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孕期感染兹卡是否应该堕胎?

更新时间:2016-2-17 8:47:47 来源:纽约时报中文网 作者:佚名

Zika Virus in Colombia Presents Complicated Choice About Abortion
孕期感染兹卡是否应该堕胎?

CÚCUTA, Colombia — Margarita Rosa Barrios was six weeks pregnant when she began to feel the symptoms that every expecting mother here has come to dread: swollen eyes, aching joints, three days of fever. Just as she feared, she had the Zika virus.

哥伦比亚库库塔——怀孕六周的时候,玛加丽塔·罗莎·巴里奥斯(Margarita Rosa Barrios)开始感到身体出现了一些让这里的准妈妈们感到恐惧的症状:眼睛肿胀,关节疼痛,持续发烧三天。正如自己所担忧的,她感染了兹卡病毒。

Ms. Barrios, 24, knows that thousands of babies have been reported born with abnormally small heads during the Zika epidemic in neighboring Brazil and that researchers there say the virus is to blame.

24岁的巴里奥斯知道,兹卡(Zika)疫情在邻国巴西蔓延期间,据称有成千上万的婴儿出生时出现头异常小的症状,研究人员表示,这是由兹卡病毒造成。

And Ms. Barrios is not expecting just one child. She is carrying twins.

况且,巴里奥斯怀的不只是一个孩子,而是双胞胎。

Nearly 3,000 pregnant women in Colombia are in Ms. Barrios’s agonizing position, having recovered from Zika only to be left in a terrible dilemma. Unlike in Brazil, in Colombia some expecting mothers are being given the choice to to end their pregnancies, under laws that allow abortions in some cases.

哥伦比亚有将近3000名孕妇处在和巴里奥斯一样的痛苦中,她们在感染兹卡病毒后康复,跟着却陷入了这种可怕的两难境地。与巴西的情况不同,在哥伦比亚,法律允许在某些情况下人工流产,一些怀孕妇女有了终止妊娠的选项。

Colombia has emerged as the second front in the battle against Zika in the Americas. At least 25,000 Colombians have contracted the virus, a number officials say could surge to 600,000.

在美洲地区,哥伦比亚新近成为对抗兹卡病毒的第二个战场。至少有2.5万名哥伦比亚人感染了这种病毒,有官员表示,这个数字可能会激增至60万。

But unlike in Brazil — where there have been an estimated 1.5 million infections dating to 2014 — in Colombia the first cases of Zika were detected only in October. Most pregnant women who have contracted the disease in this country have not given birth yet, and no cases have been confirmed of infants born with abnormally small heads, a condition known as microcephaly.

不过,与2014年已经有大约150万感染病例的巴西不同,哥伦比亚去年10月才出现了第一批兹卡病毒感染病例。在这里,感染病毒的孕妇大多还没生产,还没出现婴儿出生时头异常小的确诊病例,这种症状被称为小头畸形症。

This has put women here in Colombia in the difficult position of considering — and, in some cases, having — abortions even before any microcephaly cases have appeared in the country.

这使哥伦比亚的女性陷入需要考虑人工流产的艰难境地,有些已经这么做了——尽管该国还没有出现小头畸形病例。

“There’s a lot we don’t know about this disease,” Fernando Ruiz Gómez, Colombia’s deputy health minister, said. “What we know is there’s a growing disparity between what we’re seeing in Colombia with Zika and the experience in Brazil.”

“关于这种疾病,我们不了解的地方还有很多,”哥伦比亚卫生部副部长费尔南多·鲁伊斯·戈麦斯(Fernando Ruiz Gómez)说。“我们所知道的是,我们在哥伦比亚看到的兹卡病毒感染情况,与在巴西的经验有越来越大的差异。”

Colombia is one of the few nations in Latin America with abortion laws that allow women to terminate pregnancies under a variety of circumstances, including rape, birth defects that make a fetus unable to survive outside the womb or when there are risks to the pregnant woman’s physical or mental health.

哥伦比亚是拉丁美洲为数不多的有堕胎法允许女性在多种情况下终止妊娠的国家之一。这些情况包括强奸、会导致胎儿无法在子宫外存活的先天缺陷,或存在损害孕妇生理和心理健康的风险。

While legal abortions remain rare in Colombia, there are signs that the law is undergoing a major new test. Some medical officials say that microcephaly is grounds for abortion and that they will offer the procedure to pregnant women if the fetus shows signs of the condition.

尽管合法堕胎在哥伦比亚并不多见,但有迹象显示,这项法律正在经受一次重大的新考验。一些卫生官员表示,小头畸形症可以成为堕胎的理由,如果胎儿有患此类病症的迹象,他们会给孕妇提供堕胎服务。

Others have gone further.

其他人在这方面走得更远。

Ms. Barrios says her doctors offered to perform an abortion, even though there is no evidence that the babies she is carrying have microcephaly.

巴里奥斯表示,她的医生提出可以给她进行堕胎手术,尽管并没有证据显示她怀的胎儿患有小头畸形症。

“The doctor asked me if I might be ready to have two deformed children,” she said. “How do you tell a mother that?”

“医生问我是否做好了生出两个畸形儿的准备,”她说。“怎么能跟一个母亲讲这种话?”

Vanesa, a 28-year-old woman in the coastal city of Barranquilla, said she decided to end her pregnancy after she contracted Zika. An ultrasound showed what doctors said could be a deformity, possibly microcephaly.

28岁的瓦妮莎生活在沿海城市巴兰基亚,她表示,在得知自己感染兹卡病毒后,她决定终止妊娠。超声波扫描显示,她怀的胎儿可能如医生所说有先天畸形,而且有可能是小头畸形症。

“I cried a lot,” said Vanesa, who asked that her full name be withheld because she did not want others to know she had an abortion. “We are Catholics, and we prayed to God. We decided not to have the baby.”

“我哭得很厉害,”瓦妮莎说。她要求报道时不使用她的全名,因为她不想让其他人知道自己堕胎了。“我们是天主教徒,会向上帝祷告。我们决定放弃这个胎儿。”

The issue is all the more complex because the scientific link between Zika and microcephaly in infants has not been proved. International health officials say the connection is “strongly suspected,” but they warn that it may take months to know for sure.

这个问题正变得愈加复杂,因为兹卡病毒和婴儿患小头畸形症之间存在联系这一点,还没有得到科学证明。有多名国际卫生官员表示,他们对这种联系持“强烈怀疑”态度。但他们也警告,这个问题的答案可能要在数月之后才能确定。

Even if Zika does cause microcephaly, there is often no way to predict how a baby will be affected. Infants with microcephaly can endure a wide range of mental and physical disabilities, while some, about 10 percent, have no limitations.

即使兹卡病毒不会引起小头畸形症,往往也无法预测胎儿会受到怎样的影响。患小头畸形症的婴儿有可能会有各种各样的心理和生理残疾,但也有大约10%的这种婴儿没有什么缺陷。

Zika has already spread to 250 cities and towns in Colombia. It is here in Cúcuta, a city of 650,000 on the border of Venezuela that sits squarely in the range of the mosquitoes that transmit the virus, along with two other diseases, dengue and chikungunya.

兹卡病毒已经在哥伦比亚的250个城镇传播开来。靠近委内瑞拉边境、有65万人口的库库塔,正好处在会传播这种病毒的蚊子滋生的区域,这种蚊子还会传播另外两种病毒,即登革热和基孔肯雅热。

On the streets here in Cúcuta, it is now difficult to find a person who has not had Zika or known someone who did. Entire families have come down with symptoms.

在库库塔街头,现在很难找到一个不曾感染兹卡病毒或不认识此类感染者的人。很多是全家人都染上了这种病。

At the center of town is a large tent camp where dozens of homeless Colombians sleep after having been forced out of Venezuela last year for not having proper visas. Across the street is a culvert swarming with mosquitoes.

这个城市的中心有个不小的帐篷营地,有数十个无家可归的哥伦比亚人住在里面,他们在去年因没有合格的签证文件而被迫离开了委内瑞拉。街对面有一个涵洞,里面聚集了成群的蚊子。

Two pregnant women live in the camp. Neither has contracted Zika yet, according to residents, but it is assumed that everyone will be infected here at some point.

有两名孕妇生活在这个营地。这里的住户称,这两人都还没有感染兹卡病毒,但他们认为最终这里所有的人都会感染。

Marlenia Ortíz, a 37-year-old mother of five, said one of her children had already contracted Zika. Last year, the entire family was infected with chikungunya, she said.

37岁的马琳娜·奥提兹(Marlenia Ortíz)是五个孩子的母亲,她说其中有一个孩子已经染上兹卡病毒。她说,去年他们一家人都曾感染基孔肯雅热。

“Not one person in my family escaped it,” she said. “The same will happen with Zika.”

“家里没一个人能逃脱,”她说。“这次的兹卡病毒也是一样。”

Scrambling for a response to the disease, Colombian officials have warned women to postpone getting pregnant for months, until more is known about the virus and its effects on infants.

哥伦比亚官员正在绞尽脑汁寻找应对这种疾病的方法,他们提醒女性最好将怀孕计划推迟几个月,直到医学界掌握更多有关这种病毒的信息,更了解它对婴儿的影响。

But in recent months, the country has made progress on what could be an innovative way of controlling the disease. Iván Darío Vélez, a tropical disease specialist at the University of Antioquia in Colombia, said scientists there had successfully bred a mosquito that was resistant to Zika, dengue, chikungunya and yellow fever.

不过,最近几个月,在有可能带来控制这种疾病的创新方法的研究上,这个国家取得了进展。哥伦比亚安蒂奥基亚大学(University of Antioquia)热带疾病专家伊万·达里奥·贝莱斯(Iván Darío Vélez)表示,那里的科学家已经成功繁殖出一种可以抗兹卡、登革热、基孔肯雅热病毒和黄热病的蚊子。

To create the strain, Dr. Veléz infected mosquitoes with bacteria that block the insects from picking up the virus. When the mosquitoes breed with ones that are susceptible to the disease, their progeny are shielded.

为了培育这种品种,贝莱斯博士让一些蚊子染上一种可以阻止昆虫携带兹卡病毒的细菌。当这些蚊子和容易染上兹卡的蚊子交配后,其后代就会具备这种抵抗力。

“The results are encouraging,” Dr. Vélez said, citing a recent pilot project near Medellín in which 80 percent of mosquitoes were rendered unable to transmit Zika.

“结果很令人振奋,”贝莱斯以麦德林附近最近进行一个试点项目为例说道。在这个项目中,研究人员已经实现让80%的蚊子无法传播兹卡病毒。

At the main hospital here, more than 80 pregnant women have come in with the virus since October, said its director, Dr. Juan Agustín Ramírez.

库库塔这家主要医院的院长胡安·阿古斯丁·拉米雷斯(Juan Agustín Ramírez)博士说,自去年10月以来,有80%的孕妇都是携带着兹卡病毒前来就诊。

About 35 percent of the women arrived in the first trimester, when microcephaly is most likely to develop, he said.

其中大约有35%的孕妇是在妊娠头三个月住进医院,那是最有可能出现小头畸形症的阶段,他说。

Dr. Ramírez said the hospital had not performed any Zika-related abortions, but he was firm that any women whose fetuses showed signs of the condition would be offered the procedure.

拉米雷斯还表示,该院还没有进行过和兹卡病毒有关的堕胎手术,但他肯定地表示,任何女性都会得到堕胎的选择,只要她的胎儿有患小头畸形症的迹象。

No woman, he said, should be forced to carry “a child that, in a few words, is useless to society.”

他表示,任何女性都不该被迫养育一个“简单来说,对社会无益的孩子”。

Ms. Barrios ultimately did not find herself in that position.

巴里奥斯最终没有走到堕胎的那一步。

After recovering from the virus, she discussed her pregnancy and the doctors’ offer of an abortion with her husband. An ultrasound showed that their twin fetuses were developing normally, she said, and the couple turned down the procedure.

从病毒感染中康复之后,她就自己怀孕的情况和医生提出的堕胎建议与丈夫商量。她说,后来她做了个超声波扫描,显示肚子里的双胞胎发育正常,夫妇二人于是拒绝了堕胎的提议。

But Ms. Barrios remains on edge.

不过,巴里奥斯仍然感到不安。

She continues to have regular ultrasounds to check for birth defects. As a Catholic, she said, she will accept whatever is discovered when the babies arrive.

她还在定期做超声波检查,查看胎儿有无先天缺陷。她说,作为一名天主教徒,孩子生出来后,不管是什么样,她都会接受。

“If it’s something that God wants, then so be it,” she said.

“如果那是上帝的旨意,就顺其自然,”她说。

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