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JAMA Neuology:公众需要了解真相,神经系统功能性失调可能与疫苗接种无关

2021-07-29 MedSci原创 MedSci原创

有效的沟通将有助于教育公众,减少恐惧,以便患者能够自己做出接受疫苗的知情决定,以降低新冠肺炎的风险。

截至2021年1月底,全球接种了9730多万剂新冠肺炎疫苗,美国接种了3180万剂。尽管重要的上市后监测仍在进行,它目前非常有效和安全,副作用包括短暂的症状,如发烧/寒战、头痛、疲劳、肌痛/关节痛、淋巴结病、恶心或肿胀、红斑或疼痛的局部影响。随着公众接种疫苗,最近社交媒体上流传着关于接种新冠肺炎疫苗后主要神经不良事件,如果医疗专业人员没有向公众进行有效沟通,这可能会导致疫苗接种率下降和疫情不必要的延长。必须指出,这些信息可能没有证据,也不确定是否在这些情况下接种了新冠肺炎疫苗。然而,据新闻报道,至少有1名患者被他们的医生告知诊断为转换障碍,4名也称为神经系统功能性失调(FND)。

David Dongkyung Kim等在JAMA Neuology杂志发表文章,提供了关于FND和新冠肺炎疫苗接种之间潜在联系的背景。

FND是神经学和精神病学交叉的一种真正的、基于大脑的疾病,患者发展出一系列由生物、心理和/或环境因素引发和延续的神经症状,反映了George Engel描述的临床形成的生物心理社会模式。FND可以由身体和/或情感上有价值的事件引发,包括头部损伤、医疗/外科手术和疫苗接种。这些加速因素虽然与症状的发展密切相关,但并不是由疫苗中的物质直接引起的。相反,诸如期望、信念、身体注意力的增强、唤醒和威胁/情绪处理等因素在FND的病理生理学中起着重要的机械作用。贝叶斯层次神经认知模型认为,异常的期望或信念可以与感觉运动知觉相互作用,从而在一定程度上为功能性神经症状提供机械方程。在包括疫苗接种在内的突发物理事件中,重要的生物过程是对身体的关注,而不是直接的神经毒性或免疫介导的过程。此外,疫苗会产生伤害性体验,如局部注射部位反应或全身肌痛,这些不愉快的感觉会促进注意力转向身体。

关于FND和新冠肺炎疫苗接种的交叉问题,美国疾病控制和预防中心迄今的回应是重申疫苗的安全性,而没有直接解决这些问题。随着关注的增加,卫生保健官员有必要就这个问题直接教育公众。缺乏直接的信息可能会被公众错误地认为疾病控制和预防中心没有适当地监测不良症状,甚至更糟糕的是,没有掩盖这些症状。这些患者可能会感到闻所未闻或被忽视,这可能会增加对卫生保健官员的不信任。

必须透明和不加判断地解释FND的性质,包括这些症状是真实的,但不是有毒疫苗效应的直接结果。理论上,它们可以在注射生理盐水等触发因素下发生,这些事件并不意味着目前的疫苗是不安全的。此外,需要对公众进行FND(大多数人从未听说过的最常见的神经疾病)的教育。社会比以往任何时候都更需要透明度和有效的沟通,像FND这样普遍和潜在的衰弱状况不能再被边缘化和处于阴影中。有效的沟通将有助于教育公众,减少恐惧,以便患者能够自己做出接受疫苗的知情决定,以降低新冠肺炎的风险。

原文出处

Kim DD, Kung CS, Perez DL. Helping the Public Understand Adverse Events Associated With COVID-19 Vaccinations: Lessons Learned From Functional Neurological Disorder. JAMA Neurol. 2021;78(7):789–790. doi:10.1001/jamaneurol.2021.1042

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    2021-07-29 小小医者

    #新冠疫苗#,其实疫苗接种是相当安全的,但是社会有很多反疫苗人士,以及很多认知错误的,需要大量的#科普#和教育!希望#梅斯医学#能不断宣传正确的观念!

    0

  5. [GetPortalCommentsPageByObjectIdResponse(id=1915557, encodeId=d4bb191555e62, content=<a href='/topic/show?id=22a1328e7e5' target=_blank style='color:#2F92EE;'>#功能性#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=72, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=32877, encryptionId=22a1328e7e5, topicName=功能性)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=570f404, createdName=xlxchina, createdTime=Thu Sep 02 19:57:51 CST 2021, time=2021-09-02, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1258070, encodeId=067a12580e062, content=<a href='/topic/show?id=f538e0501e9' target=_blank style='color:#2F92EE;'>#疫苗接种#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=92, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=70501, encryptionId=f538e0501e9, topicName=疫苗接种)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=5c0050, createdName=lishiwen, createdTime=Sat Jul 31 04:57:51 CST 2021, time=2021-07-31, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1283186, encodeId=a7f9128318691, content=<a href='/topic/show?id=4fade445192' target=_blank style='color:#2F92EE;'>#神经系统#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=63, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=74451, encryptionId=4fade445192, topicName=神经系统)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=02f5179, createdName=luoxiaog, createdTime=Sat Jul 31 04:57:51 CST 2021, time=2021-07-31, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1003657, encodeId=a4bc100365e7e, content=<a href='/topic/show?id=4dbd580630b' target=_blank style='color:#2F92EE;'>#新冠疫苗#</a>,其实疫苗接种是相当安全的,但是社会有很多反疫苗人士,以及很多认知错误的,需要大量的<a href='/topic/show?id=99e6e4983cc' target=_blank style='color:#2F92EE;'>#科普#</a>和教育!希望<a href='/topic/show?id=148562431a3' target=_blank style='color:#2F92EE;'>#梅斯医学#</a>能不断宣传正确的观念!, beContent=null, objectType=article, channel=null, level=null, likeNumber=218, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=58063, encryptionId=4dbd580630b, topicName=新冠疫苗), TopicDto(id=74983, encryptionId=99e6e4983cc, topicName=科普), TopicDto(id=62431, encryptionId=148562431a3, topicName=梅斯医学)], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20220519/c2ab253484ee4527a2d4e9589a4821ac/45de9bf494a54becb2ea4369c9d11e85.jpg, createdBy=7a3710, createdName=小小医者, createdTime=Thu Jul 29 20:36:10 CST 2021, time=2021-07-29, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1036775, encodeId=78101036e75a5, content=顶刊就是顶刊,谢谢梅斯带来这么高水平的研究报道,我们科里同事经常看梅斯,分享梅斯上的信息, beContent=null, objectType=article, channel=null, level=null, likeNumber=78, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=旺医, createdTime=Thu Jul 29 16:57:51 CST 2021, time=2021-07-29, status=1, ipAttribution=)]
    2021-07-29 旺医

    顶刊就是顶刊,谢谢梅斯带来这么高水平的研究报道,我们科里同事经常看梅斯,分享梅斯上的信息

    0

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