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Cutar da ke Faruwa

Daga Wikipedia, Insakulofidiya ta kyauta.
Cutar da ke Faruwa
Description (en) Fassara
Iri infection (en) Fassara, medical case (en) Fassara
edge case (en) Fassara
Identifier (en) Fassara
MeSH D000093742
cuta

Cutar da ke yaduwa shine yanayi da cuta ke kama wanda aka riga akai wa allurar rigakafi daga irin cutar da ake nufin rigakafin.[1] A sauƙaƙe, suna faruwa lokacin da alluran rigakafi suka kasa samar da rigakafin ƙwayoyin cuta waɗanda aka tsara su don yin niyya. An gano cewa breakthrough infection sun faru akan mutane daban daban da aka riga akai wa allurar rigakafin cututtuka daban -daban da suka haɗa da Mumps, Varicella (Chicken Pox), da Influenza.[2][3][4] Halayen wadannan cututtuka sun dogara ne akan kwayoyin cututtukan da kanta. Sau da yawa, kamuwa da cuta a cikin mutumin da aka yi wa allurar yana haifar da ƙananan alamun cutar kuma yana da ɗan gajeren lokaci fiye da yadda aka kamu da cutar ta halitta.[5]

Abubuwan da ke haifar da kamuwa da cuta sun haɗa da rashin kulawa ko adana alluran rigakafi, maye gurbi a cikin ƙwayoyin cuta da toshe ƙwayoyin rigakafi . Saboda waɗannan dalilai, alluran rigakafi ba safai suke tasiri 100% ba. An kiyasta allurar rigakafin mura na yau da kullun yana ba da rigakafin mura a cikin 58% na masu karɓa.[6] Allurar rigakafin cutar kyanda ta kasa samar da rigakafi ga kashi 2% na yaran da suka karɓi allurar. Amma (herd infection) yana rage faruwar samun breakthrough na kwayoyin cuta.[7] Dangane da haka, rigakafin garken yana rage adadin cututtukan da ke ci gaba a cikin al'umma.[8]

Dangane da cuta

[gyara sashe | gyara masomin]

Varicella

[gyara sashe | gyara masomin]

Allurar rigakafin varicella tana da tasiri 85% wajen hana kamuwa da varicella (ƙyanda).[9] Koyaya, kashi 75% na mutanen da aka gano tare da ci gaban varicella suna nuna alamun rauni fiye da mutanen da ba a yi musu allurar ba.[5] Waɗannan mutanen da ke da ƙananan varicella suna da ƙarancin zazzabi, ƙasa da raunuka 50 akan fatarsu da fatar maculopapular es. Sabanin haka, mutanen da ba a allurar riga-kafi yawanci suna da zazzabi na 102, 200-500 raunin fata da macules (raunin da ba a ɗaga su ba) yana canzawa zuwa papules da raunin vesicular.[10] [5]Bugu da ƙari, kamuwa da cuta a cikin mutanen da ba a allurar riga -kafi ba yana ɗaukar tsawon lokaci fiye da na mutanen da suka kamu da cutar.[5]

Mafi yawan lokuta na ci gaban varicella ana danganta su ga gazawar mutum ya ɗauki allurar rigakafin varicella.[9] Saboda haka, don hana kamuwa da cututtuka, an ba da shawarar cewa yara su sami kashi na biyu na allurar varicella ƙasa da shekara guda bayan samun allurar su ta farko.[9]

Kanjamau

[gyara sashe | gyara masomin]

Allurar rigakafin cutar sankarau wani sashi ne na allurar rigakafin Kyanda, Kyanda da Rubella (MMR).[11] Allurar rigakafin zazzabin cizon sauro, musamman, yana da tasiri 88% a hana rigakafin cutar sankara.[12] Mutanen da ke fama da cutar zazzabin cizon sauro suna da ƙarancin wahala daga kamuwa da cututtuka idan aka kwatanta da mutanen da ba a yi musu allurar rigakafi ba.[13] Waɗannan matsalolin sun haɗa da haɓaka aseptic meningitis da encephalitis.[13]

A halin yanzu ba a fahimci musabbabin cizon sauro ba. Juyin kwayar cutar ( antigic drift ) ana tsammanin zai bayyana mafi yawan lokuta masu nasara.[13] Wasu ra'ayoyin suna ba da shawarar cewa ƙwaƙwalwar T lymphocytes suna taka rawa wajen haɓaka cututtukan da ke ci gaba.[13]

Hepatitis B

[gyara sashe | gyara masomin]

Abubuwan da ke haifar da cutar Hepatitis B da farko ana danganta su da maye gurbi a cikin ƙwayar cutar Hepatitis B (HBV) wanda ke sa ƙwayoyin HBV ba za a iya gane su ba ga ƙwayoyin rigakafi da aka samar daga allurar HBV.[14][15][16]Kwayoyin cuta masu irin wannan maye gurbi ana kiransu da “mutun na tserewa allurar rigakafi”. Hakanan ana iya haifar da kamuwa da cututtuka ta hanyar jinkirta allurar rigakafi, rigakafin rigakafi, da nauyin hoto na mahaifa.[15] Yana yiwuwa mutum ya kamu da cutar HBV amma ya zama asymptomatic.[14]

CUTAR COVID-19

[gyara sashe | gyara masomin]

A watan Afrilu na 2021, masana kimiyya sun ba da rahoton cewa a cikin rukunin mutane 417 da aka yi wa allurar rigakafi mata biyu sun kamu da cututtukan da ke haifar da allurar rigakafin tun lokacin da aka buga su kuma sun gano canjin ƙwayoyin cuta na bambance -bambancen su.[17][18] A cikin wannan watan, CDC ta ba da rahoton cewa a cikin Amurka akwai cututtukan COVID- 5,814 na ci gaba, da mutuwar 74 a cikin sama da mutane miliyan 75 da suka yi cikakkiyar rigakafin cutar ta COVID-19.[19][20][21][22][23][24] A cikin Yuli 2021, masana kimiyya sun ba da rahoton cewa a cikin barkewar bambancin SARS-CoV-2 Delta, wanda ke da alaƙa da manyan taron jama'a, kashi 74% na kamuwa da cuta ya faru a cikin cikakken allurar rigakafin,[25][26] wanda na iya zama ba daidai ba tare da binciken da ke nuna alluran rigakafi na yanzu don yin tasiri sosai [27][28][29] akan duk bambance -bambancen "Delta".

Koyaya, a cewar Manajan garin Provincetown, ya zuwa 28 ga Yuli, jimlar adadin shari'o'in da ke da alaƙa da gungun lardin sun haura 833, wanda 7 kawai ke asibiti (5 a MA da 2 a wasu jahohin) kuma babu mutuwa hade da barkewar cutar, yana mai jaddada cewa alluran rigakafin sun yi matukar tasiri wajen hana asibiti da mutuwa. [30]

Halaye

[gyara sashe | gyara masomin]

Halittun halittu

[gyara sashe | gyara masomin]

Shekaru

[gyara sashe | gyara masomin]

Yayin da mutum ya tsufa, tsarin garkuwar jikinsu yana samun jerin canje -canje, a cikin tsarin da ake kira immunosenescence.[31] Sanannen abu a cikin waɗannan canje -canjen shine raguwar samar da ƙwayoyin T na butulci da ƙwayoyin B marasa ƙarfi.[32] An rage yawan adadin lymphocytes na butulci (ƙwayoyin T da B) saboda gaskiyar cewa telomeres a cikin sel sel hematopoietic (HSCs), sun lalace a tsawon lokaci kuma, a sakamakon haka, iyakance yaduwar HSCs da samar da ƙwayoyin ƙwayoyin lymphoid.[31][32] Wannan yana haɗe da gaskiyar cewa, tare da lokaci, HSCs sun fi son samar da ƙwayoyin ƙwayoyin myeloid akan ƙwayoyin magabatan lymphoid. [33] Hakanan lymphocytes balaga ba sa iya yaduwa har abada.[31] Ƙarfafa, raguwar adadin ƙwayoyin lymphocytes na butulci da ƙuntatawa na damar haɓaka ƙwayoyin lymphocytes masu balaga suna ba da gudummawa ga iyakance adadi da iri -iri na lymphocytes don amsa ƙwayoyin cuta da aka gabatar a cikin allurar rigakafi.[32]

Lallai, alluran rigakafi, gami da allurar mura, Tdap, da allurar rigakafin cutar huhu, ba su da tasiri a cikin manya sama da shekaru 65.[32][34] Duk da haka, CDC ta ba da shawarar cewa tsofaffi su sami allurar mura saboda kamuwa da mura yana da haɗari musamman a cikin wannan yawan kuma allurar tana ba da aƙalla matsakaicin matakin rigakafi ga ƙwayar mura.[33]

Tsoma bakin Antibody

[gyara sashe | gyara masomin]

A gaban masu juna biyu antibodies a jarirai takaita inganci na inactivated, attenuated da subunit alurar.[35] Kwayoyin rigakafi na mahaifa na iya ɗaure wa epitopes akan sunadaran da kwayar cutar ta samar a cikin allurar rigakafi. Gane sunadarin sunadarai ta hanyar garkuwar jiki na mahaifa yana kawar da kwayar cutar.[36] Bugu da ƙari, ƙwayoyin mahaifa sun mamaye masu karɓar sel B a kan ƙwayoyin B na jariri don ɗaure wa antigen. Don haka, tsarin garkuwar jariri ba a kunna shi sosai kuma jariri yana samar da ƙananan ƙwayoyin rigakafi.[8][34] Ko da lokacin da ƙwayoyin B ke ɗaure da ƙwayoyin cuta, ana mayar da martani na rigakafi akai -akai. Idan masu karɓar sel na B suna ɗaure ga antigen da masu karɓa na FC a lokaci guda suna ɗaure da ƙwayar mahaifa, masu karɓar FC suna aika siginar zuwa masu karɓar sel na B wanda ke hana rarraba sel. [37] Saboda tsarin garkuwar jikin jariri baya motsawa kuma an hana rarraba sel B, ana samar da ƙwayoyin ƙwaƙwalwar ƙwaƙwalwa B kaɗan. Matsayin ƙwaƙwalwar B-sel bai isa ba don tabbatar da juriyar jariri ga mai cutar. [38] [37]

A mafi yawan jarirai, ƙwayoyin garkuwar jiki suna ɓacewa bayan watanni 12-15 bayan haihuwa, don haka alluran da ake gudanarwa a wajen wannan taga ba sa yin kutse ta hanyar kutse na mahaifa.[8]

Tsawon rayuwar ƙwaƙwalwar ƙwaƙwalwa B

[gyara sashe | gyara masomin]

Lokacin da aka yiwa mutum allurar rigakafin wata cuta, tsarin garkuwar jikin mutum yana haifar kuma ƙwayoyin B na ƙwaƙwalwar ajiya suna adana takamaiman martani na rigakafi.[8] Waɗannan ƙwayoyin suna ci gaba da yaduwa har sai an kawar da kamuwa da cutar. Saboda telomeres a cikin kwayoyin halitta suna lalacewa bayan kowane rarrabuwa na sel, ƙwayoyin lymphocytes, gami da ƙwayoyin ƙwaƙwalwar B ba su iya haɓaka har abada.[31] Yawanci, ƙwayoyin suna rayuwa tsawon shekaru da yawa, amma akwai bambanci a tsawon rayuwar waɗannan sel dangane da nau'in allurar da aka ƙarfafa su da allurar rigakafin.[35] Dalilin banbance -banbance a tsawon rayuwar ƙwayoyin ƙwaƙwalwar B a halin yanzu ba a sani ba. Koyaya, an ba da shawarar cewa bambance -bambancen da ke cikin ƙwaƙwalwar ƙwaƙwalwar ƙwaƙwalwar ƙwaƙwalwa B yana faruwa ne saboda saurin da kwayar cuta ke cutar da jiki kuma, daidai da haka, adadin da nau'in sel da ke cikin amsawar rigakafi ga ƙwayoyin cuta a cikin allurar.[39]

Juyin halittar cutar

[gyara sashe | gyara masomin]

Lokacin da aka yiwa mutum allurar rigakafi, tsarin garkuwar jikinsu yana haɓaka ƙwayoyin rigakafi waɗanda ke gane ƙwayoyin cuta na musamman ( epitopes ) ko furotin da ke haifar da ƙwayoyin cuta. Bayan lokaci, duk da haka, ƙwayoyin cuta suna tara maye gurbi wanda zai iya yin tasiri ga tsarin 3d na sunadaran ƙwayoyin cuta.[37] Idan waɗannan maye gurbi sun faru a cikin rukunin yanar gizo waɗanda ƙwayoyin garkuwar jiki ke ganewa, maye gurɓin yana toshe garkuwar jiki wanda ke hana amsawar rigakafi.[38] Wannan sabon abu ana kiransa guntuwar antigenic. Cutar cutar Hepatitis B da mumps wani ɓangare ana danganta su da ɓarkewar antigen.[15][13]

Wasu dalilai

[gyara sashe | gyara masomin]

Ingancin alluran rigakafi da gudanarwa

[gyara sashe | gyara masomin]

Alluran rigakafi na iya kasa samar da rigakafi idan allurar ba ta da inganci yayin gudanar da ita. Allurar rigakafi tana rasa ƙarfi idan an adana ta a yanayin zafin da bai dace ba ko kuma idan an kiyaye ta bayan ranar karewa.[40] Hakanan, allurar rigakafin da ta dace tana da mahimmanci don tabbatar da rigakafi. Sashin allurar rigakafin ya dogara da abubuwan da suka haɗa da shekarun mai haƙuri da nauyi.[39] Rashin yin lissafin waɗannan abubuwan na iya haifar da marasa lafiya da samun adadin allurar da ba daidai ba. Marasa lafiya waɗanda ke karɓar ƙaramin allurai fiye da shawarar allurar rigakafi ba su da isasshen maganin rigakafi ga allurar don tabbatar da rigakafi.[35]

Domin allurar rigakafin ta yi tasiri, dole ne mutum ya mai da martani ga ƙwayoyin cuta a cikin allurar ta hanyar reshe mai daidaita tsarin garkuwar jiki kuma dole ne a adana wannan amsar a cikin ƙwaƙwalwar ƙwaƙwalwar mutum.[8] Mai yiyuwa ne mutum ya tsagaita da share wata cuta ta hanyar amsawar ban dariya ba tare da kunna amsawar rigakafi ta daidaita ba.[8] Alluran rigakafin da ke da rauni ko ƙarancin ƙwayoyin cuta, kamar yadda lamarin yake lokacin da allurar ba ta da inganci yayin gudanar da ita, na iya haifar da martani na ban dariya, kuma, ta haka, ta kasa tabbatar da rigakafin gaba.[8]

Hanyoyin waje

[gyara sashe | gyara masomin]

Manazarta

[gyara sashe | gyara masomin]
  1. ↑ CDC (2020-02-11). "COVID-19 Vaccination". Centers for Disease Control and Prevention. Retrieved 2022-01-06.
  2. ↑ "Factsheet for health professionals". ecdc.europa.eu (in Turanci). Archived from the original on 2017-02-24. Retrieved 2017-02-24.
  3. ↑ "Chickenpox | Clinical Overview | Varicella | CDC". www.cdc.gov (in Turanci). Retrieved 2017-02-24.
  4. ↑ "Use of Antivirals | Health Professionals | Seasonal Influenza (Flu)". www.cdc.gov (in Turanci). Retrieved 2017-02-24.
  5. ↑ 5.0 5.1 5.2 5.3 "Chickenpox (Varicella)". Center for Disease Control and Prevention. 1 July 2016.
  6. ↑ Osterholm, Michael T; Kelley, Nicholas S; Sommer, Alfred; Belongia, Edward A (2012). "Efficacy and effectiveness of influenza vaccines: a systematic review and meta-analysis". The Lancet Infectious Diseases. 12 (1): 36–44. doi:10.1016/s1473-3099(11)70295-x. PMID 22032844.
  7. ↑ Fine, P.; Eames, K.; Heymann, D. L. (2011-04-01). ""Herd Immunity": A Rough Guide". Clinical Infectious Diseases (in Turanci). 52 (7): 911–916. doi:10.1093/cid/cir007. ISSN 1058-4838. PMID 21427399.
  8. ↑ 8.0 8.1 8.2 8.3 8.4 8.5 8.6 Owen, Judith; Punt, Jenni; Stranford, Sharon (2013). Kuby Immunology (7th ed.). New York City, New York: W.H. Freeman and Company. pp. 576–578. ISBN 978-14292-1919-8.
  9. ↑ 9.0 9.1 9.2 Papaloukas, Orestis; Giannouli, Georgia; Papaevangelou, Vassiliki (2014-03-01). "Successes and challenges in varicella vaccine". Therapeutic Advances in Vaccines. 2 (2): 39–55. doi:10.1177/2051013613515621. ISSN 2051-0136. PMC 3991154. PMID 24757524.
  10. ↑ "Pinkbook | Varicella | Epidemiology of Vaccine Preventable Diseases | CDC". www.cdc.gov (in Turanci). Retrieved 2017-02-17.
  11. ↑ "Factsheet for health professionals". ecdc.europa.eu (in Turanci). Archived from the original on 2017-02-24. Retrieved 2017-02-17.
  12. ↑ "Mumps | Cases and Outbreaks | CDC". www.cdc.gov (in Turanci). Retrieved 2017-02-17.
  13. ↑ 13.0 13.1 13.2 13.3 13.4 Latner, Donald R.; Hickman, Carole J. (2015-05-07). "Remembering Mumps". PLOS Pathogens. 11 (5): e1004791. doi:10.1371/journal.ppat.1004791. ISSN 1553-7374. PMC 4423963. PMID 25951183.
  14. ↑ 14.0 14.1 Seed, Clive R.; Jones, Ngaire T.; Pickworth, Anne M.; Graham, Wendy R. (2012-01-01). "Two cases of asymptomatic HBV "vaccine breakthrough" infection detected in blood donors screened for HBV DNA". Medical Journal of Australia. 196 (10). ISSN 0025-729X.
  15. ↑ 15.0 15.1 15.2 Chang, Mei-Hwei (2010). "Breakthrough HBV infection in vaccinated children in Taiwan: surveillance for HBV mutants". Antiviral Therapy (in Turanci). 15 (3 Part B): 463–469. doi:10.3851/imp1555. PMID 20516566.
  16. ↑ Coleman, Paul F. (2017-02-17). "Detecting Hepatitis B Surface Antigen Mutants". Emerging Infectious Diseases. 12 (2): 198–203. doi:10.3201/eid1203.050038. ISSN 1080-6040. PMC 3293431. PMID 16494742.
  17. ↑ Howard, Jacqueline. "Only 2 'breakthrough' infections among hundreds of fully vaccinated people, new study finds". CNN. Retrieved 11 May 2021.
  18. ↑ Hacisuleyman, Ezgi; Hale, Caryn; Saito, Yuhki; Blachere, Nathalie E.; Bergh, Marissa; Conlon, Erin G.; Schaefer-Babajew, Dennis J.; DaSilva, Justin; Muecksch, Frauke; Gaebler, Christian; Lifton, Richard; Nussenzweig, Michel C.; Hatziioannou, Theodora; Bieniasz, Paul D.; Darnell, Robert B. (21 April 2021). "Vaccine Breakthrough Infections with SARS-CoV-2 Variants". New England Journal of Medicine (in Turanci). doi:10.1056/NEJMoa2105000. Retrieved 10 May 2021.
  19. ↑ Gilbert, Ben; Brubeck, Hilary (15 April 2021). "CDC: 5,800 COVID-19 infections, 74 deaths in the more than 75 million fully vaccinated people". Business Insider. Retrieved 18 April 2021.
  20. ↑ Krieger, Lisa M. (15 April 2021). "COVID vaccines: The mystery of "breakthrough" infections after shots - CDC reports 5,800 COVID-19 infections, 74 deaths in fully vaccinated people". The Mercury News. Retrieved 18 April 2021.
  21. ↑ Tinker, Ben; Fox, Maggie (15 April 2021). "CDC reports 5,800 COVID-19 infections, 74 deaths in fully vaccinated people". Orange County Register. Retrieved 18 April 2021.
  22. ↑ Masson, Gabrielle (15 April 2021). "5,800 COVID-19 infections detected among 77 million fully vaccinated people: CDC". Beckers Hospital Review. Retrieved 18 April 2021.
  23. ↑ May, Brandon (15 April 2021). "COVID-19 Infection After Vaccine is Rare But Possible, CDC Says". BioSpace. Retrieved 18 April 2021.
  24. ↑ Whelan, Robbie (15 April 2021). "CDC Identifies Small Group of Covid-19 Infections Among Fully Vaccinated Patients - Incidence is rare, occurring in only 0.008% of cases and in line with expectations". The Wall Street Journal. Retrieved 18 April 2021.
  25. ↑ Wadman, Meredith (4 August 2021). "What does the Delta variant have in store for the United States? We asked coronavirus experts". Science News. Retrieved 2021-08-23. In the Massachusetts outbreak, fully vaccinated people accounted for 74% of nearly 469 COVID-19 cases.
  26. ↑ Brown, Catherine M. (2021). "Outbreak of SARS-CoV-2 Infections, Including COVID-19 Vaccine Breakthrough Infections, Associated with Large Public Gatherings — Barnstable County, Massachusetts, July 2021". MMWR. Morbidity and Mortality Weekly Report (in Turanci). 70 (31): 1059–1062. doi:10.15585/mmwr.mm7031e2. ISSN 0149-2195. PMC 8367314 Check |pmc= value (help). PMID 34351882 Check |pmid= value (help). S2CID 236935466 Check |s2cid= value (help).
  27. ↑ Bernal, Jamie Lopez; Andrews, Nick; Gower, Charlotte; Gallagher, Eileen; Simmons, Ruth; Thelwall, Simon; Stowe, Julia; Tessier, Elise; Groves, Natalie; Dabrera, Gavin; Myers, Richard; Campbell, Colin N. J.; Amirthalingam, Gayatri; Edmunds, Matt; Zambon, Maria; Brown, Kevin E.; Hopkins, Susan; Chand, Meera; Ramsay, Mary (21 July 2021). "Effectiveness of Covid-19 Vaccines against the B.1.617.2 (Delta) Variant". New England Journal of Medicine (in Turanci). 385 (7): 585–594. doi:10.1056/NEJMoa2108891. PMC 8314739 Check |pmc= value (help). PMID 34289274 Check |pmid= value (help).
  28. ↑ Samfuri:Cite document
  29. ↑ Sheikh, Aziz; McMenamin, Jim; Taylor, Bob; Robertson, Chris (26 June 2021). "SARS-CoV-2 Delta VOC in Scotland: demographics, risk of hospital admission, and vaccine effectiveness". The Lancet (in English). 397 (10293): 2461–2462. doi:10.1016/S0140-6736(21)01358-1. ISSN 0140-6736. PMC 8201647 Check |pmc= value (help). PMID 34139198 Check |pmid= value (help).CS1 maint: unrecognized language (link)
  30. ↑ https://www.facebook.com/ProvincetownManager/posts/156605409902966
  31. ↑ 31.0 31.1 31.2 31.3 Lord, Janet M. (2013-06-12). "The effect of aging of the immune system on vaccination responses". Human Vaccines & Immunotherapeutics. 9 (6): 1364–1367. doi:10.4161/hv.24696. ISSN 2164-5515. PMC 3901832. PMID 23584248.
  32. ↑ 32.0 32.1 32.2 32.3 Goronzy, Jörg J; Weyand, Cornelia M (2013). "Understanding immunosenescence to improve responses to vaccines". Nature Immunology. 14 (5): 428–436. doi:10.1038/ni.2588. PMC 4183346. PMID 23598398.
  33. ↑ 33.0 33.1 Empty citation (help)
  34. ↑ 34.0 34.1 "Vaccine Effectiveness - How Well Does the Flu Vaccine Work? | Seasonal Influenza (Flu) | CDC". www.cdc.gov (in Turanci). Retrieved 2017-02-23.
  35. ↑ 35.0 35.1 35.2 Edwards, Kathryn M. (2015-11-25). "Maternal antibodies and infant immune responses to vaccines". Vaccine. Advancing Maternal Immunization Programs through Research in Low and Medium Income Countries. 33 (47): 6469–6472. doi:10.1016/j.vaccine.2015.07.085. PMID 26256526.
  36. ↑ Siegrist, Claire-Anne (2013). "Vaccine Immunology". Vaccines. Elsevier. ISBN 9781455700905.
  37. ↑ 37.0 37.1 37.2 Empty citation (help)
  38. ↑ 38.0 38.1 Empty citation (help)
  39. ↑ 39.0 39.1 "Top 20 Questions about Vaccination | History of Vaccines". www.historyofvaccines.org (in Turanci). Retrieved 2017-02-15.
  40. ↑ Hamborsky, Jennifer; Kroger, Andrew; Wolfe, Charles (2013). Epidemiology and Prevention of Vaccine Preventable Diseases. Washington D.C.: Center for Disease Control and Prevention.
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