华尔街日报 未知的传染病
本帖最后由 krypton 于 2009-2-22 16:51 编辑[链接]：http://online.wsj.com/article/SB123480107672193383.html
[标题]：未知的传染病
正文：
中国是否隐瞒了禽流感的爆发？
中国在国际卫生事业合作上，说得好听些，有个令人尴尬的纪录。北京因为未能报道2002~2003年期间大家熟知的病毒性流行病SARS而受到严厉的批评。因为北京的耽搁，这种流行性疾病在四大洲导致774人死亡，8098人致病，如今人们对有对北京有意掩盖病情的信号表示担忧，而这次则是禽流感。
上周，北京宣布一月份发现8例禽流感感染病例，这是有史以来发病最多的一个月。但这些报告并没展现更高的透明度而是既让人迷惑有令人担忧。首先，1月份的出现的这几例病例分散范围超过1000km，看上去好像这几个病例不可能传播到这么大的区域，这就表示其中有没有报道的病例，这可能是因为北京官方也不知道这些病例。
人们可能对H5N1引发的疾病可能与冬季感冒和季节性流感相混淆，——或者是因为他们不愿意披露发病的范围。
还有不常见的是，一月份人感染禽流感创下纪录，但二月中感染人数几乎为零，这种突然下降与正常检测到的模式相比很不典型，考虑到H5N1在中国家禽中已形成流行病，而中国今年只报道了一例禽流感在家禽中大面积暴发报道是很难让人理解的。
所有这些迹象对专家来说都表明禽流感在家禽和人类中爆发的病例数都可能被草草的低估了，对H5N1爆发的准确报告对对抗这种疾病是至关重要的。目前，禽流感通常是人接触染病病禽或者死禽而感染的，人传染人的情况目前还属未知。然而一旦人感染了此疾病则是相当危险的——目前的致死率为60%。这表明，如果这种病毒变异成易在人之间传染的变种时，其引发的传染病是极其危险的。大多数病毒学家认为这种基因“转变”是无法避免的。
由于这种突变是随机发生的，全世界的公共卫生官员必须严格监控，这样他们才能迅速准确定位，控制疾病的爆发——其中可能就有发生这种危险突变的病毒。这对中国尤其重要，中国是人口和家禽数量最多的国家，引发禽流感爆发担忧的大部分区域也在中国。
但在中国，获取准确的发病数据几乎是不可能的，相对原始的实验室和医疗基础设施有时成为北京了解问题程度的障碍。我们同时也要牢记中国官员长期以来都有保密的爱好，经常对国际机构采取拒绝和不合作的态度。在这个北京对独裁经济下社会不稳定感到担心的时候，官员们似乎不不愿意公开承认这些可能导致传染病大流行的失败举措，而拿将来的问题冒险。
H5N1的状况与2002年中国政府掩盖出现SARS病毒的情形相似，当时，中国官员SARS爆发后三个月都没有通知世界卫生组织，并限制媒体，阻止事情外泄。这种对坦白的缺乏导致控制传染病的努力被大大的推延。
不管北京有什么理由，这种做法是很短视的。亚洲其他政府已经非常成功的开发了H5N1的监控机制和对H5N1的爆发区域和随机性爆发的报道计划。但由于地理，大小和畜牧业等原因，中国必须成为努力检测并致力于减少H5N1大流行的成员中负责任的一员。否这，中国不仅把本国人民，而且把世界人民都置于危险中。
Miller博士，前流感病毒研究人员，美国粮食和药检属官员，目前从业于在斯坦福大学Hoover研究所。
原文
An Unknown Epidemic Is China hiding an outbreak of avian flu infections?
By HENRY I. MILLER | From today's Wall Street Journal Asia.China has an unenviable record on international public health cooperation, to put it kindly. Beijing was heavily criticized for its failure to report an outbreak of a previously unknown viral infection, Severe Acute Respiratory Syndrome, in 2002-2003. That delay contributed to the spread of the disease in an epidemic that cost 774 lives and sickened 8,098 on four continents. Now there are worrying signs Beijing may be stonewalling again, this time with avian influenza.
http://s.wsj.net/public/resources/images/OB-DD427_oj_mil_E_20090216173544.jpg Reuters Sticking its neck out: A worried chicken in Hong Kong.
Last week, China announced that there were eight H5N1 infections of humans in January, its most ever in a single month. Yet rather than representing greater transparency, this report is both puzzling and worrisome. First, the January cases were scattered over a distance of more than 1,000 kilometers. It seems improbable that so few cases would be spread over such a large area, which suggests there are others that have gone unreported. This could be because authorities in Beijing don't know about them --
H5N1-caused illnesses may be confused with winter colds or the seasonal flu -- or because they are unwilling to reveal the scale of the problem.
It's also unusual that after a record number of reported human infections in January, cases have dropped to near-zero in February. Such a sudden drop-off is atypical compared to the pattern normally observed. And given that H5N1 is endemic in fowl in China, it is almost inconceivable that only one widespread outbreak in birds has been reported this year, earlier this month.
All of this suggests to experts that the reported numbers of outbreaks in both birds and humans are probably gross underestimates. Accurate reporting of H5N1 outbreaks is critical to fighting the disease: In its present form, the H5N1 flu strain is usually contracted by a person after handling a diseased or dead bird, and human-to-human transmission is virtually unknown. However once a person is infected it is extremely dangerous, with about 60% of known cases proving fatal. That suggests that if the virus were to mutate into a form that could spread easily between humans, the resulting epidemic could be extremely dangerous. Most virologists believe that such a genetic "shift" is inevitable.
Because these sorts of mutations are random, public health officials around the world must perform careful surveillance, so they can quickly spot and contain outbreaks that might indicate a dangerous genetic change in the virus. This is particularly important in China, which is home to the world's largest population of both fowl and humans, and comprises a large part of the region at the center of bird flu concern.
But getting accurate numbers in China is almost impossible. The relatively primitive laboratory and health-care infrastructure sometimes prevents Beijing itself from knowing the scale of the problem. One must also keep in mind that Chinese officials have long shown a penchant for secrecy, denial and noncooperation with international agencies. At a time when Beijing is already worried about social instability amid a deteriorating economy, officials may be unwilling to risk further problems by admitting publicly to failures that could contribute to a pandemic.
The H5N1 situation is ominously similar to the Chinese government's stonewalling in response to the 2002 appearance of SARS, when officials failed to inform the World Health Organization of the outbreak for three months, and restricted media coverage to keep the word from getting out. This lack of candor caused a lengthy delay in efforts to control the epidemic.
Whatever Beijing's reasons, their actions are shortsighted. Other governments in Asia have developed highly successful surveillance and reporting regimes and contingency plans for H5N1 outbreaks, but for reasons of geography, size and animal husbandry practices, China must be a responsible participant in any effort to detect and attenuate an H5N1 pandemic. Otherwise, China will be endangering not only the health of its own people, but of everyone else.
Dr. Miller, former influenza virus researcher and official at the U.S. Food and Drug Administration, is a fellow at Stanford University's Hoover Institution.
既然明白中国对于世界牵一发而动全身，
就少点指手划脚，叽叽喳喳。 就敢这么猜？了不得，唯恐天下不乱
分布广就证明一定有遗漏？又不是人际传染，人禽传染本来偶然性很大，难道还恨不得所有接触禽类的都感染上，就符合分布规律了？
2月份咋就没有了？这个问题也很蠢，1月份报道多了，人们采取了措施更加小心了，就染不着了呗。你说人有那么蠢么？ 别人的怀疑是有道理的。
我至今也很纳闷，为什么在1月份突然出现了那么多例禽流感致死病例，隔几天就蹦出一个，搞得当时我也有些紧张。而从2月份到现在好像突然又都没事了。
官方也没有给出解释。
难道是因为1月份有一群感冒的候鸟飞过中国，而2月份飞过的候鸟都没有感这个冒？ 非常奇怪的是，SARS基因序列中有美国某实验室的基因序列；栽赃？穿帮？为了保持中美关系长期正常的成果，中国需要咽下这口黄莲...............................
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