1. 2022年8月22日，在巴基斯坦拉合市，一名生工作者，在挨家挨行脊髓灰炎疫苗接活期，校童施予脊髓灰炎疫苗滴。 (援用自原文)
BY JEFFREY KLUGER
AUGUST 31, 2022
The recent return of polio has hit like something of an epidemiological thunderclap. It was in 1979 that polio was officially declared eradicated in the U.S.—an early step in a multi-generational effort to wipe out the disease around the world.
最近脊髓灰炎的返，已有像流行病上的晴天霹般，人造成影。於1979年，脊髓灰炎在美被正式宣根。是於世界各地，多代人努力消疾病中的一早期段。
On July 21, however, the New York State Department of Health announced a case of polio in an unvaccinated man in Rockland County, and since then, circulating poliovirus has been found in wastewater there and in neighboring Orange County, as well as in New York City. In London, the virus was also found in wastewater in February, and in Jerusalem, a case of the disease tured up that same month.
不，2022年7月21日，美州生部宣布一起，於克，一名未接疫苗的男子，感染上脊髓灰炎病例。那起，除了市之外，在那及近之治的水中，已循的脊髓灰炎病毒。於2月，在敦的水中，也了病毒。於同月，在耶路撒冷出了一例疾病。
The three cases, though seemingly isolated, point to a troubling trend—one that goes against more than three decades of progress in eradicating the disease. In 1988, polio was endemic in 125 countries and led to the death or paralysis of 350,000 people—mostly children—each year, according to the World Health Organization (WHO).
然看似孤立的，不三起事例指向了，一令人不安的向。三十多年，在根疾病上的展背道而。根世界生(WHO)的。於1988年，脊髓灰炎在125家流行，致每年35人(主要是童)死亡或麻症。
But thanks to a massive vaccination push by the WHO, Rotary International, UNICEF, the U.S. Centers for Disease Control and Prevention (CDC), and more, polio is now endemic in just two countries—Afghanistan and Pakistan—which have seen only 18 cases between them so far this year.
不，由於世界生、扶社、合童基金、美疾病控制暨防中心(CDC)等，推的大模疫苗接。目前，脊髓灰炎在阿富汗及巴基斯坦，家是流行病。到目前止，今年家，已18起病例。
Polio, however, is creeping back, and health officials are now on the alert for what Raul Andino-Pavlovsky, a professor of microbiology and immunology at the University of California, San Francisco, calls a “silent epidemic” of the disease around the world. “This is just the tip of the iceberg,” he warns.
不，脊髓灰炎正悄悄土重。目前，美生官密切注意著，有加州大金山分校微生物暨免疫教授，Raul Andino-Pavlovsky所，是一於世界各地之“寂的流行病”。他警告：「只是冰山一角。」
Adds Yvonne Maldonado, a professor of gloal health and infectious disease at Stanford University School of Medicine, “The case we saw [in New York] was unusual but a red flag that we need to be on the lookout for potential outbreaks. We do run the risk of developing more cases of paralytic disease.”
美史丹佛大院全球生暨染病教授，Yvonne Maldonado 充道：「我在[市]的病例是不常的，而且是我需要警惕，是可能爆的一旗(危)。我冒著，出更多麻症病例的。」
The bad news is that polio is stalking us anew. The good news is that just in the past year, a new vaccine has been added to the arsenal of existing polio vaccines—one that, properly deployed, could halt a new global outbreak of polio before it can get started. No matter what, the reappearance of the disease has raised a host of challenges—all of which need to be met if we’re to keep polio contained.
消息是脊髓灰炎，正再度悄悄靠近我。好消息是，就在去年，一新疫苗已添加到有脊髓灰炎疫苗中。倘若部署得，在其能始之前，那疫苗可能阻止脊髓灰炎新的全球爆。如何，疾病的再次出，已引多挑。倘若要控制脊髓灰炎，必需面所有此些挑。
Multiple factors have played a role in the return of polio—not the least of which is complacency, especially in the U.S. and other developed countries. When a majority of people alive have never encountered a case of a given disease, it’s easy to put it out of mind.
在脊髓灰炎的返中，多因素一直扮演一角色。其中最重要的是自，特是在美及其他已家。大多活著的人，未曾遭遇特定疾病的病例，很容易它後。
“People don’t remember polio, they don’t see it,” says Ian Lipkin, professor of epidemiology at Columbia University’s Mailman School of Public Health. “There’s something about our species that just allows us to forget about the importance of these things.”
美哥比大梅曼公共生院流行病教授，Ian Lipkin宣：「人不得脊髓灰炎(小麻症)，他看不到它。於咱物有某事物，使我於，有此些事情的重要性。」
That can lead to a slow erosion in vaccine compliance—something that the numbers bear out in the U.S. Nationwide, 92.6% of children are fully vaccinated against polio by age 2, according to the CDC. Broadly speaking, that’s an encouraging figure, but vaccination rates vary state to state and even county to county.
在疫苗依性上，那致慢弱。根美疾病控制暨防中心的法，92.6%的童到2，完全接了抗脊髓灰炎的疫苗，此一字了，在美全性值得重的事。，那是一令人鼓舞的字。不，疫苗接率各州，甚至各不一。
In Oklahoma, for example, polio vaccination rates are just 79.5%, and in South Carolina, the figure is 80.3%. In the Rockland County zip code where the case of polio turned up in June, the vaccination rate stands at an alarmingly low 37.3%.
譬如，在俄克拉荷州，脊髓灰炎疫苗接率79.5%，而在南卡州，一字80.3%。在州克政中，於6月出小麻症病例的地方，疫苗接率於低得令人的37.3%
The COVID-19 pandemic has also played a role in the return of the disease. “During the COVID era, families didn’t see their doctors or pediatricians as frequently as they normally would,” says Dr. William Schaffner, professor of infectious diseases at Vanderbilt University School of Medicine in Nashville, Tenn. “That has resulted in children falling behind in their routine vaccination schedules.”
在疾病的返上，2019冠病毒症(COVID-19：Coronavirus Disease-19)也曾扮演一角色。美田西州什市，范德比特大院染病教授，William Schaffner博士宣：「在冠病毒症期，多家庭不像它往常那，繁地看生或科生。那已致童，在其例行的疫苗接表上，延落後。」
According to Maldonado, the fall-off has been minimal, with just a 1% decline in polio vaccination rates among children since the pandemic began. But when it comes to infectious diseases, even a single percent can matter a lot.
根Maldonado的法，下降一直是微的，打上述大流行病始以，童的脊髓灰炎疫苗接率，下降1%。不，涉及染病，即使百分之一也有重大。
“It translates to tens of thousands of kids who aren’t completely vaccinated,” Maldonado says, “and those children are at risk for diseases that really shouldn’t exist in well-resourced countries.”
Maldonado宣：「意味著，有名孩童有完全接疫苗。而那些孩童冒有，在源富家中，上不存在的疾病。」
The irony of polio’s comeback is that the very vaccination campaign the CDC estimates has prevented 16 million cases of paralysis and 1.5 million deaths since 1988 is also partly responsible for the new resurgence. There are two kinds of polio vaccines.
脊髓灰炎返的反是，美疾病防暨控制中心估，打1988年以，已防1600麻症病例及150例死亡的同一疫苗接，也是致新的部分原因。有脊髓灰炎疫苗。
The first, known as the inactivated polio vaccine (IPV)—administered by injection—uses a killed virus to familiarize the body with the disease and prime it to recognize and attack a live virus if it ever encounters it.
第一，被通活的脊髓灰炎疫苗(IPV)，藉由注射施予。使用一死的病毒，使身熟悉疾病，使其好，倘若一再遭遇此活病毒，能行及攻。
The other, known as the oral polio vaccine (OPV)—administered by mouth—uses an attenuated, or weakened, virus that can do the same job of priming the immune system, without actually causing the disease. The advantage of the OPV is that it’s easier and cheaper to administer, which is why it’s used in global eradication campaigns. The big disadvantage is that on rare occasions, the weakened vaccine can revert to its virulent strain.
另一，被通口服的脊髓灰炎疫苗(OPV)，由口施予。使用一，能行免疫系的相同工作，而不真正引起疾病之少或弱毒性的病毒。由於容易施予且廉是OPV的，是何它被用於全球根中的原因。最大的缺是，在稀少的情下，弱化的疫苗其有毒的病毒株。
That can potentially lead to the disease in the person who received the vaccine, and even if it doesn’t, the reinvigorated virus is shed in feces, entering wastewater and potentially infecting other people. For that reason, the U.S. switched to the IPV exclusively in 2000—even though cases of viral reversion were exceedingly rare.
在上，在接此疫苗的人中，那致疾病。即使有，恢活力的病毒落於便中，之後入水中。因此，可能感染其他人。管，病毒逆的情罕。了那原因，在2000年，美排他性地向IPV。
“The crude estimate was one in 3 million doses of oral vaccine administered would lead to a case of polio in the U.S. before 2000,” Schaffner says. “It’s rare, but it’s not inconsequential.”
Schaffner宣：「粗略估，在美2000年之前，每300被施予的口服疫苗中，有一致一起脊髓灰炎症的病例。很罕，不非要。」
Indeed it’s not. Genetic sequencing revealed that the virus that caused the recent cases in New York and Jerusalem and was found in wastewater in London was so-called circulating vaccine-derived poliovirus (cVDPV).
事上非如此。基因排序示，致最近在及耶路撒冷的病例，及在敦水中被的病毒，是所循之疫苗衍生的脊髓灰炎病毒(cVDPV，是倘若人口重免疫力不足，有多易感的童，排泄之疫苗衍生的脊髓灰炎病毒，始在社中循。如果疫苗病毒能延，不循。它就生，且在12-18月的程中，重新得神毒性的病毒。)。
So far this year, cVDPV has led to 535 other cases of polio in 18 other countries, according to the Global Polio Eradication Initiative (GPEI).But the IPV has its problems too—in addition to its comparative difficulty of administration.
今年迄今止，根全球根脊髓灰炎倡(GPEI)的，cVDPV 在其他18家中，已致535起其他的脊髓灰炎病例。不，除了施予的比困之外IPV也有其。
The OPV, since it’s taken orally, establishes what’s known as gut immunity. Assuming the person who receives the vaccine is not among the unlucky few in whom the virus reverts to its virulent form, there is no viral replication in the intestinal system and thus no virus shed in the feces.
因OPV是口服的，其建立了所被通道的免疫力。假接此疫苗者，非少不幸在此病毒其毒性形式之列的人，那道系中有病毒。因此，便中有病毒落。
The IPV protects the recipient from ever contracting polio, but does not prevent intestinal replication and spread if that person ever picks up a cVDPV.
IPV保接受者免於感染脊髓灰炎，不倘若人感染上cVDPV，不阻止道及散播。
Andino-Pavlovsky believes that sampling wastewater in any part of the world where the IPV is used would likely turn up some circulating vaccine-derived poliovirus that IPV recipients contracted, replicated, and shed, endangering unvaccinated people.
Andino-Pavlovsky，在世界上使用IPV的任何地方，行水，可能一些，IPV接受者感染、及散播之循疫苗衍生的脊髓灰炎病毒，而危及未接疫苗接者。
“In Europe, in America, in Australia—every place where people are using the inactivated vaccine—it is likely,” he says. Even with the drawbacks to both vaccines, getting vaccinated is obviously better than not getting vaccinated, since all vaccine recipients are protected against contracting symptomatic polio.
他宣：「在洲、美、澳大利，人正在使用化之疫苗的每地方，是有可能的。」即使疫苗皆有缺，接疫苗然比不接疫苗要好。因，所有疫苗接受者皆受到，免於有症之脊髓灰炎的保。
But the OPV and IPV do exist in a state of tension, with one producing vaccine-derived virus and the other contributing to its spread. For that reason, the WHO and other global health organizations call for an eventual switchover to the IPV exclusively—a move that would mean there would be no vaccine-derived virus to be picked up and shed at all.
不，OPVIPV存在一。因，一生疫苗衍生的病毒，另一有助於其散播。了那原因，世界生及其他全球生呼，最底向IPV。一措意味著，全然不有疫苗衍生的病毒被及落。
“We need to stop giving the live virus so it stops circulating,” says Maldonado.
Maldonado宣：「我需要停止提供活病毒，以便其停止循。」
That, however, is not practical at the moment—not while there are still millions of babies and children who need vaccines in the developing world, where the IPV remains too pricey and skilled vaccinators who can administer injections are in far shorter supply than field workers who require little special training to administer drops to the mouth.
不，在目前那是不切的。因，在中家，IPV仍太昂，且施予注射之熟疫苗接人的供少於，需要少特殊培，即可口腔施予滴之工作人的地方，仍有百及童需要疫苗。
As a stopgap, the WHO, the Bill and Melinda Gates Foundation, and the U.K.’s National Institute for Biological Standards and Control have come together to develop a new oral vaccine that is far more stable than previous versions, reducing the likelihood of the attenuated virus used in the drops ever reverting to its virulent state.
作一宜之，世界生、比暨梅琳茨基金及英家生物暨控制研究所，已共同出一，比以前版本更定的新型口服疫苗，以降低弱之病毒，被使用於此些滴中，其毒性的可能性。
Andino-Pavlovsky, who was part of the team that designed the vaccine, explains that it works by targeting the spot on the viral genome that is responsible for reversion to virulence. In existing OPVs, that part of the genome needs to go through just a single mutation to go from being harmless to dangerous.
疫苗之的成，Andino-Pavlovsky解，其藉由定，於致毒性之病毒基因上的位，起作用。在有的OPV中，基因的那一部分，需一次突，就害向有危。
“What we basically did was modify this sequence,” he says, “so a single point mutation cannot cause reversion; virus now has to go through four or five different changes before acquiring a more virulent phenotype. Basically, it’s a numbers game.” As Andino-Pavlovsky earlier described it to the journal Nature, “It’s like putting the virus in an evolutionary cage.”
他宣：「基本上，我所做的是修改此序列。以便突不引起。目前，在得更具毒性的表型之前，一病毒必四或五次不同的改。基本上，是一字。」如同早些候，Andino-Pavlovsky向《自然》期刊描述那，「像是此病毒放在演化的子。」
The vaccine that contains that caged virus went into use in March 2021 and so far, 450 million doses have been administered in 22 countries. “The new vaccine is as effective as the previous one in generating immunity,” says Andino-Pavlovsky, “[and is] able to stop the silent epidemic.”
那具有上述中病毒的疫苗，於2021年3月投入使用，迄今止，在22家中，已被施予4.5。Andino-Pavlovsky宣：「在生免疫力上，新疫苗以前的疫苗一有效，[且]能阻止寂的流行病。」
The goal, ultimately, is to drive polio over the cliff to extinction—as smallpox was in 1980—with a slow phase-out of all OPV, universal use of IPV, and the eradication of any form of poliovirus circulating anywhere in the world. The current return of the disease is a reminder that that job is not nearly done. Until it is, an old scourge will haunt us anew.
最，此目是藉由慢逐步淘汰所有OPV、全面性使用IPV及消於世界任何地方循之任何形式的脊髓灰炎病毒，使脊髓灰炎，如同天花於1980年般，崖落向。目前，疾病的，是那工作有底被完成的一提醒之事。在完成之前，害以新方式常我。
址：https://time.com/6210019/polio-new-vaccine/?utm_medium=email&utm_source=sfmc&utm_campaign=newsletter+brief+default+ac&utm_cOntent=+++20220902+++body&et_rid=207513678&lctg=207513678
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