spreading around sickening and killing millions. But what you probably didn't know is that

傳播到各地令人作嘔，並殺死數百萬人。但是，你可能不知道的是，

the disease has created one of the world's longest pandemics ... ever. So what exactly

這種疾病創造了世界上最長的流行病之一... 有史以來。那麼到底是什麼

does cholera do to the body? How can we prevent it? And why has this ancient disease lasted

霍亂對身體有什麼影響？我們又該如何預防呢？為什麼這種古老的疾病會持續

throughout the ages?

古往今來？

It's actually a good time to be talking about cholera because of the COVID pandemic right

因為COVID大流行，所以現在其實是一個談論霍亂的好時機吧？

now because cholera causes pandemics and we've had seven pandemics of cholera in the last

因為霍亂會引起大流行 我們在過去已經有七次霍亂大流行了

200 years.

200年

I am Anita Zaidi and I'm the director for the Bill and Melinda Gates Foundation

我是Anita Zaidi，我是比爾和梅林達-蓋茨基金會的主任。

in enteric and diarrheal diseases.

在腸道疾病和腹瀉疾病中。

First discovered in the Ganges delta in India, Cholera is caused by the bacteria vibrio cholerae.

霍亂最早發現於印度恆河三角洲，由霍亂弧菌引起。

And it's been around since ancient times, with multiple pandemics starting in 1817.

而且自古以來就有，從1817年開始就有多次大流行。

During that first outbreak was when the world really got to know about this disease. Out

在第一次爆發的時候，是世界真正瞭解這種疾病的時候。爆發

of the more than 200 serogroups of V. cholerae, only two are known to actually cause Cholera:

在200多個霍亂病毒血清型中，只有兩個血清型能真正引起霍亂。

O1 which is responsible for most of the recent outbreaks, and O139 which is linked to more isolated

導致最近大部分疫情爆發的O1和與更多的孤立疫情有關的O139。

cases.  So how exactly does the bacteria spread?

的情況。 那麼，細菌到底是如何傳播的呢？

Well, that mystery was solved thanks to a pump back in 1854.

好吧，這個謎團被解開了，多虧了1854年的一個泵。

John Snow is like one of those legendary epidemiology figures that everybody learns about when they

約翰-斯諾就像那些傳說中的流行病學人物一樣，每個人都會了解到，當他們

learn about cholera. John Snow noticed, that there was a lot of cholera happening in London

瞭解霍亂的情況。約翰-斯諾注意到，在倫敦發生了很多霍亂事件

and he started looking at the patterns of how cholera was spreading and he noticed that

他開始觀察霍亂的傳播模式 他注意到

the areas which had high incidence of cholera, all had a similar drinking source, a water pump.

霍亂高發地區，都有類似的飲用水源，即水泵。

And so he removed that water pump and it showed that cholera rates in those areas went down

所以他拆掉了那個水泵，結果顯示那些地區的霍亂髮病率下降了。

and it's a famous epidemiology story about one smart person paying attention to patterns

這是一個著名的流行病學故事，關於一個聰明人關注模式的故事

of disease and figuring out how to stop it. And two centuries later, we're still trying

並找出阻止疾病的方法。兩個世紀後，我們仍然在嘗試...

to figure it out.

來解決這個問題。

What we know is that when a person contracts cholera, it's usually through a contaminated

我們知道的是，當一個人感染霍亂， 它通常是通過汙染的。

source like drinking water that's come into contact with infected feces. Now, after that

像飲用水的來源 接觸到感染的糞便。現在，在那之後

first sip, it takes the bacteria anywhere from a few hours to a couple of days to begin

細菌需要幾個小時到幾天的時間才能開始繁殖。

wreaking havoc on the body.

對身體造成了極大的破壞。

When you ingest the bacteria, it goes from your mouth, into your esophagus, into your stomach, and then

當你攝入細菌時，它從你的嘴裡，進入食道，進入你的胃裡，然後...

pass the stomach and where it causes disease is in the small intestine.

通過胃，而引起疾病的地方是在小腸。

Once there, the bacteria swims towards the intestinal wall, pushing through the thick

一旦到了那裡，細菌就會遊向腸壁，推開厚厚的腸壁。

mucous layer of the intestines' epithelial cells where it then attaches itself and begins

腸道上皮細胞的粘膜層，然後它在那裡附著並開始

to multiply, releasing toxins that stimulate the cells to secrete water. And that's where

釋放出毒素，刺激細胞分泌水。而這就是

the chaos begins.

混亂開始。

What it does to the body is it will cause vomiting. It causes stomach pains. It causes

它對身體的影響就是會引起嘔吐。它會導致胃痛。它導致

bad watery diarrhea. All of a sudden, all of the water in your body starts being secreted

嚴重的水樣腹瀉。突然間，你身體裡的水都開始分泌了

through your intestinal cells. The secretion of fluids is so massive that you basically

通過你的腸道細胞。液體的分泌是如此之多，以至於你基本上

pour out liters of fluid from your body. That's how cholera kills, right, because it just

從你的身體裡倒出幾公升的液體。這就是霍亂的殺傷力，對吧，因為它只是。

dehydrates then all of the organs shut down. Like if you've seen a cholera dehydration in

脫水了，那麼所有的器官都會關閉。就像你見過的霍亂脫水的人一樣

your life once, you never forget it.

你的生命只有一次，你永遠不會忘記它。

Oh and if that weren't scary enough, that rapid loss of fluid can all happen within

如果這還不夠可怕的話，液體的快速流失可能會發生在以下時間段內

a matter of hours of showing symptoms.  Thankfully, only a minority of cases experience

在出現症狀的幾個小時內。 值得慶幸的是，只有少數病例經歷

this. While the rest have mild to moderate symptoms, developing bouts of nausea, vomiting,

這。而其餘的人則有輕到中度的症狀，出現陣陣噁心、嘔吐。

and loose stools. But milder cases still present a threat because patients can excrete V. cholerae

和鬆散的大便。但較輕的病例仍然存在威脅，因為患者可以排出霍亂病毒。

for up to two weeks after the infection has passed.

感染過後，可持續兩週。

Luckily though, we know how to treat it. For patients suffering, the most important thing

不過還好，我們知道如何治療。對於患者的痛苦，最重要的是

to do is to replace the rapid loss of minerals, so a solution of oral rehydration salts is

要做的是補充快速流失的礦物質，所以口服補液鹽的溶液是

usually given and in the more extreme cases, IV fluids can be used to get the job done

通常給予，在更極端的情況下，可以使用靜脈點滴來完成工作。

faster. And to stem future spread, antibiotics can help reduce the amount of the bacteria

更快。而為了阻止未來的傳播，抗生素可以幫助減少細菌的數量。

present in the stool.

存在於大便中。

As for prevention, there are two main methods: One is of course making sure that people have

至於預防，主要有兩種方法。一個當然是確保人們有

access to clean water and sanitation and now we know much more about the types of areas

潔淨水和衛生設施，現在我們更清楚地瞭解了這些地區的類型。

where cholera spreads, they're called hotspots, where there is a lot of people living in close

在霍亂傳播的地方，他們被稱為熱點，有很多人生活在接近的地方。

proximity, so high population density slums, inner city areas in developing countries and

是以，開發中國家的高人口密度貧民窟、內城地區和內城地區的人口密度都很高。

typically they are close to a body of water.

通常它們靠近水體。

While the other is vaccines. Currently, there's the oral cholera vaccine, which is taken in

而另一種則是疫苗。目前，有口服霍亂疫苗，它是在

two doses one to two weeks apart. It's the main one used in mass vaccination efforts

兩劑相隔一到兩週。這是大規模疫苗接種工作中主要使用的疫苗

and it's produced by two manufacturers: Euvichol and Shanchol. And the best part is,

而且它是由兩個廠家生產的。Euvichol和Shanchol.而最棒的是。

is that it's really cheap, at less than two dollars a dose.

是它真的很便宜，一劑不到兩塊錢。

This vaccine has now saved thousands and thousands of lives. 30 to 40 million doses are being

這種疫苗現在已經挽救了成千上萬人的生命。目前正在進行3000萬至4000萬劑的疫苗接種。

used every year in the cholera hotspots.  This is for the first time that so many doses

每年在霍亂熱點地區使用。 這是第一次使用這麼多劑量的藥物。

of vaccines are being used that we are now seeing a number of deaths from cholera decreasing

疫苗的使用，使我們現在看到霍亂的死亡人數在減少。

in the world for the last two years and so that's really good news on cholera.

在過去的兩年裡，世界上的霍亂，所以這是真正的好消息，霍亂。

So if we know how to treat the disease and have a way to prevent it, then why is this

所以，如果我們知道如何治療這種疾病，並且有辦法預防，那麼為什麼這個

ancient disease still an issue today?

古代疾病在今天仍然是個問題？

The reason that Cholera has persisted is that we have not addressed poverty to the level

霍亂之所以持續存在，是因為我們沒有將貧困問題解決到一定程度。

that we should and with time we know how Cholera happens and where it happens and we should

我們應該，隨著時間的推移，我們知道霍亂是如何發生的，在哪裡發生的，我們應該。

be able to focus on those cholera hotspots as first priority for areas which need improved

能夠將霍亂熱點地區作為需要改善的地區的第一優先事項。

sanitation and hygiene. And that's countries working together prioritizing health over

環境衛生和個人衛生。這就是各國共同努力，將健康置於優先地位，而不是將衛生設施置於優先地位。

other things and improving their own infrastructure.

其他事情，並改善自己的基礎設施。

So when we can do that, cholera will disappear.

所以當我們能做到這一點時，霍亂就會消失。

To help get there, the World Health Assembly,

為了幫助實現這一目標，世界衛生大會：

which is the WHO's decision making body, pledged to eradicate cholera by 2030, hoping

世衛組織的決策機構，承諾到2030年根除霍亂，並希望

to reduce deaths worldwide by 90%. And if we can achieve that goal, we may soon see the

將全球死亡人數減少90%。如果我們能夠實現這個目標，我們可能很快就會看到。

end of one of the world's longest pandemics.

世界上最長的流行病之一的結束。

We have an opportunity to get rid of cholera from the world forever and also an opportunity

我們有機會讓世界永遠擺脫霍亂，也有機會讓世界永遠擺脫霍亂。

for the world to understand how we have worked together as a multinational effort, coming

讓世界瞭解我們是如何作為一個多國努力而共同努力的。

together to control cholera as an infectious disease pandemic and what are the lessons

共同控制霍亂這一傳染病大流行，有哪些經驗教訓？

learned for controlling COVID in the same way.

學會了用同樣的方法控制COVID。