Anthrax: The Investigation of a Deadly Outbreak
Anthrax: The Investigation of a Deadly Outbreak
复制标题
炭疽：致命爆发的调查
DOI：
10.1038/73067
复制
发表时间：
2000
期刊：
影响因子：
82.9
通讯作者：
D. Henderson
中科院分区：
文献类型：
--
作者：
D. Henderson
1979年4月2日，乌拉尔山脉的苏联城市斯维尔德洛夫斯克的一个生物武器生产设施意外释放出一小团炭疽孢子。它在城市南部的一部分上空缓慢地向东南方向漂移，看不见，无法识别。两天后，第一批受害者病倒了。在接下来的六个星期里，大约有100人患上了这种疾病，至少有70人因感染而死亡，感染距离孢子释放点的顺风三英里。这是第一次也是唯一一次已知的吸入性炭疽病流行。计算表明，释放的孢子数量可能不到一克，炭疽是最致命的潜在生物武器之一，也是那些希望生产这种武器的人最普遍喜欢的制剂。在自然界中，它主要是一种放牧动物的疾病，通过污染的土壤获得感染。人类的自然感染是由于与动物或动物产品接触造成的，通常会引起皮肤溃疡，这种溃疡很容易用抗生素治疗。食用未煮熟的受污染的肉类时，偶尔会爆发小规模的胃肠道疾病。然而，吸入性炭疽是一种极其罕见但严重的疾病，可导致高达80%的受害者死亡。从感染到死亡通常不超过两到四天。抗生素在治疗中几乎没有好处，除非在第一个症状出现后立即使用。在她的书炭疽，珍妮Guillemin提供了可怕的斯维尔德洛夫斯克流行病的唯一详细说明，一个事件，可以重复在更大的规模是炭疽孢子在气溶胶的形式，今天由恐怖分子传播。这本书的结构围绕着由哈佛生物学家马修·梅塞尔森领导的对这一事件的不断发展的调查展开，并得到了作者和几位俄罗斯和美国科学家的协助。这种形式让人想起了伯顿·鲁切的《纽约客》流行病侦探故事。从1979年疫情发生之时起，俄罗斯科学家就将其原因归咎于食用了受污染的肉类。然而，流亡者提供的谣言向美国情报分析师提出了相反的建议。为了消除对俄罗斯生物武器发展的怀疑，梅塞尔松一再敦促俄罗斯官员和科学家对这一事件进行全面和公开的调查。最后，在1992年6月，一个美国小组获准访问斯维尔德洛夫斯克。俄罗斯卫生部官员坚持认为，原因是受污染的肉类，几乎没有提供必要的数据。该小组面临的挑战是调查一种十多年前的流行病，其中临床记录已被克格勃没收，大多数受害者死于这种疾病。一开始，两名病理学家完成了大量的尸检，其中42例被他们认为是典型的吸入性炭疽，这是一个重大的突破。幸运的是，这些标本被克格勃官员忽略了，他们试图没收所有相关数据。小组中的一名美国病理学家能够证实，他们是典型的吸入性炭疽。此后，随着作者在俄罗斯同行的协助下采访了许多幸存者的亲属，并系统地逐件收集了有关这一流行病的大量信息，故事逐渐展开。也许最重要的发现是，吸入性炭疽病的潜伏期并不像实验动物研究所表明的那样，也不像标准教科书所宣称的那样，只有两到六天。而是两天到至少四十五天。这一发现的含义是，在发现流行病后，将有足够的时间进行挽救生命的抗生素预防，以防止高达75%的潜在受害者患病。科学家和政策制定者都将感到失望，因为作者没有投入更多的时间和精力来分析和阐明显然收集到的流行病学信息。一部引人入胜的流行病学侦探小说往往会变成一部漫无边际的游记，其中有大量不相关的离题。这本书应该是任何严重关注生物恐怖主义的人的必读阅读，但很难推荐给其他对流行病学或文化人类学有更普遍兴趣的人。
On 2 April 1979, a small cloud of anthrax spores was accidentally released from a bioweapons production facility in Sverdlovsk, a Soviet city in the Ural Mountains. It drifted slowly southeast over a portion of the city’s southern suburbs—invisible, unrecognized. Two days later, the first victims fell ill. Over the following six weeks, some 100 people developed the disease and at least 70 died as a result of infection acquired as far as three miles downwind from the release point of the spores. This was the first and only known epidemic of inhalation anthrax. Calculations indicate that the quantity of spores released may have weighed less than one gram. Anthrax is one of the most deadly of the potential biological weapons and the agent most universally favored by those desiring to produce such weapons. In nature, it is mainly a disease of grazing animals, which acquire infection from contaminated soil. Natural infections in man result from contact with animals or animal products and usually cause an ulcer of the skin that is readily treated with antibiotics. There are occasional small outbreaks of gastrointestinal disease when undercooked, contaminated meat is consumed. However, inhalation anthrax is an exceedingly rare but grave form of the disease that kills up to 80% of its victims. From the onset of infection to death is usually no more than two to four days. Antibiotics are of little benefit in treatment unless administered very soon after the first symptoms occur. In her book Anthrax, Jeanne Guillemin provides the only detailed account of the appalling Sverdlovsk epidemic, an event that could be repeated on a far larger scale were anthrax spores in an aerosol form to be disseminated today by a terrorist. The book is structured around the evolving investigation of the event led by Harvard biologist Mathew Meselson, assisted by the author and several Russian and American scientists. The format is reminiscent of Berton Roueche’s New Yorker tales of epidemic sleuthing. From the time of occurrence of the epidemic in 1979, Russian scientists attributed its cause to the consumption of contaminated meat. However, rumors provided by emigrés suggested otherwise to US intelligence analysts. In the interest of defusing suspicions about Russian biological weapons developments, Meselson had repeatedly pressed Russian officials and scientists for a full and open investigation of the incident. Finally, in June 1992, permission was granted for an American team to visit Sverdlovsk. Russian Ministry of Health officials persisted in their assertion that the cause was contaminated meat and provided little essential data. The challenge to the team was that of investigating an epidemic more than a decade old, one in which the clinical records had been confiscated by the KGB and in which most victims had died of the disease. At the outset, an essential breakthrough occurred with the discovery of two pathologists who had completed numerous autopsies, 42 of which they considered to be classical inhalation anthrax. Fortunately, the specimens had been overlooked by KGB officials seeking to confiscate all relevant data. An American pathologist on the team was able to confirm that they were typical of inhalation anthrax. Gradually, thereafter, the story unfolded as the author, assisted by Russian counterparts, interviewed relatives of many of the survivors and systematically assembled, piece by piece, considerable information about the epidemic. Perhaps the most important finding was the discovery that the incubation period for inhalation anthrax was not two to six days, as experimental animal studies had shown and as standard textbooks proclaimed. Rather, it was two to at least forty-five days. The implication of this finding is that after discovery of an epidemic, there would be sufficient time to administer life-saving antibiotic prophylaxis to prevent disease in up to 75% of the potential victims. Scientists and policy-makers alike will be disappointed that the author did not devote more time and effort to the analysis and elucidation of the trove of epidemiological information that apparently was collected. And what might have been a riveting epidemiological detective story drifts too often into a rambling travelogue with extended irrelevant digressions. The book should be required reading for anyone seriously concerned about biological terrorism, but it is difficult to recommend it to others with a more general interest in epidemiology or cultural anthropology.