

The ability of such patients to fend off the novel coronavirus is not just a footnote in the pandemic involving one unlucky group — but potentially a critical part of the narrative about how new, more contagious variants are continuing to emerge worldwide.

這類患者抵御新型冠狀病毒的能力不僅是涉及一個不幸群體的大流行中的一個注腳，而且可能是敘述新的、更具傳染性的變種如何在世界范圍內繼續(xù)出現的一個關鍵部分。
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The interaction between immunocompromised people and the virus is perhaps one of the pandemic’s most fraught questions. Case studies have detailed how some patients can have active infections for many months — resulting in questions about whether they can act as incubators for mutations that lead to new variants and underscoring the need for an effective vaccine strategy not just for their sake, but for the greater good.

免疫功能低下的人和病毒之間的相互作用可能是大流行中最令人擔憂的問題之一。案例研究詳細說明了一些患者如何在數月內發(fā)生活動性感染，由此產生了一個問題，即他們是否可以充當導致新變異的突變的孵化器，并強調需要一種有效的疫苗策略，不僅是為了他們，而且是為了更大的利益。

CDC Director Rochelle Walensky and White House adviser Anthony S. Fauci highlighted the challenges of such patients and the vaccines in a recent news briefing in which they acknowledged that the first documented case of the so-called New York variant, B. 1.526, was found in a patient with advanced AIDS.

疾病控制中心主任羅謝爾瓦倫斯基和白宮顧問安東尼S。Fauci在最近的一次新聞簡報中強調了這類患者和疫苗面臨的挑戰(zhàn)，他們在簡報中承認，第一例有記載的所謂紐約變種B。1.526，在一名晚期艾滋病患者中發(fā)現。

“Early studies actually show that these variants could emerge in a single host — in a single immunocompromised host,” Walensky said.

沃倫斯基說：“早期的研究實際上表明，這些變異可能出現在一個單一的宿主身上——在一個免疫功能低下的宿主身上。”。
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But neither the federal government nor vaccine makers Pfizer-BioNTech and Moderna has stepped up to do a comprehensive study about whether the vaccines protect people with immune issues. As such, most of the research has been conducted piecemeal in academic centers — and many are reaching differing, sometimes conflicting, conclusions.

但無論是聯邦政府還是疫苗制造商輝瑞生物科技公司（Pfizer BioNTech）和摩德納公司（Moderna）都沒有加緊對疫苗是否能保護有免疫問題的人進行全面研究。因此，大多數研究都是在學術中心零零碎碎地進行的——許多研究得出了不同的、有時相互矛盾的結論。

Early data suggests that the vaccines offer some protection, although perhaps to a lesser degree, for most patients with HIV and autoimmune conditions such as rheumatoid arthritis. But there’s worry about people with blood cancers and transplant recipients. Some of the weakened response appears to be related to certain immunosuppressive drugs, and potentially a commonly prescribed steroid.

早期的數據表明，疫苗對大多數艾滋病患者和類風濕性關節(jié)炎等自身免疫性疾病有一定的保護作用，盡管保護程度可能較低。但是有人擔心血癌患者和移植受者。一些減弱的反應似乎與某些免疫抑制藥物有關，也可能與常用的類固醇有關。

“The overwhelming majority of transplant patients, even after a second dose of the vaccine, appear to have suboptimal protection — if any protection — from the vaccine, which is frightening, disappointing and a bit surprising,” said Dorry Segev, a researcher at the Johns Hopkins University School of Medicine.

約翰·霍普金斯大學醫(yī)學院研究員多里·塞格夫說：“絕大多數移植患者，即使接種了第二劑疫苗，對疫苗的保護（如果有保護的話）似乎也不理想，這是令人恐懼、失望和有點驚訝的?！薄?/b>

For most of the pandemic, Segev said, it was rare to see transplant recipients get sick with covid-19, the disease caused by the coronavirus, because they had been so careful about staying at home. But that changed over the past two months, with newly infected patients now coming in at a pace of nearly one each day, he said.

塞格夫說，在大流行的大部分時間里，很少看到移植受者感染冠狀病毒引起的covid-19，因為他們一直非常小心地呆在家里。但在過去的兩個月里，情況發(fā)生了變化，新感染的病人現在幾乎每天都有一個。

Many tell the same story: After being fully vaccinated, they had finally ventured out for a meal, reunited with family members or otherwise relaxed their social distancing precautions.

許多人講述了同樣的故事：在接種完疫苗后，他們終于冒險出去吃飯，與家人團聚，或者以其他方式放松社交距離的預防措施。

“We expected a slightly blunted effect,” Segev said, “not something this stark.”

“我們預計會有一點減弱的影響，”塞格夫說，“不會有這么明顯的影響?！?/b>

The good news, he and other researchers say, is that scientists are prepared with some potential solutions, such as boosters or high-dose shots. They just need to scramble to study them so they can offer them as soon as possible.

他和其他研究人員說，好消息是，科學家們已經準備好了一些可能的解決方案，比如助推器或高劑量注射。他們只需要迅速地研究它們，以便盡快提供它們。

Immune mystery

免疫之謎

The body’s immune system can be a capricious thing.

人體的免疫系統(tǒng)可能是一個反復無常的東西。

It can serve as a defensive shield one minute, and then shift into overdrive the next and attack itself. Many scientists believe that figuring out the puzzle of how the different components work together and how to control them is one of the holy grails of medicine that could lead to cures for many of the ills that plague humanity.

它可以在前一分鐘充當防御盾牌，然后在下一分鐘轉換到超速檔并攻擊自己。許多科學家認為，找出不同成分如何協(xié)同工作以及如何控制它們的謎團，是能夠治愈許多困擾人類的疾病的醫(yī)學圣杯之一。

But compared with, say, the heart, researchers’ understanding of the immune system is still limited. They’ve long known, for example, that vaccines work better in some people than others but they are still trying to figure out why.

但與心臟相比，研究人員對免疫系統(tǒng)的了解仍然有限。例如，他們早就知道疫苗在某些人身上比在其他人身上效果更好，但他們仍在試圖找出原因。

From studying other vaccines, for instance, they know that age and underlying conditions can be factors. People older than 65 have been shown to produce 50 to 75 percent fewer antibodies in response to flu shots than their younger counterparts, which is why manufacturers produce a high-dose version for them. HIV patients often receive three hepatitis B shots, instead of two.

例如，通過對其他疫苗的研究，他們知道年齡和潛在條件可能是一個因素。研究表明，65歲以上的人注射流感疫苗后產生的抗體比年輕人少50%到75%，這就是為什么制造商為他們生產高劑量疫苗的原因。艾滋病患者通常接受三次乙肝疫苗注射，而不是兩次。

Given this knowledge, some differences in the coronavirus vaccine response of immunocompromised people were expected.

鑒于這一知識，免疫功能低下人群的冠狀病毒疫苗反應可能存在一些差異。

Most of the work has looked at only one facet of the immune response — the creation of antibodies, which are simple to measure with a blood test. Studies have mostly focused on the mRNA vaccines made by Pfizer-BioNTech and Moderna because they are most widely used.

大部分工作只關注了免疫反應的一個方面——抗體的產生，這很容易用血液測試來衡量。研究主要集中在輝瑞生物科技公司（Pfizer BioNTech）和Moderna公司生產的mRNA疫苗上，因為它們的應用最為廣泛。
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At the University of California at San Francisco, Monica Gandhi and her colleagues found that HIV patients seem to produce fewer antibodies on average, but she is optimistic that the amount is sufficient to protect most people.

在加州大學舊金山分校，莫妮卡·甘地和她的同事發(fā)現，艾滋病患者平均產生的抗體似乎較少，但她樂觀地認為，這一數量足以保護大多數人。

She said one recent study showed that another arm of the immune system — T cells, or the white blood cells that fight infection — appear to respond to the vaccines similarly in both HIV patients and those without the disease.

她說，最近的一項研究表明，免疫系統(tǒng)的另一個分支——T細胞，或抗感染的白細胞——對艾滋病患者和無艾滋病患者的疫苗反應相似。

“With the antibody response being blunted, but the T-cell response not, it may mean more susceptibility to mild infection, but not likely severe disease,” she said.

她說：“抗體反應減弱，但T細胞反應沒有減弱，這可能意味著更容易受到輕度感染，但不太可能是嚴重疾病?！?。

Gandhi said that although more research is needed, the strong T-cell response may reflect how many people with HIV in the United States are quite healthy because they are treated with retroviral drugs. She said the situation may be different in Africa and other parts of the world for those not on treatment. She said she gave one of her vaccinated patients who had zero antibody response an extra dose of the Johnson & Johnson coronavirus vaccine.

甘地說，盡管還需要更多的研究，但強大的T細胞反應可能反映出美國有多少艾滋病毒感染者相當健康，因為他們接受了逆轉錄病毒藥物治療。她說，對于那些沒有接受治療的人來說，非洲和世界其他地區(qū)的情況可能不同。她說，她給一個抗體反應為零的接種過疫苗的病人額外注射了強生冠狀病毒疫苗。

For most of her patients, however, she said she has “no concerns yet.”

然而，對于她的大多數病人，她說她“還沒有擔心”

“We are a very tightknit HIV community. We all talk, and would know if we were seeing a lot of breakthrough infections,” she said. “But fortunately we are not.”

“我們是一個非常緊密的艾滋病社區(qū)。她說：“我們都在交談，如果有很多爆發(fā)性的感染，我們會知道。”但幸運的是我們沒有?！?/b>

‘Disheartening’

'令人沮喪'

The results have been more disappointing for some other types of immunocompromised patients.

對于其他類型的免疫功能低下患者來說，結果更令人失望。
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Mounzer Agha, a hematologist at the University of Pittsburgh Medical Center and lead author of a study on blood cancers and the vaccines posted online before peer review, described how crushed he felt when he saw the low antibody results for nearly half of the 67 patients his group tracked.

匹茲堡大學醫(yī)學中心的血液學專家、同行評議前在網上發(fā)布的一項關于血癌和疫苗的研究的主要作者Mounzer Agha描述了當他看到他的小組跟蹤的67名患者中近一半的抗體水平低下時，他是多么的沮喪。

Patients on treatments that impact B-cell function appeared to have the weakest results. That made sense to him because B cells produce antibodies.

接受影響B(tài)細胞功能治療的患者似乎效果最差。這對他來說是有意義的，因為B細胞產生抗體。

But the data also contained what he called an “unwelcome surprise”: Patients with a condition known as chronic lymphocytic leukemia had a very weak response even if they were not undergoing treatment. The condition, which affects the blood and bone marrow, can sometimes be asymptomatic.

但這些數據也包含了他所謂的“不受歡迎的驚喜”：患有慢性淋巴細胞白血病的患者即使沒有接受治療，反應也非常微弱。這種影響血液和骨髓的疾病有時是無癥狀的。

“When I found patients who had never received therapy still did not respond to the vaccine, that was very disheartening,” he said. “Now what are you going to do for these individuals?”

他說：“當我發(fā)現從未接受過治療的病人仍然對疫苗沒有反應時，這是非常令人沮喪的。”現在你要為這些人做些什么？”

Agha said his clinic has been scrambling to reassess care plans in the context of the pandemic. Some patients who are more stable are taking cancer treatment “holidays” while they get the vaccine; others have opted to forgo the shots.

阿加說，他的診所一直在迅速地重新評估大流行背景下的護理計劃。一些病情較穩(wěn)定的患者在接種疫苗的同時正在“休假”接受癌癥治療；其他人則選擇放棄注射。

“The information has come out so recently that there are no clinical guidelines, and decisions have to be made on a case-by-case basis on the fly,” he said.

他說：“這些信息是最近才出來的，因此沒有臨床指南，必須在工作中根據具體情況作出決定?！?。
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Agha said he fears that for some patients, the vaccines may never work even at higher doses, and that they will have to rely on the inoculation of those around them for their safety.

阿加說，他擔心，對一些病人來說，疫苗可能永遠不會起作用，甚至在更高的劑量，他們將不得不依靠接種周圍的人，他們的安全。

“Everyone should get the vaccine for the sake of their loved ones,” he urged. “Everyone knows someone who has cancer. And if you care about that person, you should get the vaccine and tell your friends to get it.”

“為了親人，每個人都應該接種疫苗，”他敦促道每個人都知道有人得了癌癥。如果你關心那個人，你應該接種疫苗，并告訴你的朋友接種?！?/b>

As for transplant patients, the early data are also concerning: A May 5 study published in JAMA found that 46 percent of 658 transplant patients did not mount an antibody response after two doses of the Pfizer-BioNTech or Moderna vaccines.

至于移植患者，早期的數據也涉及到：5月5日發(fā)表在JAMA的一項研究發(fā)現，658名移植患者中，46%的患者在兩劑輝瑞B(yǎng)ioNTech或Moderna疫苗后沒有產生抗體反應。

“Although this study demonstrates an improvement in … antibody responses in transplant recipients after dose two … these data suggest that a substantial proportion of transplant recipients likely remain at risk for covid-19 after 2 doses of mRNA vaccine,” the researchers wrote. They think this lack of reaction is probably a result of the immunosuppressive drugs they take.

研究人員寫道：“盡管這項研究表明，第二劑后，移植受者的抗體反應有所改善……但這些數據表明，相當一部分移植受者可能在第二劑mRNA疫苗后仍有感染covid-19的風險。”。他們認為這種缺乏反應可能是他們服用免疫抑制藥物的結果。

Segev, a co-author, said that although antibody reaction is only part of the picture, “knowing what we know about immunosuppression, I would be surprised if transplant patients who had no antibody response had a robust T-cell response.”

合著者塞格夫說，雖然抗體反應只是其中的一部分，“了解我們對免疫抑制的了解，如果沒有抗體反應的移植患者有強大的T細胞反應，我會感到驚訝?！?/b>

“The irony of it all is transplant patients were being very, very careful,” he said, adding: “It’s a very scary problem.”

“諷刺的是，移植病人要非常非常小心，”他說，“這是一個非?？膳碌膯栴}。”
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In St. Louis, Washington University’s Alfred Kim said that although the majority of patients with autoimmune conditions who were studied are mounting a healthy antibody response, about 15 percent had very blunted or undetectable antibody responses. The participants in the study had a wide range of illnesses, including inflammatory bowel disease, systemic lupus and rheumatoid arthritis.

在圣路易斯，華盛頓大學的Alfred Kim說，盡管被研究的大多數患有自身免疫疾病的患者都出現了健康的抗體反應，但大約15%的患者的抗體反應非常遲鈍或無法檢測到。參與研究的人患有多種疾病，包括炎癥性腸病、系統(tǒng)性狼瘡和類風濕性關節(jié)炎。
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The original study, which has not yet been peer reviewed, was based on 133 people, but it has now grown to more than 300, with similar results.

最初的研究還沒有經過同行評審，是以133人為研究對象的，但現在已經發(fā)展到300多人，結果相似。

As with the blood cancer study, many of those most severely affected were on B-cell-depleting medications, such as rituximab, used to treat certain autoimmune diseases and cancer, or ocrelizumab, a newer drug for multiple sclerosis.

與血癌研究一樣，許多受影響最嚴重的患者服用了B細胞消耗藥物，如用于治療某些自身免疫性疾病和癌癥的利妥昔單抗，或用于治療多發(fā)性硬化癥的新型藥物奧列珠單抗。

Patients taking drugs for rheumatoid arthritis were likely to have a moderately reduced response.

服用類風濕性關節(jié)炎藥物的患者可能會有中度的緩解。

Kim, an assistant professor in the division of rheumatology, said one perplexing finding is that steroid use also appeared to diminish the vaccine response. Although he cautioned that only a small number of patients were involved, he said prednisone, which is used to treat such conditions as arthritis in adults and breathing difficulties in children, appeared to result in a tenfold reduction in antibody production, regardless of the dose given if administered around the time of the vaccine.

風濕病學系的助理教授Kim說，一個令人困惑的發(fā)現是類固醇的使用似乎也減少了疫苗的反應。盡管他提醒說，只有少數患者參與，但他說，用于治療成人關節(jié)炎和兒童呼吸困難等疾病的強的松似乎會導致抗體產生量減少10倍，而不管疫苗接種前后給藥的劑量是多少。

“Right now, we’re telling them to pretend they weren’t vaccinated,” Kim said. “That is the easiest solution but it’s only a short-term one. The step beyond is: What do we do to mitigate this?”

“現在，我們告訴他們要假裝沒有接種疫苗，”金說這是最簡單的解決辦法，但只是短期的。接下來的步驟是：我們該怎么做來緩解這種情況？”

Boosting immunity

增強免疫力

Numerous potential solutions for the immunocompromised are being debated. One simple idea is to provide one or more booster shots for those with weak responses. So an immunocompromised person might get three doses of the Pfizer-BioNTech or Moderna vaccine, instead of two.

免疫功能低下的許多潛在解決方案正在辯論中。一個簡單的想法是為那些反應較弱的人提供一個或多個助推器注射。所以一個免疫功能低下的人可能會得到三劑輝瑞生物技術或摩德納疫苗，而不是兩劑。

Another possibility is to try preventive doses of lab-produced antibody proteins known as monoclonal antibodies that until now have been mostly used as treatments for those who are infected with the coronavirus.

另一種可能性是嘗試預防劑量的實驗室產生的抗體蛋白，稱為單克隆抗體，迄今為止，這些抗體主要用于治療那些感染冠狀病毒的人。

One thing doctors don’t recommend is for vaccinated people to get antibody tests. First of all, no one knows what levels of antibodies are effective against the virus. Moreover, Kim emphasized that antibodies are only one part of the immune system and that it’s possible that the vaccines have activated other, more difficult-to-measure components.

醫(yī)生不推薦的一件事是讓接種疫苗的人接受抗體檢測。首先，沒有人知道抗體的水平對病毒有效。此外，金先生強調，抗體只是免疫系統(tǒng)的一部分，疫苗可能激活了其他更難測量的成分。

“It’s not something that we can act on,” he said of such information. “All it can do is mount worries for the patient.”

“我們無法采取行動，”他談到這些信息時說它所能做的就是為病人增加憂慮?！?/b>

Many physicians urge immunocompromised patients to continue to practice social distancing and take other precautions.

許多醫(yī)生敦促免疫受損的患者繼續(xù)進行社會隔離，并采取其他預防措施。

Seville Christian, 60, an HIV-positive substance abuse counselor in San Francisco, has been working in person through the pandemic and said she plans to continue to do so.

60歲的塞維利亞·克里斯蒂安是舊金山的艾滋病毒陽性藥物濫用顧問，在這場流行病期間她一個人工作，她說她計劃繼續(xù)這樣做。

But she said optional social outings will remain off the table. Even though she planned to get her second shot May 12, she will go to restaurants only for takeout, meet friends virtually and minimize her time in stores until the science is clearer.

但她說，社交活動會繼續(xù)停止。盡管她計劃5月12日打第二針疫苗，但她還是會去餐館買外賣，盡量減少和朋友見面以及呆在商店里的時間，直到研究更清楚為止。

She’s still weighing whether return to her to church, fully masked, when it reopens.

她也考慮是否回到教堂，戴著口罩，當它重新開放的時候。

“I wish I could go back to normal, but there are still a lot of questions I have,” Christian said.

“我希望我能回到正常的狀態(tài)，但我還有很多問題，”Christian說。

Hoffman, too, is struggling to navigate the new normal in Charleston. After having a kidney transplant at age 9 and spending most of her childhood in hospitals, she is acutely aware of her mortality. So she said she tries to find the right balance between living her life and staying safe.

霍夫曼也在努力適應在查爾斯頓的新常態(tài)。在9歲接受腎臟移植，并將大部分童年都花在醫(yī)院后，她敏銳地意識到自己的死亡命運。所以她說她試圖在生活和安全之間找到正確的平衡。

When a friend gets married in Ohio in a few weeks, she hopes to go and participate in the outdoor events. She is also talking to friends about reserving a socially distant spot for an outdoor band performance. But otherwise, she’s continuing to keep her distance from others.

當一個朋友會在俄亥俄州數周后結婚，她希望出去并參加這個戶外活動。她還和朋友們談論，為了看戶外樂隊表演預留一個社交距離較遠的地點。否則，她將繼續(xù)保持與他人的距離。

“I just love talking to people and meeting people,” she said. “It has been crazy and lonely.”

“我只是喜歡與人交談以及認識別人?！彼f，“這是瘋狂和孤獨。”