【英语中国】中国禽流感:应当关注 无需惊恐

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2013-4-27 00:41

小艾摘要: TEVI TROYThe outbreak of avian flu in China has killed at least 22 people and infected more than 108─including a man in Taiwan who had traveled in the eastern Chinese city of Suzhou. For two months a ...
TEVI TROY

The outbreak of avian flu in China has killed at least 22 people and infected more than 108─including a man in Taiwan who had traveled in the eastern Chinese city of Suzhou. For two months airline stocks have been buffeted and officials have raised concerns about a possible pandemic. So why does the American public seem so unconcerned?

There are some good and some bad reasons for the relatively blasé reaction. Most obvious is that the disease seems far away. In addition, talk of pandemics is often overblown. The 2009 swine flu was bad but nowhere near the disaster that some experts feared.

On the positive side, public health has made significant advances in dealing with flu. These suggest cause for optimism about this outbreak and possible future ones.

The first major improvement is in the cooperative posture of the Chinese government─a far cry from the unfortunate experience with the SARS virus a decade ago. Back then, Beijing kept outside organizations such as the World Health Organization in the dark about the outbreak, which ultimately infected 8,000 people and killed about 800.

SARS spread across the Pacific (to Canada) and cost the global economy as much as $50 billion. A quicker and more open Chinese response could have limited the outbreak.

This time, by contrast, China is sharing information with the World Health Organization, closely monitoring the disease and aggressively culling flocks of chickens that could be infected.

Not that we should all sing kumbaya. Shanghai, where this flu began, is a relatively open part of China, which may account for some of the government's new transparency. In addition, the current director-general of the World Health Organization is China's own Margaret Chan. Her successors may not be viewed as favorably by Beijing.

Another positive story has to do with vaccine development and production. Thanks in large part to a push for greater vaccine capacity during the Bush administration, the United States now has a more reliable annual supply of the regular flu vaccine. Researchers in the U.S. have also seen improvements in cell-based vaccine technology that can supplement and perhaps even supplant traditional egg-based vaccines─meaning that vaccine quantity wouldn't be limited by the supply of eggs and wouldn't risk harming people with food allergies.

Regarding this outbreak's particular strain (H7N9), Chinese authorities have shared the virus with international flu labs, and U.S. health officials are developing lab strains that would allow American manufacturers to produce large amounts of a vaccine if needed.

The U.S. Biomedical Advanced Research and Development Authority and Novartis NOVN.VX +0.58% have a partnership that enabled them to start creating a vaccine before H7N9 even left China, based on the posted genetic sequence. This virus is particularly concerning because the H7 strain is hard for vaccine makers to match (and this year's flu vaccine had a not atypical effectiveness rate of only 62%). Still, Americans are much better off than they were just a decade ago.

The third cause for optimism is that there have been no recorded cases of so-called sustained human-to-human transmissions, meaning the movement of the virus from a single infected person to more than one other person. That occurred with SARS but not in previous cases of avian flu. If it did, it would be the nightmare scenario for public-health officials.

We aren't out of the woods just yet. While China has been tracking severe cases, it is unknown whether any individuals are mildly affected─having few symptoms but still being contagious. A recent World Health Organization report revealed that 40% of those infected had no obvious interactions with poultry, but they must have been infected somehow. The source of those transmissions is unknown.

Because of the uncertainties about transmission, the difficulties in matching H7 strains, and concerns about asymptomatic transmitters, the H7N9 outbreak bears careful watching. But the global public-health system is far more capable of dealing with flu than it was 10 years ago. Here's hoping that the current outbreak doesn't spread and test the limits of this improved system.

Mr. Troy is a senior fellow at the Hudson Institute and a former deputy secretary of Health and Human Services.

TEVI TROY

中国禽流感爆发已经导致至少22人死亡,超过108人感染,其中包括一名曾前往华东城市苏州的台湾男子。两个月以来,航空类股受到严重冲击,相关官员更加担忧这种疫病可能大规模流行。那么,为何美国公众似乎表现得无动于衷?

AFP/Getty Images上周,上海市中心的通勤者戴着口罩。这种相对来说漠不关心的反应原因众多,有好有坏。最明显的理由是,这种疾病似乎离美国人很远。除此而外,疫病大规模流行的说法常常言过其实。2009年的猪流感远远没有达到一些专家所担忧的程度。

从积极的一面说,公共卫生部门在应对流感方面取得了极大的进步。这是人们对于此次以及未来可能出现的禽流感爆发感到乐观的原因所在。

第一个重大进步是中国政府的合作姿态,这种表现与10年前非典(SARS)病毒流行时令人遗憾的经验大不相同。当时,中国政府向世界卫生组织(World Health Organization)等外部机构隐瞒了非典爆发的情况,非典最终导致8,000人感染,大约800人死亡。

非典蔓延到了太平洋对岸(加拿大),令全球经济至多损失500亿美元。如果中国方面当时反应更迅速、更坦率,本可以限制爆发的规模。

相比之下,这一次中国与世界卫生组织分享信息,密切监控疾病情况,并积极扑杀可能被感染的活禽。

这并不是说我们都应当大唱圣歌。这场禽流感的起源地上海是中国相对开放的地方,这可能也是中国政府此次表现透明的部分原因。另外,世卫组织现任总干事是来自中国的陈冯富珍。她的继任者在中国政府眼中可能不会如此亲切。

另一个积极方面与疫苗开发和生产有关。在很大程度上多亏了布什政府追求更大疫苗产能的努力,如今美国拥有更可靠的常规流感疫苗年度供应。美国的研究人员还看到了细胞疫苗技术的进步,相对于传统的基于鸡胚胎的疫苗,细胞疫苗可能作为补充甚至替代产品,这意味着疫苗数量将不受鸡蛋供应量的限制,对于食物过敏者也没有风险。

这次H7N9型禽流感爆发后,中国有关部门与国际上的一些流感实验室分享了病毒信息,美国卫生官员正在培育实验室菌株,使美国制造商可以在需要的情况下大批生产疫苗。

生物医学高级研究和发展管理局(Biomedical Advanced Research and Development Authority)和诺华(Novartis)结成了伙伴关系,它们因此能够在H7N9离开中国前,根据公布的基因序列开始研发疫苗。H7N9病毒尤其令人担忧,因为疫苗制造商很难匹配H7型毒株(今年的流感疫苗的有效性仅为62%,这并不是什么特例)。不过,美国人的状况比10年前要好得多。

第三个乐观的理由是,目前还没有出现所谓的持续人际传播的例子,持续人际传播指的是一名感染者传染多人的情况。SARS就是持续人际传播的例子,但是之前发生的禽流感病例都不属此类。如果H7N9可以持续人际传播,那对于公共卫生官员来说将是一场噩梦。

我们还没有脱离险境。尽管中国一直在追踪重症患者,目前还不清楚是否有轻度感染的患者(即没有出现症状,但仍有传染性)。世界卫生组织最近在一份报告中披露,40%的被感染者未曾与禽类有过明显接触,但是他们一定是通过某种其他方式被感染的。这种传播来源目前尚不清楚。

因为病毒传播的不确定性、匹配H7菌株的难度以及对无症状病毒传播者的担忧,H7N9疫情仍需谨慎观察。但与10年前相比,全球公共卫生系统应对流感的能力已经有了极大提高。希望疫情不会进一步扩大,也不会超出业已改善的全球公共卫生系统的能力范围。

(TEVI TROY是哈德逊研究所(Hudson Institute)的高级研究员,也是美国卫生及公共服务部(Department of Health and Human Services)前副部长。)

(本文版权归道琼斯公司所有,未经许可不得翻译或转载。)

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