ABSTRACT

Introduction

The world is currently fighting a COVID-19 pandemic, perhaps the most disruptive infectious disease outbreak since the 1918 Spanish influenza. Governments have taken drastic measures to curb the spread of SARS-CoV-2, and the development of safe and efficacious vaccine candidates is being accelerated. The possibility of vaccine-mediated disease enhancement with coronavirus vaccines has been flagged as a potential safety concern, and, despite the urgent need, should be thoroughly assessed as vaccines against SARS-CoV-2 are being tested.

Area covered

We review the in vivo evidence suggesting a theoretical risk of disease enhancement after vaccination with SARS-CoV and MERS-CoV vaccine candidates. We also identify knowledge gaps that need to be filled to maximize the chance of developing a safe vaccine and minimize the risk of encountering disease enhancement in vaccinated individuals after exposure to SARS-CoV-2.

Expert opinion

We compile and propose avenues to investigate the risk of vaccine-mediated disease enhancement both during pre-clinical and early clinical development. While the pressing need for a vaccine against COVID-19 (and future epidemic coronaviruses) cannot be ignored, we advocate to keep safety at the center of the debate. Protecting individuals with effective and safe vaccines should be a priority, even during extraordinary times like the COVID-19 pandemic.

中文翻译：

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SARS-CoV-2 疫苗接种和疾病增强 - 已知和未知。

 抽象的

 介绍

世界目前正在抗击新冠肺炎 (COVID-19) 大流行，这可能是自 1918 年西班牙流感以来最具破坏性的传染病爆发。各国政府已采取严厉措施遏制 SARS-CoV-2 的传播，并正在加速开发安全有效的候选疫苗。冠状病毒疫苗增强疫苗介导疾病的可能性已被标记为潜在的安全问题，尽管迫切需要，但应在针对 SARS-CoV-2 的疫苗进行测试时进行彻底评估。

 覆盖面积

我们回顾了体内证据，表明接种 SARS-CoV 和 MERS-CoV 候选疫苗后理论上存在疾病增强的风险。我们还确定了需要填补的知识空白，以最大限度地提高开发安全疫苗的机会，并最大限度地降低接种疫苗的个体在接触 SARS-CoV-2 后疾病加重的风险。

 专家意见

我们汇编并提出了在临床前和早期临床开发过程中调查疫苗介导的疾病增强风险的途径。尽管对 COVID-19（以及未来流行的冠状病毒）疫苗的迫切需求不容忽视，但我们主张将安全置于辩论的中心。即使在像 COVID-19 大流行这样的特殊时期，使用有效和安全的疫苗来保护个人也应该是当务之急。