One of the first patients I had to see as a pediatrician was Sol, a beautiful month-old baby who was admitted with signs of a severe respiratory infection. Until then, I had never seen a patient worsen so fast. In just two days she was connected to a respirator and on the third day she died. Sol had whooping cough. After discussing the case in the room and after a quite distressing catharsis, I remember my chief resident said to me, "Okay, take a deep breath. Wash your face. And now comes the hardest part: We have to go talk to her parents." At that time, a thousand questions came to mind, from, "How could a one-month-old baby be so unfortunate?" to, "Could we have done something about it?"
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。 一个一月大漂亮的婴儿, 她患有严重的呼吸道感染的症状。 在她之前,我从没看过 病人的病情恶化得这么快。 短短两天,她就得戴上呼吸器, 然后第三天的时候她就死了。 索尔患的是百日咳。 在房间里讨论了这个病例, 并静静宣泄了心中的悲伤之后, 我记得 我们的总住院医师对我说: 「来,深呼吸,把脸洗干净。 现在要做的才是最艰难的, 我们得去告诉她的父母。」 那个时候,我的心中涌现无数问题, 从 「为什么一个才一个月大的婴儿 要遭受如此不幸?」 到 「还有什么是我们本可以做到的?」
Before vaccines existed, many infectious diseases killed millions of people per year. During the 1918 flu pandemic 50 million people died. That's greater than Argentina's current population. Perhaps, the older ones among you remember the polio epidemic that occurred in Argentina in 1956. At that time, there was no vaccine available against polio. People didn't know what to do. They were going crazy. They would go painting trees with caustic lime. They'd put little bags of camphor in their children's underwear, as if that could do something. During the polio epidemic, thousands of people died. And thousands of people were left with very significant neurological damage. I know this because I read about it, because thanks to vaccines, my generation was lucky to not live through an epidemic as terrible as this.
在疫苗出现之前 每年有成千上万人死于感染性疾病 1918年的大型流感 造成了五千万人死亡 这比阿根廷现在的人口还多 或许,在座年长些的人 还记得1956年在阿根廷肆虐的小儿麻痹症 当时,没有可以用来 预防小儿麻痹症的疫苗 人们不知道该怎么办 大家都快急疯了 他们往树上洒生石灰 他们将小袋的樟脑 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 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 我知道这个事实, 因为我读过相关的书, 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
Vaccines are one of the great successes of the 20th century's public health. After potable water, they are the interventions that have most reduced mortality, even more than antibiotics. Vaccines eradicated terrible diseases such as smallpox from the planet and succeeded in significantly reducing mortality due to other diseases such as measles, whooping cough, polio and many more.
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 能够最大幅度降低死亡率的干预手段 它的效果甚至超过抗生素 疫苗彻底根除了 像天花那样可怕的疾病 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
All these diseases are considered vaccine-preventable diseases. What does this mean? That they are potentially preventable, but in order to be so, something must be done. You need to get vaccinated. I imagine that most, if not all of us here today, received a vaccine at some point in our life. Now, I'm not so sure that many of us know which vaccines or boosters we should receive after adolescence. Have you ever wondered who we are protecting when we vaccinate? What do I mean by that? Is there any other effect beyond protecting ourselves?
所有的这些疾病都被认为是 用疫苗可以预防的疾病 这是什么意思呢? 这表示它们是可以被预防的 但要预防,你必须采取一定的措施 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 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 成年之后我们应该接种 哪些疫苗或者辅助药剂 你曾想过当我们接种疫苗是为了保护谁吗? 我们应该在何时接种疫苗? 我这么说是什么意思呢? 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. Imagine for a moment that we are in a city that has never had a case of a particular disease, such as the measles. This would mean that no one in the city has ever had contact with the disease. No one has natural defenses against, nor been vaccinated against measles. If one day, a person sick with the measles appears in this city the disease won't find much resistance and will begin spreading from person to person, and in no time it will disseminate throughout the community. After a certain time a big part of the population will be ill. This happened when there were no vaccines.
让我来展示给你们看 想象一下 我们正身处在一个城市里 而这个城市从未有过某种疾病的病例 比如说麻疹 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 如果有一天,一个麻疹患者来到这个城市 这个疾病将不会受到任何阻碍 并在人们之间开始传播 然后很快它就会传遍整个社区 不久后 很大一部分的人就会患病 这是没有疫苗的情况
Now, imagine the complete opposite case. We are in a city where more than 90 percent of the population has defenses against the measles, which means that they either had the disease, survived, and developed natural defenses; or that they had been immunized against measles. If one day, a person sick with the measles appears in this city, the disease will find much more resistance and won't be transmitted that much from person to person. The spread will probably remain contained and a measles outbreak won't happen.
现在,让我们试着想想一个完全相反的情况 我们在一个城市 这里百分之九十的居民 都对麻疹有免疫力,这也就意味着 他们要么曾经得过麻疹并活了下来, 产生了自然的免疫力 要么已经接种过疫苗并对麻疹产生了免疫力 如果有一天 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, 也不会在人和人之间传染得那么快 它的传播很有可能会得到控制 于是也不会有麻疹疫情爆发
I would like you to pay attention to something. People who are vaccinated are not only protecting themselves, but by blocking the dissemination of the disease within the community, they are indirectly protecting the people in this community who are not vaccinated. They create a kind of protective shield which prevents them from coming in contact with the disease, so that these people are protected. This indirect protection that the unvaccinated people within a community receive simply by being surrounded by vaccinated people, is called herd immunity.
我希望你能够关注到其中的一些东西 接种了疫苗的人们 不仅仅在保护自己 也在阻碍着社区内 疾病的传播 他们间接地保护着这个社区里 没有接种过疫苗的人们 他们创造了一种防护盾 以使他们不与疾病接触 从而让这些人得到保护 这种通过接种人群 来达到保护未接种人群目的 的间接保护措施 叫做群体免疫
Many people in the community depend almost exclusively on this herd immunity to be protected against disease. The unvaccinated people you see in infographics are not just hypothetical. Those people are our nieces and nephews, our children, who may be too young to receive their first shots. They are our parents, our siblings, our acquaintances, who may have a disease, or take medication that lowers their defenses. There are also people who are allergic to a particular vaccine. They could even be among us, any of us who got vaccinated, but the vaccine didn't produce the expected effect, because not all vaccines are always 100 percent effective. All these people depend almost exclusively on herd immunity to be protected against diseases.
社区中的很多人 几乎完全依靠这种群体免疫 来预防疾病 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 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、 我们的熟识的人 他们可能带有疾病 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 他们甚至可能就在我们身边 那些接种过疫苗 但没有产生预期的效果的人, 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 来预防各种的疾病
To achieve this effect of herd immunity, it is necessary that a large percentage of the population be vaccinated. This percentage is called the threshold. The threshold depends on many variables: It depends on the germ's characteristics, and those of the immune response that the vaccine generates. But they all have something in common. If the percentage of the population in a vaccinated community is below this threshold number, the disease will begin to spread more freely and may generate an outbreak of this disease within the community. Even diseases which were at some point controlled may reappear.
要实现群体免疫, 就需要群体中大部分人接种疫苗 这个百分比被称作阈值 这个阈值取决于很多变量 它取决于微生物的特性 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 如果社区里接种过疫苗的人口百分比 低于这个阈值的数字 那么这个疾病就会很容易传播 且这个社区可能会爆发这种疾病 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. This has happened, and is still happening. In 1998, a British researcher published an article in one of the most important medical journals, saying that the MMR vaccine, which is given for measles, mumps and rubella, was associated with autism. This generated an immediate impact. People began to stop getting vaccinated, and stopped vaccinating their children. And what happened? The number of people vaccinated, in many communities around the world, fell below this threshold. And there were outbreaks of measles in many cities in the world -- in the U.S., in Europe. Many people got sick. People died of measles. What happened?
这不仅仅是一个理论 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 在一本很有影响力的医学杂志上 发表了一篇文章 他说,用来预防 麻疹、腮腺炎和风疹的MMR混合疫苗 可能会引发自闭症 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 接下来发生了什么呢? 世界上很多社区里 接种过疫苗的人数降至这个阈值之下 接着麻疹在世界上很多城市爆发-- 包挂美国以及欧洲的城市 很多人都生病了 许多人死于麻疹 为什么会这样呢?
This article also generated a huge stir within the medical community. Dozens of researchers began to assess if this was actually true. Not only could no one find a causal association between MMR and autism at the population level, but it was also found that this article had incorrect claims. Even more, it was fraudulent. It was fraudulent. In fact, the journal publicly retracted the article in 2010. One of the main concerns and excuses for not getting vaccinated are the adverse effects.
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 不仅没有人找到 MMR和自闭症之间的因果联系 且人们发现这篇文章的主张并不正确, 甚至可以说,它是有欺诈性的 它是虚假的 事实上,这本杂志于2010年 公开地撤回了这篇文章 导致人们不愿接种疫苗最大的顾虑和借口之一就是 疫苗的副作用
Vaccines, like other drugs, can have potential adverse effects. Most are mild and temporary. But the benefits are always greater than possible complications. When we are ill, we want to heal fast. Many of us who are here take antibiotics when we have an infection, we take anti-hypertensives when we have high blood pressure, we take cardiac medications. Why? Because we are sick and we want to heal fast. And we don't question it much. Why is it so difficult to think of preventing diseases, by taking care of ourselves when we are healthy? We take care of ourselves a lot when affected by an illness, or in situations of imminent danger.
疫苗和其他药品一样都可能有副作用 多数的副作用轻微而短暂 但是疫苗的好处远远大于潜在的副作用 我们生病时,我们都希望迅速恢复 在座的大多数 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 我们服用心脏药物 为什么?因为我们生病时, 我们都想要快点恢复健康 我们不会对其提出很大质疑 为什么想到预防会如此困难? 为什么不在患病前好好照顾自己、预防疾病? 我们在生病时或生命垂危时 很会照顾自己
I imagine most of us here, remember the influenza-A pandemic which broke out in 2009 in Argentina and worldwide. When the first cases began to come to light, we, here in Argentina, were entering the winter season. We knew absolutely nothing. Everything was a mess. People wore masks on the street, ran into pharmacies to buy alcohol gel. People would line up in pharmacies to get a vaccine, without even knowing if it was the right vaccine that would protect them against this new virus. We knew absolutely nothing. At that time, in addition to doing my fellowship at the Infant Foundation, I worked as a home pediatrician for a prepaid medicine company. I remember that I started my shift at 8 a.m., and by 8, I already had a list of 50 scheduled visits. It was chaos; people didn't know what to do. I remember the types of patients that I was examining. The patients were a little older than what we were used to seeing in winter, with longer fevers.
我想在座的大多数人 都还记得2009年在阿根廷以至全世界 爆发的大型流感疫情 首名患者被确诊的时候, 我们的阿根廷正步入冬季 我们对此流感一无所知 一切都非常混乱 大家在街上都戴口罩, 跑去药房买酒精凝胶 大家去药房排队打疫苗 他们甚至都不知道这个疫苗 能否对抗这个新的病毒 我们实在是一无所知 那时,我除了在婴儿基金会服务 还在一家预付药品公司 从事家庭小儿科医师 我记得我在早上八点开始轮班 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 我记得我所检查的一些病人的样子 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
And I mentioned that to my fellowship mentor, and he, for his part, had heard the same from a colleague, about the large number of pregnant women and young adults being hospitalized in intensive care, with hard-to-manage clinical profiles. At that time, we set out to understand what was happening. First thing Monday morning, we took the car and went to a hospital in Buenos Aires Province, that served as a referral hospital for cases of the new influenza virus. We arrived at the hospital; it was crowded. All health staff were dressed in NASA-like bio-safety suits. We all had face masks in our pockets. I, being a hypochondriac, didn't breathe for two hours. But we could see what was happening. Immediately, we started reaching out to pediatricians from six hospitals in the city and in Buenos Aires Province. Our main goal was to find out how this new virus behaved in contact with our children, in the shortest time possible. A marathon work. In less than three months, we could see what effect this new H1N1 virus had on the 251 children hospitalized by this virus. We could see which children got more seriously ill: children under four, especially those less than one year old; patients with neurological diseases; and young children with chronic pulmonary diseases. Identifying these at-risk groups was important to include them as priority groups in the recommendations for getting the influenza vaccine, not only here in Argentina, but also in other countries which the pandemic not yet reached.
我向我的导师提起时 他说他从其他同事那里, 也听到过同样的情况: 许多的怀孕妇女 和年轻人 住进了加护病房 病情十分棘手 那时,我们想要了解到底怎么一回事 我们首先做的就是在周一早晨开车去 布宜諾斯艾利斯省的一个医院 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 所有医护人员都穿着如太空人的 生物安全服 我们口袋里都有口罩 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 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 我们的主要目标是 在最短的时间内找到 这个新病毒在小孩身上的反应 那是一次同病毒抗争的马拉松 不到三个月, 我们看到了这个新H1N1病毒 在251例患病住院的小孩身上的表现 我们可以看出哪些孩子的患病程度会更加严重 这其中包括四岁以下的小孩, 尤其是一岁以下的小孩 还有患有神经系统疾病的小孩 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, 因为这样的话 我们就可以将他们纳入优先接种的人群 不仅仅是在阿根廷 更是在其他这个流感尚未侵袭的国家
A year later, when a vaccine against the pandemic H1N1 virus became available, we wanted to see what happened. After a huge vaccination campaign aimed at protecting at-risk groups, these hospitals, with 93 percent of the at-risk groups vaccinated, had not hospitalized a single patient for the pandemic H1N1 virus. (Applause) In 2009: 251. In 2010: zero.
一年后 当有了对抗H1N1流感疫苗 我们想知道情况如何 在进行了针对高风险人群的 大型接种运动之后 那些有93%的高风险群接种率的医院 再没接到过一例 H1N1 流感患者 (掌声) 从2009年的251例 到2010年的0例,
Vaccination is an act of individual responsibility, but it has a huge collective impact. If I get vaccinated, not only am I protecting myself, but I am also protecting others. Sol had whooping cough. Sol was very young, and she hadn't yet received her first vaccine against whooping cough. I still wonder what would have happened if everyone around Sol had been vaccinated. (Applause)
接种疫苗虽然是为自己负责的行为 但是对群体却有巨大的影响 如果我打了疫苗, 我不仅保护了我自己 还保护了其他人 索尔患上了百日咳 她还太小 以至于她还没有接种百日咳的疫苗 我还是常想 如果索尔旁边的人都打了疫苗, 她会如何呢? (掌声)