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纽约时报

疾控中心无视各州验证新型麻疹检测的请求(赠阅文章)C.D.C. Ignored Request From States to Validate a New Measles Test (Gift Article)

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美国疾控中心忽视各州要求验证新麻疹检测方法的请求 该机构两个月后回复称有“其他优先事项”,西部各州联盟官员透露。

C.D.C. Ignored Request From States to Validate a New Measles Test The agency replied two months later, saying it had “competing priorities,” officials from a coalition of Western states said.

今年春季面临麻疹疫情的加利福尼亚州和华盛顿州卫生官员,于5月请求疾病控制与预防中心(C.D.C.)验证一种可在八小时内诊断500例病例的检测方法。

Health officials in California and Washington, facing outbreaks of measles this past spring, asked the Centers for Disease Control and Prevention in May to validate a test that can diagnose 500 cases in eight hours.

他们两个月都未收到回复。西海岸健康联盟——加利福尼亚州、华盛顿州、俄勒冈州和夏威夷州——的官员本周在致疾控中心新任主任埃里卡·施瓦茨博士的信中讲述了这一经历,施瓦茨于8月上任,就在他们收到该机构回复后不久。据《纽约时报》获得的这封信显示,疾控中心告知他们,因有“其他优先事项”,无法抽出时间让高通量检测可供州实验室使用。

They did not hear back for two months. Officials from the West Coast Health Alliance — California, Washington, Oregon and Hawaii — recounted the experience this week in a letter to Dr. Erica Schwartz, the C.D.C.’s new director, who assumed the position in August, shortly after they got the agency’s reply. According to the letter, obtained by The New York Times, the C.D.C. had told them that it had “other competing priorities” and could not dedicate time to making a high-volume test available to state labs.

这些官员敦促疾控中心为麻疹和其他危险病原体开发并分发此类检测方案,称这将使全国公共卫生实验室为大规模疫情做好准备。

The officials urged the C.D.C. to develop and distribute the protocols for such tests for measles and other dangerous pathogens, saying they would enable public health labs across the country to be ready for large outbreaks.

他们写道:“诊断检测的可用性和速度能极大缓解传染病疫情的早期阶段。”

“The availability and speed of diagnostic testing can dramatically mitigate the early stages of an outbreak of infectious disease,” they wrote.

监管疾控中心的卫生与公众服务部未回应关于该机构针对可快速诊断大量病例的麻疹高通量检测计划的提问。

The Department of Health and Human Services, which oversees the C.D.C., did not address questions about the agency’s plans for a high-throughput test for measles that can rapidly diagnose large numbers of cases.

该部门发言人艾米莉·希利亚德在一份电邮声明中表示,“疾控中心正在确保州和地方卫生部门获得所需支持,以加强麻疹检测和疫情应对能力。在施瓦茨博士的领导下,该机构正优先发展新兴技术,以最好地帮助我们的合作伙伴更快速、更有效地作出应对。”直到不久前,麻疹病例在美国通常较为罕见,该疾病在2000年被视为已消除。因此,目前美国尚无用于麻疹的商业快速检测试剂——这种检测本可在医生诊室或急诊室快速给出结果。

Emily Hilliard, a spokeswoman for the department, said in an emailed statement that the “C.D.C. is ensuring state and local health departments have the support needed to strengthen measles detection and outbreak response. Under Dr. Schwartz’s leadership, the agency is prioritizing emerging technologies to best assist our partners in responding more quickly and effectively.”Until recently, measles cases were generally rare in the United States and the disease was considered eliminated in the year 2000. As a result, commercial rapid tests for measles — which could provide a quick answer in a doctor’s office or an emergency room — are not currently available in the country.

但过去两年间,该疾病病例数急剧攀升。今年迄今为止,疾控中心已记录超过4400例病例,宾夕法尼亚州已报告六例与麻疹相关的死亡。

But the disease has surged drastically in the past two years. Already this year, the C.D.C. has recorded more than 4,400 cases, and Pennsylvania has reported six deaths related to measles.

鉴于病例数不断攀升,医学专家认为美国需要加强快速诊断麻疹的能力。

Given the swelling caseloads, medical experts believe the country needs to step up its ability to diagnose measles rapidly.

“在我看来,这是一个相当紧迫的需求,”纽约州公共卫生实验室沃兹沃思中心前主任吉尔·泰勒说。

“It seems to me that it’s a fairly urgent need,” said Jill Taylor, a former director of the Wadsworth Center, New York State’s public health laboratory.

麻疹通常在诊所将样本送至公共卫生实验室后作出诊断,实验室依靠经验丰富的工作人员进行检测。整个流程可能需要两个工作日,在实验室人手特别紧缺的州则可能长达五天。

Measles is typically diagnosed after a clinic sends a sample to a public health laboratory, which relies on experienced staff to run the test. The entire process can take two business days, or up to five in states where labs are particularly short on staff.

在新冠疫情期间,大多数公共卫生实验室购置了高通量设备,可大幅减少检测和所需人力时间。现在他们需要的只是一款由疾控中心开发并认可的检测试剂。

During the coronavirus pandemic, most public health labs acquired high-throughput machines, which can significantly cut down the testing and staff time required. Now all they need is a test that has been developed and endorsed by the C.D.C.

泰勒博士等人指出,美国疾病控制与预防中心(CDC)可能目前没有能力评估和验证新检测方法的可靠性。该机构的员工人数比特朗普总统第二个任期开始时减少了约30%,其工作受到卫生部长罗伯特·F·肯尼迪(Robert F. Kennedy Jr.)及其他政治任命官员的严格控制。

But the C.D.C. may not currently have the capacity to evaluate and confirm the reliability of a new test, Dr. Taylor and others noted. The agency has about 30 percent fewer employees now than it did at the start of President Trump’s second term, and its work is tightly controlled by Health Secretary Robert F. Kennedy Jr. and other political appointees.

“员工们已经不堪重负,而且目前缺乏能够帮助他们判断哪些事情真正重要的领导层,”曾参与评估CDC实验室运营工作的泰勒博士说。“我为他们感到非常难过,但鉴于当前的情况,这项工作确实应该被列为优先事项,”她补充道。

The staff are “beaten down” and “don’t have leadership at the moment to help them decide what’s important,” said Dr. Taylor, who was part of a committee convened to assess the C.D.C.’s lab operations. “I feel so bad for them, but given what’s happening, this ought to be a priority,” she added.

去年,德克萨斯州和犹他州的公共卫生实验室自行开发并验证了用于应对当地麻疹疫情的检测方法。“所有州都有能力设计和实施由自己开发的检测方法,不过拥有CDC制定的统一标准总是有帮助的,”公共卫生实验室协会(Association of Public Health Laboratories)的首席执行官斯科特·贝克尔(Scott Becker)表示。

Last year, public health labs in Texas and Utah developed and validated their own tests to cope with measles outbreaks in their states. “All states can design and implement a laboratory-developed test, but having a C.D.C. protocol is always helpful,” said Scott Becker, the chief executive of the Association of Public Health Laboratories.

然而,一些专家认为并非所有公共卫生实验室都具备自行开发检测方法的能力。“有很多公共卫生实验室无法自行开发检测方法,只能依赖外部提供的检测试剂盒或经过全面验证的检测工具,”泰勒博士说。

But some experts disagreed that all public health labs have the capacity to develop their own tests. “There are many public health labs that could not develop their own but are dependent on getting a kit and getting a fully verified test,” Dr. Taylor said.

CDC通常在开发针对新病原体的检测方法方面处于领先地位,但传统上并不负责验证那些高通量(即能够快速处理大量样本)的检测方法。不过,两位不愿公开姓名的CDC官员表示,这种情况显然需要改变。

The C.D.C. typically takes the lead in developing tests for new pathogens but has not traditionally validated high-throughput ones. But that clearly needs to change, two of the agency’s own officials said, speaking on condition of anonymity for fear of reprisal.

阿波尔瓦·曼达维利(Apoorva Mandavilli)为《纽约时报》(The Times)撰写关于科学与全球健康的报道,主要关注传染病、大流行病以及致力于应对这些问题的公共卫生机构。

Apoorva Mandavilli reports on science and global health for The Times, with a focus on infectious diseases and pandemics and the public health agencies that try to manage them.

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