It is hard to overstate the beneficial effects of immunization. According to the US Centers for Disease Control, US children born over the last 20 years -- for those children, vaccines will prevent greater than 322 million illnesses, greater than 21 million hospitalizations and greater than 730,000 deaths, with the societal cost savings of nearly 1.4 trillion dollars. Those are big numbers. But let's zoom in and look at a particular example.
免疫接种的益处 再怎么强调也不为过。 根据美国疾病控制与预防中心的数据, 过去 20 年内出生的美国小孩—— 对他们来说,疫苗能预防 超过 3.22 亿起病例、 超过 2100 万例住院, 以及超过 73 万例死亡, 并节省近 1 万 4 千亿美元的社会开支。 这些都是巨额数字。 但让我们来具体看看一个实例。
Vaccines have nearly eliminated a bacterial infection called Haemophilus influenzae. This bacterium used to infect young infants causing bloodstream infections, pneumonia, meningitis, death or permanent disability. As a young pediatrician, I saw a few cases. You folks probably have never heard of this disease, because vaccines have been so effective. You could see in the graph on the right that since the introduction of vaccines, the incidence of Haemophilus bacterial infections has plummeted like a rock, and it's nearly vanished. So vaccines are generally a success story. But we also face challenges.
疫苗已近乎根除了 一种叫做流感嗜血杆菌的细菌感染。 在过去,这种细菌 会感染年幼的婴儿, 导致血流感染、 肺炎、脑膜炎、死亡 或者终身残疾。 当我还是一名年轻的儿科医生时, 我曾见过几个案例。 大家可能从未听过这种疾病, 因为疫苗的效果非常好。 从右边的图表里可以看出, 自从引入了疫苗, 流感嗜血杆菌感染的病例 呈断崖式骤降,并已几乎绝迹了。 因此疫苗一般来说非常成功, 但我们也面临着挑战。
For one, for most vaccines, we need to give multiple doses to achieve or maintain protection. The scientific community is working on developing single-shot vaccines. Imagine being able to get only one influenza shot your whole life and not having to get a seasonal flu vaccine. Certain microbes are difficult to immunize against. A classic example is human immunodeficiency virus, or HIV. The need is urgent, progress is being made; we're not there yet. Another critical element in vaccine research right now is optimizing vaccines for the most vulnerable among us, the very young and the elderly. And this is an active area of research.
首先,大多数疫苗需要多次接种 才能获得或维持免疫。 科学界正在努力开发 只需单次接种的疫苗。 试想一下,一辈子 只需要打一次流感疫苗, 再也不用去打季节性流感疫苗了。 某些微生物导致的感染比较难预防。 一个经典例子就是人类免疫缺陷病毒, 即艾滋病毒(HIV)。 该疾病对疫苗的需求十分紧迫, 在研发方面也有所进展; 但还没有成功。 目前的疫苗研究中, 另一个至关重要的要素 是为易感人群优化疫苗, 也就是婴幼儿和老年人。 这是一个非常活跃的研究领域。
Finally, one of the biggest challenges we unfortunately face right now are anti-vax attitudes. In fact, it's alarming that over 100,000 infants and children in the United States have not received any vaccines, and that number is growing. In fact, the World Health Organization, or WHO, has declared anti-vax attitudes as one of the 10 most important threats to human health in the world today. This graphic illustrates the spread of anti-vax sentiment in the state of California, from the year 2000 to 2013, by looking at the percentage of public kindergarten students who claim the personal exemption against immunization.
然而令人遗憾的是, 我们最终面临的最大挑战之一 是反对疫苗的态度。 事实上,非常令人担忧的是, 美国有超过 10 万名婴儿与儿童 从未接种过任何疫苗, 而这个数字还在增长。 事实上,世界卫生组织(WHO) 已经把反对疫苗的态度 列为了当今世界上 对人类健康最重要的 十大威胁之一。 这张图诠释了 2000 年至 2013 年期间 在加利福尼亚州 扩散的反疫苗情绪, 显示的是公共幼儿园学生中 要求个人疫苗豁免的百分比。
Anti-vax sentiment is on the rise, and it has very real consequences. Many of you may be aware of the fact that we're seeing infections that we thought we conquered long ago coming back. Measles outbreaks have been reported in multiple US states. And many have forgotten, but measles is very infectious and dangerous. Just a few viral particles can infect an individual. And there have been even reports at sporting events and at an Olympic stadium where the virus, through the air, travels long distances and infects a vulnerable person in the crowd. In fact, if I had a measles cough right now,
反疫苗情绪正在上升, 这会带来非常现实的后果。 你们很多人可能都知道, 一些我们觉得很久以前 就已经消灭的传染病 又开始死灰复燃了。 美国多个州都报道 出现了麻疹疫情。 很多人已经遗忘了 这个严酷的事实: 麻疹传染性极强,也很危险。 仅仅少量病毒颗粒 就能感染一个人。 甚至曾有报道称, 在体育比赛现场、 在奥运会场馆内, 麻疹病毒在空气中 传播了很远的距离, 并感染了人群中 一位易感人员。 事实上,如果我的咳嗽中 带有麻疹病毒,
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somebody in the back of this auditorium could get infected. And this has had very real-world consequences. Just a few months ago, an airline stewardess contracted measles on a flight, the virus entered her brain and caused encephalitis, and she died. So people are now dying due to this anti-vax sentiment.
这个演讲厅后排的某个人 就可能会被传染。 这一现象有着非常现实的后果。 仅仅几个月前, 一位空姐在航班上感染了麻疹, 病毒进入了她的脑部, 引起了脑炎, 导致她不幸去世。 现在人们正因为 这种反疫苗情绪而丧命。
I do want to take a few minutes to address those who don't believe in vaccines and who resist vaccines. As a pediatrician who receives my yearly flu vaccination, as a parent of three children who have been vaccinated according to the recommended schedule, and as a pediatric infectious disease consultant who has taken care of young children with meningitis that would have been preventable had their parents accepted immunization, this is a personal matter to me. Let's take a look at who is going to pay the price if we start dialing back the amount of vaccination in our society. This graph depicts, on the Y axis, the number of individuals dying of infection in the world. And on the X axis, the age of the individuals who are dying. And as you can see, it's very much a U-shaped distribution, and it's particularly stark in the very young ages. So vaccines shield the very young from infection. And if we want to talk, my friends, about what vaccines cause, because there's a lot of speculation, unfounded speculation on the internet, of what vaccines cause, vaccines cause adults, OK? That's what they cause. And the other thing that they cause is for elderly individuals to live longer. Because they are shielded against influenza and other killers of the elderly.
我想花几分钟时间, 跟那些不相信疫苗、 抵制疫苗的人 说几句话。 作为一名每年都接种 流感疫苗的儿科医生, 作为根据推荐时间表 接种疫苗的三个孩子的家长, 作为一名照顾过脑膜炎患儿的 儿科传染病顾问—— 要是家长愿意为孩子接种疫苗, 他们完全可以不受病痛之苦—— 疫苗接种对于我个人 也有着非常重要的意义。 让我们看看,要是把社会中 疫苗接种的数量往回拨, 谁会为此付出代价。 这张图的纵轴显示的 是世界上因感染而死亡的人数。 横轴则代表了 死者的年龄。 可以看出,这是一个 明显的“U”型分布, 在婴幼儿年龄段, 感染风险非常高, 而疫苗能保护婴幼儿免受感染。 各位,如果我们想谈谈 疫苗会导致的后果, 因为有很多谣言—— 网上对疫苗导致的后果 有很多毫无根据的流言—— 疫苗只会“导致”你长大成人,好吧? 这就是疫苗的后果。 疫苗还能“导致”另一个后果, 那就是让老年人活得更长久。 因为它们能防护老年人 免受流感之恙, 还有其他对老年人来说 非常致命的疾病。
Now, let's talk a little bit about how we can improve vaccines even further. We can create vaccines that can immunize the most vulnerable among us and perhaps even vaccines that protect with single shots. Let me go over a little bit of the immunology. In the top panel, what you see is a simple vaccine. All vaccines contain something called an antigen. The antigen is like a piece of a germ, of a microbe, that your body remembers, right? It forms antibodies and those antibodies can protect you. So those kind of vaccines can induce an immune response, but as you see here, that immune response tends to go up and back down, and you need to get another dose and another dose to maintain protection. What can we do?
那么,让我们再讲讲 如何进一步改良疫苗。 我们能研发出为最脆弱的人群 提供免疫保护的疫苗, 或许甚至还能研发出 只需单次注射就能提供防护的疫苗。 让我简单介绍一下免疫学的原理。 上面的图展示的 是一种简单的疫苗。 所有疫苗都含有 一种叫做“抗原”的东西。 抗原就像是一小块细菌, 一小块微生物, 能让你的身体记住它。 你的身体会产生抗体, 而这些抗体能保护你。 这种疫苗能引起免疫反应。 但像这里显示的这样, 免疫反应一般会先上升,随后回跌, 于是你需要再接种一针又一针, 才能获得免疫保护。 我们能做些什么呢?
We and other scientists around the world are finding molecules that can boost a vaccine response. Those are called adjuvants, from the Latin "adjuvare," to help or aid. Adjuvants are molecules we might add to a vaccine to get a stronger response. And in the presence of the adjuvant, depicted here in red, you have a much more profound activation of the white blood cells of your immune system, and generate a much more profound immune response, with much higher antibody levels, more rapidly, and that lasts a long time for durable immunity. Interestingly, these adjuvants have different effects depending on the age or other demographic factors of the individual. Which brings me to the notion of precision vaccines.
我们和世界各地的科学家 都在寻找能增强疫苗反应的分子。 它们叫做 “佐剂(adjuvant)”, 来源于拉丁语的 “adjuvare”, 意为 “帮助”,或 “协助”。 我们能把佐剂这种分子 添加到疫苗中, 以增强免疫应答。 在有佐剂,也就是图中的 红色星星的情况下, 你的免疫系统中的白细胞 会被更强烈地激活, 产生更加强烈的免疫反应, 更快地产生更高的抗体浓度, 并会持续更长时间, 提供持久的免疫保护。 有趣的是,这些佐剂 会根据个体的年龄 或者其他人口学因素 产生不同的效果。 这也就引出了“精准疫苗”的概念。
This is the idea that we will take precision medicine -- you know what precision medicine is, right, that's the idea that populations may vary in their response to a particular medicine -- and apply that to vaccines. Right? And here in Boston Children's Hospital at the Precision Vaccines Program I direct, we have five approaches, stepwise approaches we take, to build precision vaccines that are tailored to vulnerable populations.
这个概念是说, 我们能将精准医学—— 各位知道什么是精准医学吧, 就是指不同人群对某一特定药物 会产生不同反应—— 并将其应用到疫苗上。 对吧? 在波士顿儿童医院这里, 在我负责的精准疫苗项目中, 我们会通过五种逐步式的方法 为易感人群定制 精准疫苗。
Number one, we need to understand what the attitude of a given population is towards a vaccine. You could build the most sophisticated vaccine in the world, but if nobody wants to take it, you're going nowhere. Number two, we have to think of the route of immunization. Most vaccines are intramuscular, or IM, but there are others, intranasal, oral and others. Then, as I just described to you, vaccines have components. All vaccines have an antigen, that's the part of the microbe that your body remembers, that you might make antibodies or cell-mediated immunity against. And we might add an adjuvant, as we talked about, to boost an immune response. But guess what? There are many different antigens to choose from and many different adjuvants. How are we going to make that decision? And the menu of these keeps growing.
第一, 我们需要理解某个特定群体 对待疫苗的态度。 你可以制作出世界上 最精良的疫苗, 但假如没有人愿意接种, 那还是徒劳。 第二, 我们必须考虑 免疫接种的途径。 大多数疫苗都是 通过肌肉注射接种的, 不过也有鼻内、口服等其它途径。 另外,就像我刚刚描述的那样, 疫苗有不同的组成成分。 所有疫苗都含有抗原, 也就是你的身体所记住的 微生物的一部分, 你能对它产生抗体 或者细胞介导免疫反应。 此外,我还提到过, 我们可以添加佐剂, 以增强免疫反应。 猜猜看怎么着? 我们可以从很多不同抗原 和很多不同佐剂中进行选择。 我们该如何做出决定呢? 而这些成分的种类 还在不断增长。
So on our team, we've developed ways to test vaccines outside the body -- in Latin, that's "in vitro" -- in a tissue culture dish. So we use tissue engineering with blood cells to immunize outside the body and study the effect of the vaccine against, for example, infants or elderly individuals or others. And if you think about it, this is critical, because if you look at all the infections we want to build vaccines against, like Zika virus and Ebola virus and HIV and others, all the candidate antigens, all the candidate adjuvants, all the different populations, it's going to be impossible to do large, phase III clinical trials for every combination. This is where we think being able to test vaccines outside the body can make a big difference to accelerate vaccine development.
于是我们的团队 开发了在组织培养皿中, 即在体外测试疫苗的方法—— 拉丁文叫做 “in vitro”。 我们对血细胞进行组织工程学处理, 在体外接种疫苗, 并研究疫苗对婴儿、 老年人或其他人群的效果。 仔细想想就会发现 这一步至关重要, 因为如果考虑到我们想要 通过疫苗预防的所有传染病, 比如寨卡病毒、埃博拉病毒、 艾滋病毒等等, 所有待选病原体、 所有待选佐剂、 所有不同人群, 我们不可能对每一种组合都进行 大型 Ⅲ 期临床试验。 因此我们认为, 在体外测试疫苗 能够大大加速疫苗的研发。
And finally, this whole effort is to drive an immune response that will protect against that particular pathogen, getting antibodies and other cells to defend the body. We are also using additional innovative approaches to bring the most cutting-edge science to vaccine development. We're taking a deeper dive as to how current vaccines protect. We've formed an international consortium to study how hepatitis B vaccine protects newborns from hepatitis B infection. And to do this, we've developed a technique called small sample, big data. We can get a tiny little drop of baby blood before immunization, and take a tiny little drop after immunization, and we can measure the inventory of all the cells, and all the genes and all the molecules in that drop of blood, and we can compare after the vaccine to before the vaccine in that same baby and understand in a deep way exactly how that successful vaccine protects. And those lessons we can use to build the next vaccines in the future. So this diagram is really illustrating a tiny drop of blood yielding huge amounts of information, tens of thousands of analytes, and that hairball is meant to depict the gene pathways that are turned on and the molecular pathways that are turned on. So much more to come on that, and very exciting science.
最后,所有这些努力 都是为了激活免疫反应, 针对某种特定病原体构筑防线, 让抗体和其它细胞 为身体进行防御。 我们还在使用其它创新的方法, 将最前沿的科技 引入疫苗研发中。 我们还在深入研究 目前的疫苗究竟如何提供防护。 我们形成了一个国际联合会, 研究乙肝疫苗如何保护新生儿 免遭乙肝病毒感染。 为了实现这一目标, 我们开发了一项称为 “小样本,大数据”的技术。 我们可以在接种疫苗之前以及之后 各采集一小滴婴儿的血液样本, 然后我们就能测量那一小滴血里 所有的细胞、基因和分子, 于是我们就能比较同一个婴儿 接种疫苗前后的数据, 从更深的层面理解 那个成功的疫苗 究竟是如何提供保护的。 然后我们就能将这些知识 应用到未来的疫苗研发中去。 这张图展示了一小滴血 蕴含了海量信息, 成千上万种分析物, 那边的“线团”描述的是 被启动的基因回路 和被激活的分子通路。 这是一项十分激动人心的科学, 我们将迎来很多重大进展。
So we are partnering with scientists around the world to bring all these new technologies to invigorate vaccine development in a Precision Vaccines network. We are going to advance personalized vaccines for vulnerable populations around the world. Our team includes scientists, technical experts and physicians. And we're developing vaccines against infectious diseases like pertussis, which is whooping cough. We have a whooping cough vaccine, but it requires multiple doses, and the immunity keeps dropping. We want to develop a single-shot pertussis vaccine. We're working on a vaccine for respiratory syncytial virus, the number one cause of infant hospitalization in the United States. A better vaccine against influenza, and, of course, HIV. We're also looking at vaccines against cancer, allergy and, interestingly, opioid overdose.
目前,我们在和 世界各地的科学家合作, 通过一个“精准疫苗网络” 来汇聚这些新科技 以推动疫苗研发。 我们将为了世界各地的易感人群 推进个性化疫苗研究。 我们的团队成员有科学家、 技术专家和医师。 我们还在为百日咳 这样的传染病研发疫苗。 我们已经有了百日咳疫苗, 但目前还需要多次接种, 而且免疫效果会持续下降。 我们想要研制一种只需 单次接种的百日咳疫苗。 我们也在研发一种预防 呼吸道合胞病毒的疫苗, 在美国,这是导致 婴儿住院的头号原因。 我们还在开发更好的流感疫苗, 当然还有艾滋病疫苗。 同时,我们也在研究 针对癌症和过敏的疫苗, 还有一个有意思的, 预防阿片类药物摄入过量的疫苗。
So, this is my final message to you. Vaccines protect you and your loved ones and the people around you. Not only do they protect you against infection, they prevent you from spreading it to others. Get immunized. Scientific progress is fragile and can be lost. We must foster accurate and respectful public dialogue. And finally, we're on the verge of great things, a new era of vaccination. We've just scratched the surface of what can be accomplished. Please advocate for this research.
那么,最后我想对大家说: 疫苗能保护你、你心爱的人, 还有你身边的人们。 它们不仅能保护你免受感染, 还能防止你把疾病传播给别人。 去接种疫苗吧。 科学进步是脆弱的, 随时可能会遗失。 我们必须培养准确的、 互相尊重的公共对话。 最后我要说的是, 我们正在迈入伟大的 疫苗新时代, 而目前还仅仅触及了冰山一角。 请各位鼎力支持这类研究。
Thank you.
谢谢。
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