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Cholera. You've probably heard about this disease that's plagued the world for centuries,
霍乱，你可能已经听过它的大名了，困扰世界数个世纪的疾病，
spreading around sickening and killing millions.
传播遍及世界各地，致病乃至死亡人数高达数百万。
But what you probably didn't know is that the disease has created one of the world's longest pandemics...ever.
但你可能不知道的是，这一疾病带来了……有史以来……全世界最漫长的疫情之一。
So what exactly does cholera do to the body?
那么，霍乱对人体到底有着怎样的影响呢？
How can we prevent it?
怎样才能预防呢？
And why has this ancient disease lasted throughout the ages?
还有就是，这种古老的疾病为什么会历久弥新呢？
"It's actually a good time to be talking about cholera because of the COVID pandemic right now
“事实上，现在正是聊霍乱的好时机，因为最近刚好赶上了新冠大流行，
because cholera causes pandemics and we've had seven pandemics of cholera in the last 200 years.
因为霍乱也会引起大流行，而且，过去200年时间里，我们就已经遭遇了7次霍乱大流行。
I am Anita Zaidi and I'm the director for the Bill and Melinda Gates Foundation in enteric and diarrheal diseases."
我是安妮塔·扎伊迪，我是比尔和梅林达·盖茨基金会肠道和腹泻疾病科的主任。”
First discovered in the Ganges delta in India, Cholera is caused by the bacteria vibrio cholerae.
霍乱，最早发现于印度恒河三角洲，这种病是由霍乱弧菌引起的。
And it's been around since ancient times, with multiple pandemics starting in 1817.
而且，这种病古已有之，只不过，1817年后又多次爆发了而已。
During that first outbreak was when the world really got to know about this disease.
就是那一次爆发，世界才对这种疾病有了真正的了解。
Out of the more than 200 serogroups of V. cholerae,
霍乱弧菌有200多个血清群，
only two are known to actually cause Cholera:
但目前我们知道的，会引发霍乱的血清群就两个：
O1 which is responsible for most of the recent outbreaks,
一个是O1血清群，同时它也是最近大多数疫情的罪魁祸首，
and O139 which is linked to more isolated cases.
另一个是O139血清群，该血清群往往跟比较个体的霍乱病例有关。
So how exactly does the bacteria spread?
那么，（霍乱弧菌）这种细菌到底是怎么传播的呢？
Well, that mystery was solved thanks to a pump back in 1854.
说起来，多亏了1854年的一台水泵，这个谜团才得以解开。
"So John Snow is like one of those legendary epidemiology figures
“约翰·斯诺就是流行病学领域的那种传奇，
that everybody learns about when they learn about cholera.
凡是了解过霍乱的就没有不知道他的。
John Snow noticed, that there was a lot of cholera happening in London
约翰·斯诺注意到，伦敦出现了大量的霍乱病例，
and he started looking at the patterns of how cholera was spreading
他开始观察霍乱的传播模式，
and he noticed that the areas which had high incidence of cholera,
他注意到，霍乱高发地区
all had a similar drinking source, a water pump.
都有类似的饮用水来源——水泵。
And so he removed that water pump
于是，他拆掉了那些水泵，
and it showed that cholera rates in those areas went down
结果显示，这些地区的霍乱发病率真的下降了，
and it's a famous epidemiology story
他也因此成就了一个著名的流行病学故事，
about one smart person paying attention to patterns of disease and figuring out how to stop it."
一个聪明人通过关注疾病的模式，找到了阻止它传播的办法。”
And two centuries later, we're still trying to figure it out.
两个世纪过去了，我们仍在努力寻找答案。
What we know is that when a person contracts cholera,
我们知道的是，一个人感染霍乱
it's usually through a contaminated source
往往是通过某个感染源，
like drinking water that's come into contact with infected feces.
比如被感染霍乱者排出的粪便污染的饮用水，感染的。
Now, after that first sip, it takes the bacteria anywhere from a few hours
这时，喝了一口被感染的水之后，细菌开始对感染者身体造成严重破坏
to a couple of days to begin wreaking havoc on the body.
所需的时间可能是几个小时，也可能是几天。
"When you ingest the bacteria,
“当你摄取了霍乱弧菌之后，
it goes from your mouth, into your esophagus, into your stomach,
它就会从你的口腔进入你的食道，进入你的胃，
and then pass the stomach and where it causes disease is in the small intestine."
然后穿过胃，到达最终引发疾病的部位——小肠。”
Once there, the bacteria swims towards the intestinal wall,
一旦到达这里，霍乱弧菌就会游向肠壁，
pushing through the thick mucous layer of the intestines' epithelial cells
穿过小肠上皮细胞厚厚的粘液层，
where it then attaches itself and begins to multiply,
然后附着在那里并开始繁殖，
releasing toxins that stimulate the cells to secrete water.
释放出刺激上皮细胞分泌水分的毒素。
And that's where the chaos begins.
紊乱就是从这时开始的。
"What it does to the body is it will cause vomiting.
“对人体的影响包括引发呕吐，
It causes stomach pains.
引起胃痛，
It causes bad watery diarrhea.
引发严重的水样腹泻。
All of a sudden, all of the water in your body starts being secreted through your intestinal cells.
突然之间，你体内所有的水分都开始通过你的肠道细胞分泌出来了。
The secretion of fluids is so massive that you basically pour out liters of fluid from your body.
分泌量大到你会倾泻般地排出足有几公升的液体。
And that's how cholera kills, right, because it just dehydrates, then all of the organs shut down.
这就是霍乱致命的地方，没错，因为它会让你整个人脱水，随后，你身体所有的器官都会停止工作。
Like if you've seen a cholera dehydration in your life once, you never forget it."
你只要见过一次霍乱脱水的架势，就算你想忘，也会忘不掉。”
Oh, and if that weren't scary enough,
哦对，如果这还不够恐怖，
that rapid loss of fluid can all happen within a matter of hours of showing symptoms.
（那我告诉你）从刚出现症状到出现这种体液快速流失症状可能只需几个小时。
Thankfully, only a minority of cases experience this.
值得庆幸的是，只有少数病例会发生这种情况。
While the rest have mild to moderate symptoms,
其他病例只会出现轻微到中度的症状，
developing bouts of nausea, vomiting, and loose stools.
比如一阵阵的恶心、呕吐，便稀等。
But milder cases still present a threat
不过，就算是症状较轻的病例也很危险，
because patients can excrete V. cholerae for up to two weeks after the infection has passed.
因为哪怕感染已经过去两周，患者都还有排出霍乱弧菌的可能性。
Luckily though, we know how to treat it.
幸运的是，我们已经有治疗手段了。
For patients suffering, the most important thing to do is to replace the rapid loss of minerals,
就患者而言，最重要的就是补充迅速流失的矿物质，
so a solution of oral rehydration salts is usually given
所以医生通常会给患者开口服补液盐，
and in the more extreme cases, IV fluids can be used to get the job done faster.
更极端的情况还会使用静脉输液来更快地完成这项工作。
And to stem future spread, antibiotics can help reduce the amount of the bacteria present in the stool.
而要想阻止未来的传播，抗生素可以帮助减少粪便中的细菌数量。
As for prevention, there are two main methods:
至于预防，主要有两种方法：
"One is of course making sure that people have access to clean water and sanitation
“其一当然是确保人们能够获得清洁的水和卫生设施了，
and now we know much more about the types of areas where cholera spreads,
而且，鉴于我们对霍乱传播的地区类型已经有了深刻得多的了解，
they're called hotspots, where there is a lot of people living in close proximity,
这些地区也被称之为“热点”地区，很多人住得距离彼此都很近，
so high population density slums, inner city areas in developing countries
也就是发展中国家人口密度高的贫民窟，城中村，
and typically they are close to a body of water."
而且这些地区通常都离水不远。”
While the other is vaccines.
其二就是疫苗。
Currently, there's the oral cholera vaccine, which is taken in two doses one to two weeks apart.
目前，我们已经有每隔一到两周服用两剂的口服霍乱疫苗。
It's the main one used in mass vaccination efforts
这种疫苗也是大规模疫苗接种使用的主要疫苗，
and it's produced by two manufacturers: Euvichol and Shanchol.
主要来自两家制造商：Euvicol和Shanchol。
And the best part is, is that it's really cheap, at less than two dollars a dose.
最棒的是，这种疫苗真的很便宜，一剂才不到两美元。
"This vaccine has now saved thousands and thousands of lives.
“到目前为止，该疫苗已经拯救了成千上万人的生命。
30 to 40 million doses are being used every year in the cholera hotspots.
霍乱热点地区每年的使用量高达3000万~4000万剂。
This is for the first time that so many doses of vaccines are being used
这是我们第一次使用如此大批量的疫苗，
that we are now seeing the number of deaths from cholera decreasing in the world for the last two years
我们看到，过去两年，世界上死于霍乱的人数正在减少，
and so that's really good news on cholera."
所以，就霍乱而言这已经算是很好的好消息了。”
So if we know how to treat the disease and have a way to prevent it,
那么，既然我们已经知道如何治疗，也有预防的手段了，
then why is this ancient disease still an issue today?
那为什么这种古老的疾病还会困扰我们至今呢？
"The reason that Cholera has persisted is that we have not addressed poverty to the level that we should
“霍乱持续至今的原因在于我们解决贫困问题解决得还不到位，
and with time we know how Cholera happens and where it happens
随着时间的推移，我们已经知道霍乱爆发的原因以及它会在哪里爆发了，
and we should be able to focus on those cholera hotspots as first priority
那我们就应该将重点放在这些热点地区，
for areas which need improved sanitation and hygiene.
放在需要改善卫生条件和医疗卫生设备的这些地区。
And that's countries working together prioritizing health over other things and improving their own infrastructure.
具体办法就是各国共同努力，把健康放在首位，改善各自的基础设施。
So when we can do that, cholera will disappear."
等我们能做到这一点了，霍乱自然就会消失。”
To help get there, the World Health Assembly,
为了帮助实现这一目标，世界卫生大会，
which is the WHO's decision making body, pledged to eradicate cholera by 2030,
也即世卫组织的决策机构，该大会承诺，在2030年之前根除霍乱，
hoping to reduce deaths worldwide by 90%.
希望将全球范围内的死亡人数减少90%。
And if we can achieve that goal,
如果我们能够实现这一目标，
we may soon see the end of one of the world's longest pandemics.
或许，我们很快就将看到世界上持续时间最长的流行病之一被终结于此。
"We have an opportunity to get rid of cholera from the world forever
“我们有机会让霍乱彻底从世上消失，
and also an opportunity for the world to understand how we have worked together as a multinational effort,
也有机会让世界了解作为一项多国事业，我们是如何齐心协力，
coming together to control cholera as an infectious disease pandemic
携手控制霍乱这一传染病大流行的，
and what are the lessons learned for controlling COVID in the same way."
以及我们能从以同样的方式控制新冠疫情中吸取哪些经验教训。”
