Learning from smallpox: How to eradicate a disease - Julie Garon and Walter A. Orenstein

從天花的例證看如何根除疾病—茱麗葉．蓋倫 (Julie Garon)；瓦爾特．歐瑞斯汀 (Walter A. Orenstein)

譯者: Regina Chu 審譯者: Simon Sun

For most of human history,

人類歷史上大部分時間

medical workers sought to treat diseases or cure them.

醫療人員都在尋找 治療或治癒疾病的方法

The rise of vaccination in the 19th century

興起於 19 世紀的疫苗

enhanced the potential to prevent people

增強了人類在第一時間

from contracting illnesses in the first place.

對疾病的抵抗潛力

But only in recent decades did it become possible

但是僅在近數十年 疫苗才真正

to ensure that a particular disease never threatens humanity again.

確保某些疾病不再威脅人類

The story of smallpox,

天花的故事

the first and, so far, the only disease

這個史上第一且迄今唯一

to be permanently eradicated from the world,

從世上完全根除的疾病

shows how disease eradication can happen and why it is so difficult to achieve.

說明如何完全根除疾病 及為什麼這麼難達成

Smallpox emerged in human populations thousands of years ago

天花於數千年前在人群中出現

as a contagious virus that spread rapidly,

是傳染極快的病毒

primarily through close, face to face contact,

主要經由近距離、面對面接觸傳染

causing fever, aches and rashes.

導致發燒、身體疼痛及出疹

It killed up to 30% of its victims

致死率高達 30%

and often left survivors with life-long disfiguring scars.

倖存者通常會留下難看的永久疤痕

The devastating impact of smallpox was so great

天花的破壞影響之大

that several cultures had religious deities specifically dedicated to it.

數個文化甚至有宗教將之神化

In the 20th century alone,

僅在 20 世紀

it is estimated to have killed more than 300 million people worldwide.

估計全球就有超過三億人因之喪命

With the effective deployment of vaccination,

由於有效佈署疫苗

the number of cases began to decrease.

病例開始減少

By seeking out infected individuals,

藉由找出受感染的個體

isolating them,

隔離他們

and vaccinating their contacts to prevent further transmission,

並在與他們接觸過的人身上 接種疫苗以避免進一步傳染

scientists realized that the spread of the disease could be haulted.

科學家明瞭的確有方法 阻止這種疾病蔓延

In fact, because smallpox could only survive in human hosts,

事實上，因為天花只能 存活在人類宿主上

vaccinating all of an infected persons' potential contacts

在所有與病人接觸過的人 身上接種疫苗

would stop the virus dead in its tracks

會使病毒死在傳染路徑上

and eliminate it from that region.

並從感染區消除

Once this strategy had succeeded

這個策略成功將此疾病

in ridding most industrialized countries from disease,

從大部分工業化國家清除後

health officials realized that eradicating it worldwide was within reach.

衛生官員明瞭在全球根絕 這種疾病其實可行

But this was not an easy process,

但過程並不容易

proving especially difficult in places suffering from poor infrastructure

尤其在基礎建設很差

or civil wars.

或內戰憑仍的地區證明特別困難

The eradication effort took decades

根除行動花了數十年

and involved millions of people working together,

及數百萬人共同合作

from world leaders and international organizations

包括世界領袖及國際組織

to rural doctors and community workers.

鄉下的醫師及社區工作者

In India, one of the last strongholds of the disease,

印度是此疾病頑強的據點之一

health workers visited every one of the country's 100 million households

醫療人員探訪這個國家

一億個家庭以尋找病例

to search for cases.

Through this unprecedented worldwide effort,

藉由這個史無前例的世界級努力

in which even rival superpowers cooperated,

甚至連敵對的超級強國也一同合作

smallpox was finally declared eradicated in 1980,

天花終於在 1980 宣布根除

saving approximately 40 million lives over the following two decades.

在之後二十年救了約四千萬條生命

There were several factors

有幾項因素

that made smallpox an ideal candidate for eradication.

使天花成為理想的根除候選

First, humans are essential to the smallpox lifecycle,

第一，人類是天花生命週期的要素

so breaking the chain of human to human transmission

所以打破人傳人的途徑

causes the virus to die out.

可使病毒滅絕

In contrast, many other pathogens, like ebola or the bubonic plague,

相反的，其他病原體 如伊波拉或黑死病

can survive in animal carriers,

能在載體動物上存活

while the bacteria that cause tetanus can even live in the soil.

導致破傷風的細菌 甚至能在土壤中生存

Secondly, individuals infected with smallpox

第二，感染天花的個體

displayed a characteristic rash, making them easy to identify,

會出特別的皮疹，很容易辨識

even without a lab test.

不需要檢驗也看得出來

The lack of such practical diagnostic tools

在缺乏如此實用的診斷工具情況下

for diseases with non-specific symptoms, or that have long incubation periods,

沒有特別病徵或潛伏期長的疾病

such as AIDS, makes their eradication more difficult.

如愛滋病就很難完全消滅

Third, the availability of a smallpox vaccine

第三，天花疫苗的有效性

that provided immunity for five to ten years in a single dose

一劑可提供五到十年的免疫力

meant that there was an effective intervention

表示疫苗能有效干預

to stop the virus from spreading.

中止病毒傳播

And finally, the initial success of several countries

最後一點，有幾個國家取得初步成果

in eliminating the disease within their borders

在國境內消滅這種疾病

served as a proof of principle for its eradication worldwide.

成為全球根除天花的原理論證

Today, the same criteria are applied to determine

今天，同樣的條件也應用在決定

whether other diseases can be similarly eliminated.

其他疾病是否也可用 類似的方法消滅

And even though smallpox remains the only success story thus far,

即使天花是到目前為止 唯一成功的案例

several other pathogens may be next in line.

還有其他幾種病原體 可能成為下一個目標

Great progress has been made towards eradicating guinea worm disease

根除幾內亞線龍蟲病行動

simply by use of water filters.

僅因使用濾水器就有很大進展

And vaccination for polio,

小兒麻痺症

which previously disabled hundreds of thousands of people each year

在過去每年使成千上萬的人殘障

is estimated to have prevented 13 million cases of paralysis,

其疫苗自 1988 年起估計 已防止一千三百萬人癱瘓

and 650,000 deaths since 1988.

六十五萬人免於死亡

With a 99% drop in infections since the eradication effort began,

自根除行動開始 感染率降了 99%

one final push is all that is needed

只需最後一擊

to ensure that polio will never paralyze another child.

就可確保小兒麻痺症 不會再癱瘓任何孩童

Disease eradication is one public health effort that benefits all of humanity

根除疾病是造福 所有人群的公共衛生行動

and challenges us to work together as a global community.

並挑戰我們要以全球社群一同合作

Beyond eliminating specific diseases,

除了消滅特定疾病

eradication programs benefit local populations

根除行動還造福地方居民

by improving health infrastructure.

改善他們的衛生基礎建設

For example, Nigeria recently used facilities and personnel

例如，奈及利亞最近使用 當初根絕小兒麻痺症行動

from their polio eradication program to effectively control an ebola outbreak.

留下的設施及人員 有效控制當地一場伊波拉疫情

Further more, globalization and international travel

再者，全球化及國際旅行

means that even a single infection anywhere in the world

表示即使是區域性感染

can potentially spread to other regions.

也可能傳播至世界各地

By helping to protect others, we help to protect ourselves.

幫助保護別人其實就是保護自己

Disease eradication is the ultimate gift we can give to everyone alive today,

根除疾病是我們給所有在世的人

as well as all future generations of humanity.

及人類未來子孫的最大禮物