TE||A killer in the making
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导读
什么是伤寒？伤寒有哪些症状？
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音乐| 精读 | 翻译 | 词组
A killer in the making
“杀手”正在生成
英文部分选自经济学人Science and Technology版块
Superbugs
致命漏洞
A bigger killer in the making
更强的杀手正在生成
A drug-resistant strain of typhoid could become virtually untreatable
一种抗药性的伤寒可以变得无法治愈
TYPHOID affects some 21m people each year, and about 1% of cases are fatal. Before antibiotics were used to treat the disease 70 years ago, death rates were much higher. If left unchecked, typhoid can cause internal bleeding, perforation of the gut and, in up to a fifth of cases, death. Researchers are now concerned that an “extensively drug resistant” (XDR) strain of Salmonella enterica serotype Typhi (S. typhi), the bacterium that causes the disease, could see a return to those dangerous days.
伤寒每年感染约2,100万人， 其中有1％的病例致死。 70年前，在无抗生素治疗时代，死亡率更高。 如果不加以治疗，伤寒会导致内出血，肠穿孔以及25%的人群死亡。 研究人员发现导致该疾病的伤寒沙门氏菌（S. typhi）的已出现“广泛耐药性”（XDR）菌株，有可能会让我们回到当年危险的日子。
Since November 2016 the XDR strain has led to 858 reported cases of the disease and four deaths in the Sindh province of Pakistan, according to the latest figures from Pakistan’s National Institute of Health. Together with their colleagues, Elizabeth Klemm of the Wellcome Sanger Institute near Cambridge and Rumina Hasan of the Aga Khan University in Karachi have analysed the pathogen. Their study, published recently in mBio, showed that its genome contains resistance genes for five types of antibiotic, making the Sindh epidemic the first known to be caused by an XDR strain. That, in effect, leaves doctors in Pakistan with just one oral antibiotic, azithromycin, with which to treat patients suffering from the disease.
根据巴基斯坦国家卫生研究院的最新数据，自2016年11月以来，巴基斯坦信德省耐药菌已导致858例该病的报告病例和4例死亡病例。 剑桥附近Wellcome Sanger研究所的Elizabeth Klemm，和卡拉奇Aga Khan大学的Rumina Hasan与他们的同事一起分析了病原体。 他们在mBio上最近发表的研究表明，病原体的基因组含有五种类型的抗生素的耐药基因，使信德发生第一个已知的由XDR菌株引起的流行病。 实际上，这使得巴基斯坦的医生只需要一种口服抗生素-阿奇霉素就可以治疗患耐药伤寒菌疾病的患者。
If that was not worrying enough, the researchers showed that the Sindh S. typhi was of a lineage known as H58. Since emerging on the Indian subcontinent around 30 years ago, H58, which is resistant to as many as four classes of antibiotic, has spread to much of South-East Asia and, more recently, to sub-Saharan Africa and Oceania. The researchers found that S. typhi had gained more resistance genes by acquiring a plasmid, a circular piece of DNA, from another bacterium (a process known as horizontal gene transfer). Similarities in DNA sequences between this plasmid and those of other bacteria suggest that the culprit was probably Escherichia coli, which is commonly found in the human gut. Troublingly, H58 has in the past absorbed other antibiotic-resistance genes into its chromosome, where they can become more “hard wired” than plasmids, which can just as easily be lost as gained.
如果这还不够让你忧虑，研究者发现信德省的伤寒沙门氏菌是H58的一个株系。自从三十年前H58在印度次大陆上出现后，已经对4种抗生素有耐药性，并且已经在东南亚甚至撒哈拉以南非洲以及大洋洲传播。研究者还发现伤寒沙门氏菌还通过从其他细菌获取质粒-它是一种环形DNA，获得了一些额外的耐药性基因（这一过程被称为水平的基因转移）。质粒和其他细菌间相似的DNA序列揭示着问题的根源或许是大肠杆菌，那通常能在人体肠道中找到。令人烦恼的是，H58过去吸收过抗生素基因进入它的染色体，这样它们会变得比质粒更加“难缠”，因为质粒既容易得到，也很容易摆脱。
There is no reason why S. typhi should not also become resistant to azithromycin. Indeed, many experts believe it is simply a matter of time before it does so. That would mean the only treatments left would be “antibiotics of last resort”, such as carbapenems, which are expensive and have to be injected by trained staff. In poor countries, where such treatment is unlikely, it means an epidemic may be nearly impossible to contain.
不知道为什么伤寒沙门氏菌不能对阿奇霉素产生抗药性。事实上，许多专家相信这只是时间问题（去产生抗药性）。这意味着仅有的治疗方法只能是“抗生素杀手锏”，比如碳青黴烯。这药很贵并且得由训练过的人去注射。而在贫困国家，这种疗法不太可能，这意味着这一流行病基本上不可能得到遏制。
In the long term, the solution is straightforward. The bacterium is found in the faeces of those infected, as well as a small proportion of people who have recovered but remain asymptomatic carriers. The disease spreads through water or food contaminated with infected faeces. Effective sanitation and access to clean water has largely eliminated typhoid from rich countries. It could, in time, do so in poorer ones, too. More careful use of antibiotics could help avoid a near-untreatable strain of S. typhi emerging. There are also ongoing efforts to find new antibiotics.
从长远来看，解决方案简单易行。这种细菌存在于感染者的粪便中，也存在于已经康复，但仍健康携带的少数人群的粪便中。水或食物被这种粪便污染后便能传播这种疾病。由于干净的卫生设施和清洁水源，伤寒病基本上在发达国家已经绝迹。在贫困国家也应及时推广这种行之有效的方案。另外，更谨慎地使用抗生素可以避免产生这种几乎无法治愈的伤寒沙门氏菌。此外，我们还在继续努力寻找新的抗生素。
In the short term, however, vaccination, monitoring and treatment remain the best options. Unfortunately, vaccines do not provide lasting immunity, require multiple doses or are only approved for children older than two. A new vaccine from Bharat Biotech, a firm based in Hyderabad, protects for at least three years with a single dose and can be administered to children as young as six months. GAVI, an international public-private alliance that provides vaccines to poor countries, has agreed to pay $85m for vaccinating children in countries where the disease is rife. The race is on to contain typhoid before it evolves into an even deadlier threat.
然而在短期内，疫苗、监测和治疗仍然是最好的方案。遗憾的是，疫苗无法提供持久的免疫力，需要多个剂量，或者只有两岁以上的儿童才能接种。位于印度海得拉巴（Hyderabad）的巴哈拉特（Bharat）生物技术公司研制出一种新疫苗，6个月大的婴儿就可以接种这种疫苗，一剂疫苗可以保证至少三年内免疫。全球疫苗免疫联盟GAVI，是一家公私合作的全球卫生合作组织，为贫困国家提供疫苗。并允诺在该疾病泛滥的国家，提供8500万美元让儿童接种疫苗。伤寒演变成更致命的威胁之前，人们已经开始想方设法地阻止它恶化。
注释：
1. vaccination |ˌvæksɪˈneɪʃn| noun [可数名词, 不可数名词] 疫苗 栗子：Make sure your vaccinations are up to date.一定要接种最新的疫苗。vaccination against typhoid 伤寒疫苗的接种 摘自《牛津高阶英汉双解词典》
2. Hyderabad英 [ˈhaidərəbɑ:d] 美 [ˈhaɪdərəˌbæd, -ˌbɑd, ˈhaɪdrə-]海得拉巴（印度南部一城市； 巴基斯坦东南部一城市）摘自百度翻译
3. 全球疫苗免疫联盟（The Global Alliance for Vaccines and Immunisation，GAVI）是一个公私合作的全球卫生合作组织，成立于1999年，工作宗旨是与政府和非政府组织合作促进全球健康和免疫事业的发展；工作职责是提供技术和财政支持；推广的疫苗目前有乙型肝炎、流感、黄热病。参与成员包括发展中国家和捐助国政府、WHO、UNICEF、世界银行、工业化国家和发展中国家的疫苗产业界、比尔与美琳达·盖茨基金会、非政府组织和科研及卫生技术研究机构。
4. 熟词生义 race |reɪs| noun [单数] ~ (for sth/to do sth) a situation in which a number of people, groups, organizations, etc. are competing, especially for political power or to achieve sth first 竞争；角逐栗子 the race for the presidency总统竞选 The race is on (= has begun) to find a cure for the disease. 人们开始争相寻找这种疾病的新疗法。 摘自《牛津高阶英汉双解词典》
5. 熟词生义 contain |kənˈteɪn| verb to prevent sth harmful from spreading or getting worse 防止…蔓延（或恶化）栗子to contain an epidemic 防止流行病的蔓延 摘自《牛津高阶英汉双解词典》
翻译组：
Li Xia, 女， HR, 经济学人发烧友
Xingyi，男，小硕，经济学人爱好者
LitFish ，女，药物制剂，Nature追随者
校核组：
Xingyi，男，小硕，经济学人爱好者
Helga，女，笔译民工，经济学人爱好者
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观点 |评论|思考
本次观点为Muyi独家奉献
Muyi，土偶粉丝，经济学人旁观者
人的一生将面对许多关卡，疾病是其中之一。为了能将生命延续，人们也研发出了各类药剂和治疗器具来与疾病对抗。然而，病菌的耐药性已成为当前公共健康领域所面临的一个重大挑战。的确，随着科技技术的深入发展，抗生素的效用也在不断的得以更新升级，但这个速度似乎已经跟不上耐药病菌变异进化的速度。此时，我们不禁提出了一个疑问，当今医药医疗领域研究的深入，各种先进疗法的出现是为公共健康提供了更叫高级的保障，还是在变相的培育了“超级病毒”？
也许你认为这样的说法有点夸大其词，耐药性只是一种抗菌药的效果不好，当前医药行业如此发达，换一种药就可以了。但现实是，病菌对于青霉素、头孢菌素等老牌抗菌药的耐药性正在不断提高，而20世纪80年代后除了达托霉素外，似乎并没有可供抵抗新病菌的新型抗菌药出现。这无疑为人类生存延续敲响了警钟。
因此，“抵御耐药性—今天不采取行动，明天就无药可用”，合理使用抗生药剂已成为延续人类未来生存发展的重要课题之一。一方面，我们需加大对新药和新诊断技术开发的投入，努力研制出新型药剂和治疗方法以应对超级病菌出现；另一方面，或许，我们该更新的不仅是科研技术，更是研究思维，让对病毒的研究跳出固有思维，找出不以杀死细菌为目的而是阻断细菌增殖变异的药剂，似乎也不惟是一条出路。
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愿景
小组
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