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英国《自然》杂志:中国应对禽流感H7N9,堪称典范(next to exemplary)

24/04/2013 |EDITORIAL|Nature

The fight against bird flu

 China’s well-handled response to outbreaks of H7N9 avian influenza belies the country’s bad reputation from its past dealings with disease. But there are still improvements to be made.


China deserves credit for its rapid response to the outbreaks of H7N9 avian influenza, and its early openness in the reporting and sharing of data.
A bad reputation is difficult to shake. A decade ago, China failed to report early cases of severe acute respiratory syndrome (SARS) and fumbled its initial response to the threat. Today, some commentators view its reaction to H7N9 with mistrust. But from all the evidence so far, China’s response to the virus, which had caused 104 confirmed human cases and 21 deaths asNature went to press, is next to exemplary.
China reported the H7N9 outbreak to the World Health Organization (WHO) on 31 March, just six weeks after the first known person fell ill. On the same day, it published the genomic sequences of viruses from the three human cases then identified on the database of the Global Initiative on Sharing Avian Influenza Data (GISAID). It has also shared all the sequences with the WHO, and live virus with the WHO and other laboratories. This has allowed scientists to identify the virus’s mutations, trace its origins and develop crucial diagnostic tests. China continues to report new cases daily, and its media discusses H7N9 fairly openly. Chinese and other researchers have quickly published detailed analyses of the virus in journals (R. Gao N. Engl. J. Med. http://doi.org/k7r; 2013). Chinese President Xi Jinping added political clout last week when he called for an effective response, and said that the government must ensure the release of accurate information about the outbreaks.
China’s response to the epidemic has also been brisk. Diagnostic tests have been distributed to hospitals and research labs across the country. The response, spearheaded by the Chinese Center for Disease Control and Prevention in Beijing, has united clinicians, virologists, and epidemiologists. Live-bird markets at which H7N9 has been found have been shut down, and birds culled. The agriculture ministry has tested tens of thousands of birds and other animals for the virus, to try to pin down the sources of human infections and explain their occurrence in cities hundreds of kilometres apart — no mean task given that China has some 6 billion domestic fowl and half a billion pigs, which can also carry the virus. So far, however, apart from birds at the live markets, the sources of infection remain elusive. To help track them down, and to collaborate in efforts to control H7N9, China has invited a team of WHO scientists and international flu experts to the country. They arrived last week, and are expected to report their preliminary conclusions this week.
Yet suspicions linger. Some critics have questioned, for example, the time between the first person falling ill on 19 February and China’s first announcement about the virus, and have asked whether the announcement was deliberately delayed. This is unfair. With just a handful of severe pneumonia cases caused by the virus by mid-March, it is impressive that China realized as quickly as it did that something was amiss. It took the United States, which has one of the world’s most advanced disease-surveillance systems, an almost identical amount of time to identify a novel H3N2 swine virus that caused serious illness in a child in 2011.
China has made a good start, but it is crucial for the country to continue its openness over the H7N9 outbreaks. In particular, it must promptly report any evidence of human-to-human spread. There are also areas for improvement: data made public on human cases are often limited to basic facts such as age, sex, date of onset of illness and location. Epidemiologists also need more detailed data, including possible exposures to infection and underlying medical conditions. Case reports should be published in full in journals or online as quickly as possible.
It is also important that sequences from as many cases as possible are submitted to publicly accessible databases, because sequence data are important in tracking evolutionary changes such as new mutations that could allow the virus to spread between humans more easily. They can also provide clues to the source of infection (see page 399).
Even as the Chinese authorities are being open and transparent on H7N9, some scientists are hoarding epidemiological and other data, because of intense competition to be the first to publish. Competition can be healthy, but in the face of a virus that has the potential to cause a pandemic, researchers have a duty above all else to share important data. Journals must be ready and willing, as in any public-health emergency, to fast-track peer review of H7N9 papers, and not let rapid publication of preprints stand in the way of considering papers for publication. Meanwhile, observers should continue to scrutinize China’s response to H7N9, but they should also give credit where credit is due. It is time to recognize that China has changed.

英国《自然》杂志:
24/04/2013 |EDITORIAL|Nature

据新华社电 英国权威科学杂志《自然》424日在线发表题为《与禽流感之战》的社论说,中国此次对H7N9禽流感疫情反应迅速、措施得当,改变了过去应对疫情的负面形象

  及时公开通报疫情

  社论说,疫情发生后,中国反应迅速,在及时报告和分享相关数据方面表现出的开放性也值得称道。虽然一些评论者对中国应对H7N9行动仍有不信任,但就目前所有证据来看,它对此次疫情的应对行动几乎是典范性的

  社论说,中国早在331日就向世界卫生组织通报了这次疫情,距首例病人患病仅6周时间。同日,中国公布了从三个病人体内提取的新病毒的基因测序结果,并被全球共享禽流感数据倡议数据库认证。中国还与世卫组织共享了全部测序结果,与该组织和其他实验室共享了活体病毒。这使科学家能够及时识别病毒的变异情况,追踪其来源并寻找关键的诊断方法。中国目前每天报告疫情,媒体对H7N9的讨论也相当公开坦率

  全力追踪病毒来源

社论说,中国对此次H7N9禽流感疫情的反应也十分敏锐。诊断测试工作被分散到全国各个医院和科研实验室,整个应对行动由中国疾控中心牵头,联合了临床医生、病毒学家和流行病学家共同参与。发现H7N9病毒的活禽市场被关闭,所涉及的禽类被扑杀。农业部对数万只禽类和其他动物进行了病毒测试,以确定人类感染源,弄清楚感染区域相隔数百公里的原因。要知道中国约有60亿只家禽和约5亿头猪,后者也有可能携带病毒,因此这不是一项简单的任务。


  社论说,截至目前,除活禽市场的禽类外,病毒感染源仍不清楚。为了追踪病毒来源,共同努力控制疫情,中国已邀请了一支由世卫组织科学家和国际流感专家组成的队伍

  质疑声音有失公平

  社论同时提出,有批评人士提出一些质疑,比如,从219日首例病人患病到中国公布病毒情况间隔较长,是否存在刻意拖延?社论认为,这种质疑是不公平的,3月中旬仅凭少数严重肺炎病例中国就迅速意识到了情况异常,这已经令人钦佩。即使拥有世界最先进疾病监控系统的美国,在2011年发现新型H3N2型猪流感病毒也用了几乎相同的时间

  社论说,中国取得了一个良好的开始,接下来继续保持其开放性十分重要。特别是,如有任何人际传播的证据,中国必须立即报告。

  社论最后说:观察者们应继续监督中国H7N9疫情的应对行动,但他们同样应该在这次行动值得称赞的地方不吝赞赏。是时候认识到这一点了:中国已有所改变。









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