Romina Libster: The power of herd immunity (with English subtitles) | TED

Translator: Gisela Giardino Reviewer: Romina Pol

翻译人员: Hans Chen 校对人员: wanqing jiang

One of the first patients I had to see as a pediatrician was Sol,

我成為小儿科医师後， 第一批病人中有一位病人名字是索尔。

a beautiful month-old baby

一个一月大漂亮的婴儿，

who was admitted with signs of a severe respiratory infection.

她患有严重的呼吸道感染的症状。

Until then, I had never seen a patient worsen so fast.

在她之前，我从没看过 病人的病情恶化得这么快。

In just two days she was connected to a respirator

短短两天，她就得戴上呼吸器，

and on the third day she died.

然后第三天的时候她就死了。

Sol had whooping cough.

索尔患的是百日咳。

After discussing the case in the room and after a quite distressing catharsis,

在房间里讨论了这个病例， 并静静宣泄了心中的悲伤之后，

I remember my chief resident said to me,

我记得 我们的总住院医师对我说：

"Okay, take a deep breath. Wash your face.

「来，深呼吸，把脸洗干净。

And now comes the hardest part:

现在要做的才是最艰难的，

我们得去告诉她的父母。」

We have to go talk to her parents."

那个时候，我的心中涌现无数问题，

At that time, a thousand questions came to mind,

从 「为什么一个才一个月大的婴儿 要遭受如此不幸？」

from, "How could a one-month-old baby be so unfortunate?"

to, "Could we have done something about it?"

到 「还有什么是我们本可以做到的?」

在疫苗出现之前

Before vaccines existed,

many infectious diseases killed millions of people per year.

每年有成千上万人死于感染性疾病

1918年的大型流感

During the 1918 flu pandemic

50 million people died.

造成了五千万人死亡

That's greater than Argentina's current population.

这比阿根廷现在的人口还多

或许，在座年长些的人

Perhaps, the older ones among you remember the polio epidemic

还记得1956年在阿根廷肆虐的小儿麻痹症

that occurred in Argentina in 1956.

当时，没有可以用来 预防小儿麻痹症的疫苗

At that time, there was no vaccine available against polio.

People didn't know what to do. They were going crazy.

人们不知道该怎么办 大家都快急疯了

They would go painting trees with caustic lime.

他们往树上洒生石灰

They'd put little bags of camphor

他们将小袋的樟脑

in their children's underwear, as if that could do something.

放到孩子的内衣里 好像这么做能有什么帮助似的

那次小儿麻痹症的爆发 造成了成千上万人的死亡

During the polio epidemic, thousands of people died.

另有数以千计的人虽然活了下来 却落下了严重的神经损伤

And thousands of people were left with very significant neurological damage.

I know this because I read about it,

我知道这个事实， 因为我读过相关的书，

because thanks to vaccines, my generation was lucky

因为我们这一代多亏疫苗

而得以不用经历如此可怕的流行病

to not live through an epidemic as terrible as this.

Vaccines are one of the great successes of the 20th century's public health.

疫苗是20世纪公共卫生领域的壮举之一

它是继饮用水之后

After potable water,

they are the interventions that have most reduced mortality,

能够最大幅度降低死亡率的干预手段

even more than antibiotics.

它的效果甚至超过抗生素

Vaccines eradicated terrible diseases such as smallpox from the planet

疫苗彻底根除了 像天花那样可怕的疾病

and succeeded in significantly reducing mortality

也成功地大大降低了

其他像麻疹、

百日咳、小儿麻痹等疾病 所导致的死亡率

due to other diseases such as measles,

whooping cough, polio and many more.

All these diseases are considered vaccine-preventable diseases.

所有的这些疾病都被认为是 用疫苗可以预防的疾病

What does this mean?

这是什么意思呢？

That they are potentially preventable,

这表示它们是可以被预防的

but in order to be so, something must be done.

但要预防，你必须采取一定的措施

You need to get vaccinated.

那就是接种疫苗

我猜测即使不是全部的人 今天在座的大部分人

I imagine that most, if not all of us here today,

received a vaccine at some point in our life.

在人生的某个时刻曾经接种过疫苗

现在，我不是很确定多少人知道

Now, I'm not so sure that many of us know

which vaccines or boosters we should receive after adolescence.

成年之后我们应该接种 哪些疫苗或者辅助药剂

Have you ever wondered who we are protecting

你曾想过当我们接种疫苗是为了保护谁吗？

when we vaccinate?

我们应该在何时接种疫苗？

What do I mean by that?

我这么说是什么意思呢？

Is there any other effect beyond protecting ourselves?

接种疫苗除了保护我们自己还有什么其他效果吗？

Let me show you something.

让我来展示给你们看

Imagine for a moment

想象一下

我们正身处在一个城市里

that we are in a city

that has never had a case of a particular disease,

而这个城市从未有过某种疾病的病例

such as the measles.

比如说麻疹

This would mean that no one in the city has ever had contact with the disease.

这就意味着这城市里从未有人接触过这种疾病

没有人对这个疾病有天生的抵抗力 或者曾经接种过它的疫苗

No one has natural defenses against, nor been vaccinated against measles.

If one day, a person sick with the measles appears in this city

如果有一天，一个麻疹患者来到这个城市

the disease won't find much resistance

这个疾病将不会受到任何阻碍

and will begin spreading from person to person,

并在人们之间开始传播

and in no time it will disseminate throughout the community.

然后很快它就会传遍整个社区

After a certain time

不久后

a big part of the population will be ill.

很大一部分的人就会患病

This happened when there were no vaccines.

这是没有疫苗的情况

Now, imagine the complete opposite case.

现在，让我们试着想想一个完全相反的情况

We are in a city

我们在一个城市

where more than 90 percent of the population

这里百分之九十的居民

has defenses against the measles, which means

都对麻疹有免疫力，这也就意味着

that they either had the disease, survived, and developed natural defenses;

他们要么曾经得过麻疹并活了下来， 产生了自然的免疫力

or that they had been immunized against measles.

要么已经接种过疫苗并对麻疹产生了免疫力

如果有一天

If one day,

a person sick with the measles appears in this city,

一个患有麻疹的人来到这里

这个疾病的传播将遇到更大的阻力，

the disease will find much more resistance

and won't be transmitted that much from person to person.

也不会在人和人之间传染得那么快

The spread will probably remain contained

它的传播很有可能会得到控制

and a measles outbreak won't happen.

于是也不会有麻疹疫情爆发

我希望你能够关注到其中的一些东西

I would like you to pay attention to something.

People who are vaccinated

接种了疫苗的人们

are not only protecting themselves,

不仅仅在保护自己

也在阻碍着社区内

but by blocking the dissemination of the disease

within the community,

疾病的传播

they are indirectly protecting the people in this community

他们间接地保护着这个社区里

没有接种过疫苗的人们

who are not vaccinated.

They create a kind of protective shield

他们创造了一种防护盾

which prevents them from coming in contact with the disease,

以使他们不与疾病接触

so that these people are protected.

从而让这些人得到保护

This indirect protection

这种通过接种人群

来达到保护未接种人群目的

that the unvaccinated people within a community receive

的间接保护措施

叫做群体免疫

simply by being surrounded by vaccinated people,

is called herd immunity.

社区中的很多人

Many people in the community

depend almost exclusively on this herd immunity

几乎完全依靠这种群体免疫

to be protected against disease.

来预防疾病

The unvaccinated people you see in infographics are not just hypothetical.

你在图里看见到的没有接种过的人们 并非单纯的假想

那些人可能是我们的侄女、侄子、 我们的孩子

Those people are our nieces and nephews, our children,

who may be too young to receive their first shots.

他们可能因为太小 还未接种过疫苗

另外一些人可能是我们的父母、 我们的兄弟姐妹、

They are our parents, our siblings,

our acquaintances,

我们的熟识的人

who may have a disease,

他们可能带有疾病

or take medication that lowers their defenses.

或正在服用会降低他们防御力的药物

也有一些人会对特定的疫苗过敏

There are also people who are allergic to a particular vaccine.

他们甚至可能就在我们身边

They could even be among us,

any of us who got vaccinated,

那些接种过疫苗

but the vaccine didn't produce the expected effect,

但没有产生预期的效果的人，

because not all vaccines are always 100 percent effective.

因为疫苗并不是百分之百有效的

所有这些人 几乎完全依靠群体免疫

All these people depend almost exclusively on herd immunity

to be protected against diseases.

来预防各种的疾病

要实现群体免疫，

To achieve this effect of herd immunity,

it is necessary that a large percentage of the population be vaccinated.

就需要群体中大部分人接种疫苗

This percentage is called the threshold.

这个百分比被称作阈值

这个阈值取决于很多变量

The threshold depends on many variables:

它取决于微生物的特性

It depends on the germ's characteristics,

and those of the immune response that the vaccine generates.

以及那些疫苗引起的微生物免疫反应的特性

但是它们都有共同点

But they all have something in common.

If the percentage of the population in a vaccinated community

如果社区里接种过疫苗的人口百分比

is below this threshold number,

低于这个阈值的数字

the disease will begin to spread more freely

那么这个疾病就会很容易传播

and may generate an outbreak of this disease within the community.

且这个社区可能会爆发这种疾病

Even diseases which were at some point controlled may reappear.

即使是那些一度被控制下来的疾病， 也有可能再次爆发

This is not just a theory.

这不仅仅是一个理论

This has happened, and is still happening.

这样的事情曾发生过 且还在继续发生

在1998年，一位英国研究人员

In 1998, a British researcher published an article

in one of the most important medical journals,

在一本很有影响力的医学杂志上 发表了一篇文章

saying that the MMR vaccine,

他说，用来预防

which is given for measles, mumps and rubella,

麻疹、腮腺炎和风疹的MMR混合疫苗

was associated with autism.

可能会引发自闭症

This generated an immediate impact.

这篇文章立即引起了反响

人们开始不再接种疫苗 也不再让他们的孩子接种疫苗

People began to stop getting vaccinated, and stopped vaccinating their children.

And what happened?

接下来发生了什么呢？

The number of people vaccinated,

世界上很多社区里

in many communities around the world, fell below this threshold.

接种过疫苗的人数降至这个阈值之下

And there were outbreaks of measles in many cities in the world --

接着麻疹在世界上很多城市爆发--

in the U.S., in Europe.

包挂美国以及欧洲的城市

Many people got sick.

很多人都生病了

People died of measles.

许多人死于麻疹

What happened?

为什么会这样呢？

This article also generated a huge stir within the medical community.

这篇文章也在医学界引起了巨大的骚动

很多研究员开始评测文章观点的真实性

Dozens of researchers began to assess if this was actually true.

不仅没有人找到

Not only could no one find

a causal association between MMR and autism at the population level,

MMR和自闭症之间的因果联系

but it was also found that this article had incorrect claims.

且人们发现这篇文章的主张并不正确，

Even more, it was fraudulent.

甚至可以说，它是有欺诈性的

它是虚假的

It was fraudulent.

事实上，这本杂志于2010年 公开地撤回了这篇文章

In fact, the journal publicly retracted the article in 2010.

One of the main concerns and excuses for not getting vaccinated

导致人们不愿接种疫苗最大的顾虑和借口之一就是

are the adverse effects.

疫苗的副作用

Vaccines, like other drugs, can have potential adverse effects.

疫苗和其他药品一样都可能有副作用

Most are mild and temporary.

多数的副作用轻微而短暂

But the benefits are always greater than possible complications.

但是疫苗的好处远远大于潜在的副作用

When we are ill, we want to heal fast.

我们生病时，我们都希望迅速恢复

在座的大多数

Many of us who are here

take antibiotics when we have an infection,

在受到细菌感染时会服用抗生素

在患有高血压时服用抗高血压药

we take anti-hypertensives when we have high blood pressure,

我们服用心脏药物

we take cardiac medications.

为什么？因为我们生病时， 我们都想要快点恢复健康

Why? Because we are sick and we want to heal fast.

And we don't question it much.

我们不会对其提出很大质疑

Why is it so difficult to think of preventing diseases,

为什么想到预防会如此困难？

by taking care of ourselves when we are healthy?

为什么不在患病前好好照顾自己、预防疾病？

We take care of ourselves a lot when affected by an illness,

我们在生病时或生命垂危时

or in situations of imminent danger.

很会照顾自己

我想在座的大多数人

I imagine most of us here,

remember the influenza-A pandemic

都还记得2009年在阿根廷以至全世界

爆发的大型流感疫情

which broke out in 2009 in Argentina and worldwide.

When the first cases began to come to light,

首名患者被确诊的时候，

我们的阿根廷正步入冬季

we, here in Argentina, were entering the winter season.

We knew absolutely nothing.

我们对此流感一无所知

Everything was a mess.

一切都非常混乱

People wore masks on the street, ran into pharmacies to buy alcohol gel.

大家在街上都戴口罩， 跑去药房买酒精凝胶

People would line up in pharmacies to get a vaccine,

大家去药房排队打疫苗

without even knowing if it was the right vaccine

他们甚至都不知道这个疫苗

that would protect them against this new virus.

能否对抗这个新的病毒

我们实在是一无所知

We knew absolutely nothing.

At that time, in addition to doing my fellowship at the Infant Foundation,

那时，我除了在婴儿基金会服务

I worked as a home pediatrician for a prepaid medicine company.

还在一家预付药品公司 从事家庭小儿科医师

I remember that I started my shift at 8 a.m.,

我记得我在早上八点开始轮班

and by 8, I already had a list of 50 scheduled visits.

每八点就已有50人预约看病

那时真是混乱，人们不知如何是好

It was chaos; people didn't know what to do.

I remember the types of patients that I was examining.

我记得我所检查的一些病人的样子

The patients were a little older than what we were used to seeing in winter,

那些病人比我一般在冬天看的病人 年纪大一点

他们发烧也持续更久

with longer fevers.

我向我的导师提起时

And I mentioned that to my fellowship mentor,

and he, for his part, had heard the same from a colleague,

他说他从其他同事那里， 也听到过同样的情况：

about the large number of pregnant women

许多的怀孕妇女

and young adults

和年轻人

住进了加护病房

being hospitalized in intensive care,

with hard-to-manage clinical profiles.

病情十分棘手

At that time, we set out to understand what was happening.

那时，我们想要了解到底怎么一回事

First thing Monday morning, we took the car

我们首先做的就是在周一早晨开车去

and went to a hospital in Buenos Aires Province,

布宜諾斯艾利斯省的一个医院

that served as a referral hospital for cases of the new influenza virus.

所有患上新型流感的病人都被送到那里

我们到达了那个医院； 医院非常拥挤

We arrived at the hospital; it was crowded.

All health staff were dressed in NASA-like bio-safety suits.

所有医护人员都穿着如太空人的 生物安全服

We all had face masks in our pockets.

我们口袋里都有口罩

I, being a hypochondriac, didn't breathe for two hours.

我因为过分担心自己的健康， 几乎两个小时都不敢呼吸

我们可以看到到底发生了什么

But we could see what was happening.

Immediately, we started reaching out to pediatricians

我们马上联络了

市区内以及布宜諾斯艾利斯省 六个医院的儿科医生

from six hospitals in the city and in Buenos Aires Province.

我们的主要目标是

Our main goal was to find out

how this new virus behaved in contact with our children,

在最短的时间内找到

in the shortest time possible.

这个新病毒在小孩身上的反应

A marathon work.

那是一次同病毒抗争的马拉松

In less than three months,

不到三个月，

we could see what effect this new H1N1 virus had

我们看到了这个新H1N1病毒

on the 251 children hospitalized by this virus.

在251例患病住院的小孩身上的表现

We could see which children got more seriously ill:

我们可以看出哪些孩子的患病程度会更加严重

children under four, especially those less than one year old;

这其中包括四岁以下的小孩， 尤其是一岁以下的小孩

patients with neurological diseases;

还有患有神经系统疾病的小孩

and young children with chronic pulmonary diseases.

以及有慢性肺部疾病的小孩

找出这些高危险群是十分重要的，

Identifying these at-risk groups was important

to include them as priority groups

因为这样的话

in the recommendations for getting the influenza vaccine,

我们就可以将他们纳入优先接种的人群

not only here in Argentina,

不仅仅是在阿根廷

but also in other countries which the pandemic not yet reached.

更是在其他这个流感尚未侵袭的国家

A year later,

一年后

when a vaccine against the pandemic H1N1 virus became available,

当有了对抗H1N1流感疫苗

we wanted to see what happened.

我们想知道情况如何

在进行了针对高风险人群的

After a huge vaccination campaign

大型接种运动之后

aimed at protecting at-risk groups,

these hospitals, with 93 percent of the at-risk groups vaccinated,

那些有93%的高风险群接种率的医院

had not hospitalized a single patient

再没接到过一例

for the pandemic H1N1 virus.

H1N1 流感患者

(Applause)

（掌声）

In 2009: 251.

从2009年的251例

In 2010: zero.

到2010年的0例，

Vaccination is an act of individual responsibility,

接种疫苗虽然是为自己负责的行为

but it has a huge collective impact.

但是对群体却有巨大的影响

If I get vaccinated, not only am I protecting myself,

如果我打了疫苗， 我不仅保护了我自己

but I am also protecting others.

还保护了其他人

Sol had whooping cough.

索尔患上了百日咳

Sol was very young,

她还太小

and she hadn't yet received her first vaccine against whooping cough.

以至于她还没有接种百日咳的疫苗

我还是常想

I still wonder what would have happened

如果索尔旁边的人都打了疫苗， 她会如何呢？

if everyone around Sol had been vaccinated.

(Applause)

（掌声）