Rita\u00a0Rubin<\/h3>\n\n\n\nJAMA.\u00a0<\/em>Published online February 14, 2024. doi:10.1001\/jama.2024.1014<\/h3>\n\n\n\nFor people who are immunocompromised, the COVID-19 pandemic is not over.<\/a><\/p>\n\n\n\nIn general, their immune system\u2019s response to COVID-19 vaccines and to SARS-CoV-2 infection is blunted compared with individuals who are not immunocompromised, leading to more severe disease.<\/p>\n\n\n\n![\"\"\/](\"https:\/\/cdn.jamanetwork.com\/ama\/content_public\/journal\/jama\/0\/m_jmn240004fa_1707833147.40977.png?Expires=1711134053&Signature=eODnUsLSouB~jhdUgG-5b0aj6hb3clABkfhK77bS40yOgqsx7TYcnlv7TLsaxX3FhbiMWRvsWO~YsYLp3j8UjMsZ8ZhY-IlCU-jq45ztdaaLKQPXmyorMVORV-vZCZeUpP08~5ZTh130NWH2lDB6NGCdP6QvUBAXvTN4RrweF~FKK3Xl6GmVIwttgYLh7-blsW5dAQ88otj00B6Oab5Mw2am2RgNYpeXmleY1YZWuXAX88OxQgOV4bOygUcgqBpmtol5SmDJ1uQUt~JwUgcnsSWjVQgPEV0WAbuJcEuOeC-AUUaatCS96s5ElcnMc~OD3ce6buX91DbGBXlAgEQzBw__&Key-Pair-Id=APKAIE5G5CRDK6RD3PGA\")
<\/figure>\n\n\n\niStock.com\/blackCAT<\/p>\n\n\n\n
But not all people with compromised immune systems are alike, and some are able to vanquish COVID-19 about as handily as people who aren\u2019t immunocompromised, a recently published study<\/a> in Science Translational Medicine<\/em> found.<\/a><\/p>\n\n\n\nFor those patients, \u201cI hope that this paper will provide a little reassurance,\u201d senior author Jonathan Li, MD, an infectious diseases specialist at Brigham and Women\u2019s Hospital and Harvard Medical School, told JAMA<\/em> in an interview.<\/a><\/p>\n\n\n\nThe Methods<\/p>\n\n\n\n
The study compared 56 people who were immunocompromised with 184 who weren\u2019t. Participants were enrolled in the Post-Vaccination Viral Characteristics Study (POSITIVES), a longitudinal cohort study of adults who tested positive for COVID-19 or received a prescription for a COVID-19 treatment in the Mass General Brigham health care system. Three patients, all of whom were severely immunocompromised, died of COVID-19 or its complications during the study.<\/a><\/p>\n\n\n\nThe researchers divided the people who were immunocompromised into 3 groups:<\/a><\/p>\n\n\n\n\u2022 Severely immunocompromised due to a solid organ transplant, a hematopoietic stem cell transplant, lymphoma or leukemia, or cancer treated with multiple immunosuppressants.<\/a><\/p>\n\n\n\n\u2022 Severely immunocompromised due to B-cell\u2013targeted therapy for an autoimmune disease or congenital or late-onset B-cell deficiency.<\/a><\/p>\n\n\n\n\u2022 Immunocompromised but not severely, as a result of receiving immunosuppressants such as antitumor necrosis factor for autoimmune diseases.<\/a><\/p>\n\n\n\nPeople in both the immunocompromised and nonimmunocompromised groups had received 3 COVID-19 vaccine doses on average. Both groups also included some people who had received COVID-19 monoclonal antibodies and antivirals outside of the study; those who were immunocompromised were more likely to have received the treatments. All but 1 of the participants collected their own nasal swabs for analysis.<\/a><\/p>\n\n\n\nThe Results<\/p>\n\n\n\n
The researchers assessed differences among the 3 immunocompromised groups and the nonimmunocompromised groups in 2 main areas:<\/a><\/p>\n\n\n\n\u2022 How likely the virus was to mutate, specifically among participants who had a viral genome available at baseline and at least 1 follow-up time point. Persistent SARS-CoV-2 infection in individuals who are severely immunosuppressed \u201cmost people would agree represents a key driver of viral evolution,\u201d Li said.<\/a><\/p>\n\n\n\n\u2022 How many days they shed the virus.<\/a><\/p>\n\n\n\nAmong participants with viral sequences, 39% of those who were immunocompromised had evidence of changes in the gene that encodes the SARS-CoV-2 spike protein, compared with 12% of the nonimmunocompromised group.<\/a><\/p>\n\n\n\nIn addition, clearance rates of nasal viral RNA and culturable SARS-CoV-2 differed among the immunocompromised groups. Nasal viral RNA can include SARS-CoV-2 fragments that aren\u2019t infectious, but viral RNA that can be grown in culture is infectious. On average, this was how long it took the different groups to clear viral RNA and culturable virus from their nose:<\/a><\/p>\n\n\n\n\u2022 For the group that included solid organ transplant recipients, 72 days for viral RNA, 40 days for culturable virus.<\/a><\/p>\n\n\n\n\u2022 For the other severely immunocompromised group, 10 days for nasal viral RNA, 6.5 days for culturable virus.<\/a><\/p>\n\n\n\n\u2022 For the less severely immunocompromised group, 12 days for nasal viral RNA, 6 days for culturable virus.<\/a><\/p>\n\n\n\n\u2022 For the nonimmunocompromised group, 13 days for nasal viral RNA, 7 days for culturable virus.<\/a><\/p>\n\n\n\nTaking It Seriously<\/p>\n\n\n\n
The findings about persistent SARS-CoV-2 infection in the severely compromised group confirm case reports and case series, the authors noted.<\/a><\/p>\n\n\n\n\u201cPersistent symptoms past 10 days need to be taken seriously,\u201d Li said. One danger, he noted, is that patients might mistakenly attribute their persistent symptoms to post\u2013COVID-19 condition, commonly called long COVID, and assume they can no longer spread the virus.<\/a><\/p>\n\n\n\nThe National Institutes of Health\u2019s COVID-19 treatment guidelines suggest<\/a> longer or additional courses of the antivirals nirmatrelvir-ritonavir (Paxlovid) or remdesivir (Veklury) only for patients who are immunocompromised and then only if symptoms persist and there is evidence of ongoing SARS-CoV-2 replication.<\/a><\/p>\n\n\n\nFor everyone else, treatment with nirmatrelvir-ritonavir is supposed to be a single 5-day course, while the standard treatment with remdesivir for nonhospitalized patients is 3 consecutive daily infusions. The guidelines, last updated in early November 2023, acknowledged that definitive data to support extending treatment are lacking.<\/a><\/p>\n\n\n\nA case series<\/a> of 11 patients with persistent SARS-CoV-2 infection, published by researchers in Ireland and the UK in December 2023, suggested that prolonged nirmatrelvir-ritonavir treatment can effectively treat persistent SARS-CoV-2 infection in people who are immunocompromised.<\/a><\/p>\n\n\n\nTen of the patients were hospitalized, 7 with severe COVID-19 (nirmatrelvir-ritonavir is approved only for outpatients with mild to moderate COVID-19 but can be prescribed off-label). On average, the patients, 9 of whom had a blood cancer, were treated with the antiviral pills for 10 days. None of the patients died, and 9 of them completely cleared the virus.<\/a><\/p>\n\n\n\nThe Bs and Ts of Immunity<\/p>\n\n\n\n
It might be surprising that some individuals who were immunocompromised in Li\u2019s study cleared SARS-CoV-2 even sooner than people who weren\u2019t.<\/a><\/p>\n\n\n\nBut there were hints that it could happen from the earliest days of the pandemic, he noted. For example, a report<\/a>published in May 2020 described 2 young adults with X-linked agammaglobulinemia (XLA) who developed COVID-19-related interstitial pneumonia. People with XLA, an inborn error of immunity, have no circulating B cells. B cells, one of the 2 main types of lymphocytes, produce neutralizing antibodies that attack viruses and other invaders, so there was speculation that patients with the condition would likely become very ill if infected with SARS-CoV-2.<\/a><\/p>\n\n\n\n\u201cNeutralizing antibodies are protective,\u201d Charles Hackett, PhD, deputy director of the Division of Allergy, Immunology, and Transplantation at the National Institute of Allergy and Infectious Diseases, explained in an interview with JAMA<\/em>. \u201cIf you have enough of them, you don\u2019t even get infected.\u201d<\/a><\/p>\n\n\n\nBut even though they lacked antibody-producing B cells, the 2 patients with XLA recovered without the need for intensive care or ventilation, suggesting that the T-cell response is probably important for protection against SARS-CoV-2, the authors wrote.<\/a><\/p>\n\n\n\nT cells are the other main type of lymphocyte. Unlike B cells, T cells don\u2019t recognize viruses until they infect cells, so they can\u2019t block infection, Hackett noted. Instead, T cells destroy infected cells.<\/a><\/p>\n\n\n\nOne hypothesis is that when B cells are depleted, T cells rev up to compensate, Hackett said, adding, \u201cI hope that\u2019s true.\u201d<\/a><\/p>\n\n\n\nHackett noted that he\u2019s known people infected with SARS-CoV-2 who had low neutralizing antibody titers. \u201cI was scared to death [for them], but they got over COVID just like an average person,\u201d he said.<\/a><\/p>\n\n\n\nIn people who are severely immunocompromised due to a solid organ or stem cell transplant or leukemia or lymphoma, however, \u201cyou kind of disarm all of their weapons,\u201d Yijia Li, MD, said in an interview, referring to the effects of the immunosuppressive therapies such patients receive. The treatments leave behind neither a robust B-cell nor robust T-cell immune response, explained the University of Pittsburgh Medical Center infectious diseases physician, who was the first author on the new POSITIVES article coauthored by Jonathan Li (no relation).<\/a><\/p>\n\n\n\nThe Upshot<\/p>\n\n\n\n
Both Hackett and transplant surgeon Dorry Segev, MD, PhD, codirector of the NYU Langone Center for Surgical and Transplant Applied Research, praised the study.<\/a><\/p>\n\n\n\n\u201cThe study showed, in a very interesting way, qualitatively different selection pressure put on the virus by people who have differences in their immune system,\u201d Hackett said.<\/a><\/p>\n\n\n\n\u201cIt gives us a mechanistic underpinning for what we had observed clinically, and I think that\u2019s really important,\u201d Segev noted in an interview.<\/a><\/p>\n\n\n\nUnfortunately, Segev said, clinicians lack the tools to precisely assess where a patient who\u2019s immunocompromised falls on the scale of risk of severe and persistent COVID-19. \u201cWhat patients and their providers still dream of are some clinical correlates of the immune milieu,\u201d he pointed out.<\/a><\/p>\n\n\n\nSegev acknowledged that he used to think antibody tests<\/a> were the way to go for transplant recipients and others with compromised immune systems who were concerned about their ability to fend off SARS-CoV-2. Before \u201cthings went off the rails\u201d with the Omicron variant, \u201cwe knew that detectable circulating antibody correlated with neutralizing antibody,\u201d Segev said.<\/a><\/p>\n\n\n\nToday, though, he said, the sources of circulating antibodies can be numerous and vary from patient to patient, due to combinations of COVID-19 vaccines and infections with different variants. As a result, circulating antibody titers no longer reflect neutralizing antibody titers, except in people found to have no circulating antibody, Segev explained. In that case, he said, \u201cI can guarantee you you\u2019re not going to have neutralizing antibodies.\u201d<\/a><\/p>\n\n\n\nPerhaps if effective anti\u2013SARS-CoV-2 monoclonal antibodies were to become available for preexposure prophylaxis, there would be increased interest in developing tests to help determine which patients with compromised immune systems should be at the front of the line to get such treatments, Segev observed. \u201cWe really need to step up our game in terms of patient-level clinical testing.\u201d<\/p>\n","protected":false},"excerpt":{"rendered":"
Medical News & Perspectives Quick Uptakes Feb […]<\/p>\n","protected":false},"author":3,"featured_media":0,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":[],"categories":[24,23],"tags":[],"_links":{"self":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts\/25563"}],"collection":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/users\/3"}],"replies":[{"embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=25563"}],"version-history":[{"count":1,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts\/25563\/revisions"}],"predecessor-version":[{"id":25564,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts\/25563\/revisions\/25564"}],"wp:attachment":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=25563"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=25563"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=25563"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}
For people who are immunocompromised, the COVID-19 pandemic is not over.<\/a><\/p>\n\n\n\n In general, their immune system\u2019s response to COVID-19 vaccines and to SARS-CoV-2 infection is blunted compared with individuals who are not immunocompromised, leading to more severe disease.<\/p>\n\n\n\n iStock.com\/blackCAT<\/p>\n\n\n\n But not all people with compromised immune systems are alike, and some are able to vanquish COVID-19 about as handily as people who aren\u2019t immunocompromised, a recently published study<\/a> in Science Translational Medicine<\/em> found.<\/a><\/p>\n\n\n\n For those patients, \u201cI hope that this paper will provide a little reassurance,\u201d senior author Jonathan Li, MD, an infectious diseases specialist at Brigham and Women\u2019s Hospital and Harvard Medical School, told JAMA<\/em> in an interview.<\/a><\/p>\n\n\n\n The Methods<\/p>\n\n\n\n The study compared 56 people who were immunocompromised with 184 who weren\u2019t. Participants were enrolled in the Post-Vaccination Viral Characteristics Study (POSITIVES), a longitudinal cohort study of adults who tested positive for COVID-19 or received a prescription for a COVID-19 treatment in the Mass General Brigham health care system. Three patients, all of whom were severely immunocompromised, died of COVID-19 or its complications during the study.<\/a><\/p>\n\n\n\n The researchers divided the people who were immunocompromised into 3 groups:<\/a><\/p>\n\n\n\n \u2022 Severely immunocompromised due to a solid organ transplant, a hematopoietic stem cell transplant, lymphoma or leukemia, or cancer treated with multiple immunosuppressants.<\/a><\/p>\n\n\n\n \u2022 Severely immunocompromised due to B-cell\u2013targeted therapy for an autoimmune disease or congenital or late-onset B-cell deficiency.<\/a><\/p>\n\n\n\n \u2022 Immunocompromised but not severely, as a result of receiving immunosuppressants such as antitumor necrosis factor for autoimmune diseases.<\/a><\/p>\n\n\n\n People in both the immunocompromised and nonimmunocompromised groups had received 3 COVID-19 vaccine doses on average. Both groups also included some people who had received COVID-19 monoclonal antibodies and antivirals outside of the study; those who were immunocompromised were more likely to have received the treatments. All but 1 of the participants collected their own nasal swabs for analysis.<\/a><\/p>\n\n\n\n The Results<\/p>\n\n\n\n The researchers assessed differences among the 3 immunocompromised groups and the nonimmunocompromised groups in 2 main areas:<\/a><\/p>\n\n\n\n \u2022 How likely the virus was to mutate, specifically among participants who had a viral genome available at baseline and at least 1 follow-up time point. Persistent SARS-CoV-2 infection in individuals who are severely immunosuppressed \u201cmost people would agree represents a key driver of viral evolution,\u201d Li said.<\/a><\/p>\n\n\n\n \u2022 How many days they shed the virus.<\/a><\/p>\n\n\n\n Among participants with viral sequences, 39% of those who were immunocompromised had evidence of changes in the gene that encodes the SARS-CoV-2 spike protein, compared with 12% of the nonimmunocompromised group.<\/a><\/p>\n\n\n\n In addition, clearance rates of nasal viral RNA and culturable SARS-CoV-2 differed among the immunocompromised groups. Nasal viral RNA can include SARS-CoV-2 fragments that aren\u2019t infectious, but viral RNA that can be grown in culture is infectious. On average, this was how long it took the different groups to clear viral RNA and culturable virus from their nose:<\/a><\/p>\n\n\n\n \u2022 For the group that included solid organ transplant recipients, 72 days for viral RNA, 40 days for culturable virus.<\/a><\/p>\n\n\n\n \u2022 For the other severely immunocompromised group, 10 days for nasal viral RNA, 6.5 days for culturable virus.<\/a><\/p>\n\n\n\n \u2022 For the less severely immunocompromised group, 12 days for nasal viral RNA, 6 days for culturable virus.<\/a><\/p>\n\n\n\n \u2022 For the nonimmunocompromised group, 13 days for nasal viral RNA, 7 days for culturable virus.<\/a><\/p>\n\n\n\n Taking It Seriously<\/p>\n\n\n\n The findings about persistent SARS-CoV-2 infection in the severely compromised group confirm case reports and case series, the authors noted.<\/a><\/p>\n\n\n\n \u201cPersistent symptoms past 10 days need to be taken seriously,\u201d Li said. One danger, he noted, is that patients might mistakenly attribute their persistent symptoms to post\u2013COVID-19 condition, commonly called long COVID, and assume they can no longer spread the virus.<\/a><\/p>\n\n\n\n The National Institutes of Health\u2019s COVID-19 treatment guidelines suggest<\/a> longer or additional courses of the antivirals nirmatrelvir-ritonavir (Paxlovid) or remdesivir (Veklury) only for patients who are immunocompromised and then only if symptoms persist and there is evidence of ongoing SARS-CoV-2 replication.<\/a><\/p>\n\n\n\n For everyone else, treatment with nirmatrelvir-ritonavir is supposed to be a single 5-day course, while the standard treatment with remdesivir for nonhospitalized patients is 3 consecutive daily infusions. The guidelines, last updated in early November 2023, acknowledged that definitive data to support extending treatment are lacking.<\/a><\/p>\n\n\n\n A case series<\/a> of 11 patients with persistent SARS-CoV-2 infection, published by researchers in Ireland and the UK in December 2023, suggested that prolonged nirmatrelvir-ritonavir treatment can effectively treat persistent SARS-CoV-2 infection in people who are immunocompromised.<\/a><\/p>\n\n\n\n Ten of the patients were hospitalized, 7 with severe COVID-19 (nirmatrelvir-ritonavir is approved only for outpatients with mild to moderate COVID-19 but can be prescribed off-label). On average, the patients, 9 of whom had a blood cancer, were treated with the antiviral pills for 10 days. None of the patients died, and 9 of them completely cleared the virus.<\/a><\/p>\n\n\n\n The Bs and Ts of Immunity<\/p>\n\n\n\n It might be surprising that some individuals who were immunocompromised in Li\u2019s study cleared SARS-CoV-2 even sooner than people who weren\u2019t.<\/a><\/p>\n\n\n\n But there were hints that it could happen from the earliest days of the pandemic, he noted. For example, a report<\/a>published in May 2020 described 2 young adults with X-linked agammaglobulinemia (XLA) who developed COVID-19-related interstitial pneumonia. People with XLA, an inborn error of immunity, have no circulating B cells. B cells, one of the 2 main types of lymphocytes, produce neutralizing antibodies that attack viruses and other invaders, so there was speculation that patients with the condition would likely become very ill if infected with SARS-CoV-2.<\/a><\/p>\n\n\n\n \u201cNeutralizing antibodies are protective,\u201d Charles Hackett, PhD, deputy director of the Division of Allergy, Immunology, and Transplantation at the National Institute of Allergy and Infectious Diseases, explained in an interview with JAMA<\/em>. \u201cIf you have enough of them, you don\u2019t even get infected.\u201d<\/a><\/p>\n\n\n\n But even though they lacked antibody-producing B cells, the 2 patients with XLA recovered without the need for intensive care or ventilation, suggesting that the T-cell response is probably important for protection against SARS-CoV-2, the authors wrote.<\/a><\/p>\n\n\n\n T cells are the other main type of lymphocyte. Unlike B cells, T cells don\u2019t recognize viruses until they infect cells, so they can\u2019t block infection, Hackett noted. Instead, T cells destroy infected cells.<\/a><\/p>\n\n\n\n One hypothesis is that when B cells are depleted, T cells rev up to compensate, Hackett said, adding, \u201cI hope that\u2019s true.\u201d<\/a><\/p>\n\n\n\n Hackett noted that he\u2019s known people infected with SARS-CoV-2 who had low neutralizing antibody titers. \u201cI was scared to death [for them], but they got over COVID just like an average person,\u201d he said.<\/a><\/p>\n\n\n\n In people who are severely immunocompromised due to a solid organ or stem cell transplant or leukemia or lymphoma, however, \u201cyou kind of disarm all of their weapons,\u201d Yijia Li, MD, said in an interview, referring to the effects of the immunosuppressive therapies such patients receive. The treatments leave behind neither a robust B-cell nor robust T-cell immune response, explained the University of Pittsburgh Medical Center infectious diseases physician, who was the first author on the new POSITIVES article coauthored by Jonathan Li (no relation).<\/a><\/p>\n\n\n\n The Upshot<\/p>\n\n\n\n Both Hackett and transplant surgeon Dorry Segev, MD, PhD, codirector of the NYU Langone Center for Surgical and Transplant Applied Research, praised the study.<\/a><\/p>\n\n\n\n \u201cThe study showed, in a very interesting way, qualitatively different selection pressure put on the virus by people who have differences in their immune system,\u201d Hackett said.<\/a><\/p>\n\n\n\n \u201cIt gives us a mechanistic underpinning for what we had observed clinically, and I think that\u2019s really important,\u201d Segev noted in an interview.<\/a><\/p>\n\n\n\n Unfortunately, Segev said, clinicians lack the tools to precisely assess where a patient who\u2019s immunocompromised falls on the scale of risk of severe and persistent COVID-19. \u201cWhat patients and their providers still dream of are some clinical correlates of the immune milieu,\u201d he pointed out.<\/a><\/p>\n\n\n\n Segev acknowledged that he used to think antibody tests<\/a> were the way to go for transplant recipients and others with compromised immune systems who were concerned about their ability to fend off SARS-CoV-2. Before \u201cthings went off the rails\u201d with the Omicron variant, \u201cwe knew that detectable circulating antibody correlated with neutralizing antibody,\u201d Segev said.<\/a><\/p>\n\n\n\n Today, though, he said, the sources of circulating antibodies can be numerous and vary from patient to patient, due to combinations of COVID-19 vaccines and infections with different variants. As a result, circulating antibody titers no longer reflect neutralizing antibody titers, except in people found to have no circulating antibody, Segev explained. In that case, he said, \u201cI can guarantee you you\u2019re not going to have neutralizing antibodies.\u201d<\/a><\/p>\n\n\n\n Perhaps if effective anti\u2013SARS-CoV-2 monoclonal antibodies were to become available for preexposure prophylaxis, there would be increased interest in developing tests to help determine which patients with compromised immune systems should be at the front of the line to get such treatments, Segev observed. \u201cWe really need to step up our game in terms of patient-level clinical testing.\u201d<\/p>\n","protected":false},"excerpt":{"rendered":" Medical News & Perspectives Quick Uptakes Feb […]<\/p>\n","protected":false},"author":3,"featured_media":0,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":[],"categories":[24,23],"tags":[],"_links":{"self":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts\/25563"}],"collection":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/users\/3"}],"replies":[{"embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=25563"}],"version-history":[{"count":1,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts\/25563\/revisions"}],"predecessor-version":[{"id":25564,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts\/25563\/revisions\/25564"}],"wp:attachment":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=25563"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=25563"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=25563"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}<\/figure>\n\n\n\n