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En Este Número Boletín Científico No. 21 (1-10 agosto/2021) EN ESTE NÚMERO VacCiencia es una publicación dirigida a Seguimiento de las variantes del investigadores y especialistas dedicados a SARS-CoV-2. la vacunología y temas afines, con el ob- Artículos científicos más recientes jetivo de serle útil. Usted puede realizar de Medline sobre vacunas. sugerencias sobre los contenidos y de es- Patentes más recientes en Pa- ta forma crear una retroalimentación tentscope sobre vacunas. que nos permita acercarnos más a sus Patentes más recientes en USPTO necesidades de información. sobre vacunas. 1| Copyright © 2020. Todos los derechos reservados | INSTITUTO FINLAY DE VACUNAS Boletín VacCiencia Seguimiento de las variantes del SARS-CoV-2 Todos los virus cambian con el paso del tiempo, y también lo hace el SARS-CoV-2, el virus causante de la COVID-19. La mayoría de los cambios tienen escaso o nulo efecto sobre las propiedades del virus. Sin embargo, algunos cambios pueden influir sobre algunas de ellas, como por ejemplo su facilidad de propagación, la gravedad de la enfermedad asociada o la eficacia de las vacunas, el tratamiento, los medios de diagnóstico u otras medidas de salud pública y social. La OMS, en colaboración con asociados, redes de expertos, autoridades nacionales, instituciones e investigadores, ha estado vigilando y evaluando la evolución del SARS‐CoV-2 desde enero de 2020. La aparición de variantes que suponían un mayor riesgo para la salud pública mundial, a finales de 2020, hizo que se empezaran a utilizar las categorías específicas de «variante de interés» (Variants of Interest, VOI) y «variante preocupante» (Variants of Concern, VOC), con el fin de priorizar el seguimiento y la investigación a escala mundial y, en última instancia, orientar la respuesta a la pandemia de COVID-19. Asi, se lleva a cabo un seguimiento de los cambios que experimenta el SARS-CoV-2 para que, en caso de que se detecten sustituciones significativas en aminoácidos, se pueda informar a los países y a la población acerca de las medidas que se deban adoptar a fin de reaccionar ante la variante y de prevenir su propagación. Denominación de las variantes del SARS-CoV-2 Los sistemas de nomenclatura establecidos para nombrar y rastrear los linajes genéticos del SARS-CoV-2 por GISAID, Nextstrain y Pango se siguen utilizando en círculos científicos y en la investigación científica. Para este caso la OMS ha recomendado el uso de denominaciones basadas en las letras del alfabeto griego, es decir, Alfa, Beta, Gamma, que serán más fáciles de usar y más prácticas para los debates del público no científico. 2 | Copyright © 2020. Todos los derechos reservados | INSTITUTO FINLAY DE VACUNAS Boletín VacCiencia VARIANTES DEL SARS-CoV-2 (existentes hasta el 6 de julio de 2021) Definición funcional de las variantes de interés (VOI) Las VOI son variantes del SARS-CoV-2 que: presentan cambios en el genoma que, según se ha demostrado o se prevé, afectan las características del virus como su transmisibilidad, la gravedad de la enfermedad que causa y su capacidad para escapar a la acción del sistema inmunitario, ser detectado por medios diagnósticos o ser atacado por medicamentos; y según se ha comprobado, dan lugar a una transmisión significativa en medio extrahospitalario o causan varios conglomerados de COVID-19 en distintos países, con una prevalencia relativa creciente y ocasionando números cada vez mayores de casos con el tiempo, o bien que presentan, aparentemente, otras características que indiquen que pueden entrañar un nuevo riesgo para la salud pública mundial. Tabla 1. Variantes de interés actuales (VOI) Dentro de las VOI destacan Épsilon y Lambda. Si se toma como referencia un reciente estudio elaborado por la University of Washington School of Medicine (Estados Unidos), la variante Épsilon cuenta con tres mutaciones en la proteína de pico que disminuyen la potencia neutralizadora de los anticuerpos generados a través de las vacunas y de las infecciones naturales. El estudio ha sido publicado en la revista Science y sus autores consideran que las mutaciones permiten a Épsilon evadir de forma total los anticuerpos monoclonales específicos y reducir la eficacia de los anticuerpos del plasma en las personas vacunadas. La variante Lambda es la responsable de la mayor parte de los nuevos contagios en Perú y ha generado una alta incidencia en Argentina y Chile. A pesar de que fue descubierta hace más de un año no ha sido hasta ahora cuando la OMS ha considerado que debía incluirse entre las VOI a vigilar. La evidencia científica con la que se cuenta hasta el momento sugiere que Lambda tendría una mayor capacidad para esquivar los anticuerpos que las variantes Alfa y Gamma. Han hallado ciertas similitudes de comportamiento con la variante Delta, pero no se ha encontrado evidencia concluyente de que Lambda sea capaz de evadir la respuesta inmunitaria mediada a través de las vacunas. El motivo por el que esta variante ha comenzado a ser vigilada de cerca por la OMS es su alta transmisibilidad. En menos de un año ha pasado de representar apenas el 1 % de los nuevos casos de COVID-19 en Perú a ser responsable de 3 | Copyright © 2020. Todos los derechos reservados | INSTITUTO FINLAY DE VACUNAS Boletín VacCiencia casi el 90 %. La detección de los primeros brotes provocados por Lambda en Europa, entre los que se encuentra uno localizado en Cantabria, han hecho que se refuercen los esfuerzos de vigilancia. Definición funcional de las variantes preocupantes (VOC) Las VOC son variantes del SARS-CoV-2 que cumplen con los criterios para ser definida como una VOI y en relación con la cual se ha demostrado, tras una evaluación comparativa, que está asociada a uno o más de los siguientes cambios en un grado que resulte significativo para la salud pública mundial: aumento de la transmisibilidad o cambio perjudicial en la epidemiología de la COVID-19; o aumento de la virulencia o cambio en la presentación clínica de la enfermedad; o disminución de la eficacia de las medidas sociales y de salud pública o de los medios de diagnóstico, las vacunas y los tratamientos disponibles. Tabla 2. Variantes preocupantes actuales (VOC) Variante Alfa: Identificada por primera vez en septiembre de 2020, la variante Alfa circula actualmente en 170 países. Es aproximadamente un 50% más transmisible que la cepa original del SARS-CoV-2 y, aunque ha habido informes contradictorios, parece que la variante Alfa puede causar una enfermedad más grave con mayor riesgo de mortalidad. Sin embargo, la variante Alfa es neutralizada por los anticuerpos monoclonales terapéuticos y los anticuerpos generados tras la vacunación o la recuperación de COVID-19, lo que sugiere que el riesgo de reinfección o de infección de entrada tras la vacunación es bajo. 4 | Copyright © 2020. Todos los derechos reservados | INSTITUTO FINLAY DE VACUNAS Boletín VacCiencia Variante Beta: La variante Beta fue la primera que se identificó en esta clase en mayo de 2020, y se le concedió la designación de estatus VOC en diciembre. Está asociada a una mayor transmisibilidad y se ha detectado en 119 países. Quizás lo más preocupante es que la variante Beta está asociada a una menor eficacia de la terapia con anticuerpos monoclonales y de la vacunación. También es posible la reinfección después de la COVID-19, ya que se reduce la neutralización por el suero de convalecencia. Variante Gamma: Existe un debate sobre si la variante Gamma está asociada a una mayor transmisibilidad. Sin embargo, la variante Gamma es capaz de evadir la neutralización por parte de los anticuerpos (terapias monoclonales y los inducidos por la infección por el SARS-CoV-2 o la vacunación), lo que aumenta el riesgo de reinfección y de infección por el virus. Variante Delta: La variante más reciente que se ha elevado a la categoría de variante preocupante es la variante Delta. Esta variante fue la responsable de la devastadora segunda oleada de la India y contribuyó a prolongar las restricciones de bloqueo a pesar de la vacunación generalizada en el Reino Unido, donde ya se ha vuelto dominante y representa el 90% de los casos nuevos. Debido a su mayor transmisibilidad y a la menor eficacia de los anticuerpos inducidos por la infección y la vacuna, se espera que se convierta en la cepa dominante a nivel mundial. Se estima que la variante delta es entre 30% y 60% más transmisible que otras variantes del coronavirus. La variante Delta se aisló por primera vez en octubre de 2020 en la India, ya se encuentra en más de 110 países de varias regiones geográficas y se espera que se imponga en el mundo en las próximas semanas. De igual forma, se asocia a más de un 90 por ciento de los casos de Reino Unido y Rusia, más del 20 en Francia y del 30 en Estados Unidos; de ahí que en junio de 2021 se declarara por la OMS como variante de preocupación, acotó Guzmán Tirado. Con respecto a la transmisibilidad, se considera la más contagiosa de todas, siendo un 64 por ciento más transmisible en relación a la Alfa que es entre un 40 y un 50 por ciento. Variantes del SARS-CoV-2 en Cuba La vigilancia genómica se lleva a cabo en nuestro país por un equipo de científicos de varias instituciones, organizado por el MINSAP y coordinado por el IPK, al que pertenecen los laboratorios de diagnóstico molecular del país, centros provinciales de Higiene y Epidemiología, la Universidad de las Ciencias Informáticas y las facultades de Matemática y Computación y de Biología de la Universidad de La Habana. También forman parte, el Instituto Finlay de Vacunas, los centros de Inmunología Molecular, de Ingeniería Genética y Biotecnología y de Investigaciones Científicas de la Defensa Civil.
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