Impindezelo Yeentsholongwane

INKULUNGWANE yama-20 iye yabonakala njengehambela phambili ngokumangalisayo kwinzululwazi yezonyango. Kangangamawaka amane eminyaka, umntu phantse ebebonakala njengongenaluncedo ngokuphathelele ubhubhani weentsholongwane ezibulalayo. Kodwa izinto zaye zaqalisa ukuguquka embindini wee-1930 xa izazinzulu zafumanisa isulfanilamide, ichiza lokuqala elalinokoyisa iintsholongwane ngaphandle kokumvisa iintlungu umntu owasulelweyo.a

Kwiminyaka eyalandelayo, izazinzulu zavelisa amayeza amatsha anamandla okulwa nezifo ezasulelayo—ichloroquine ukuhlasela isifo seengcongconi namayeza okubulala iintsholongwane ukuthibaza inyumoniya, iscarlet fever nesifo sephepha. Ngowe-1965 kwaye kwaveliswa amayeza awahlukeneyo okubulala iintsholongwane angama-25 000. Izazinzulu ezininzi zagqiba kwelokuba izifo ezibangelwa ziintsholongwane azisaxhomisi mehlo kangako okanye azisafuni kwenziwe uphando. Ngapha koko, ngaba sikho isizathu sokufundisisa ngezifo eziza kuphela kungekudala?

Kumazwe ehlabathi ahambele phambili, amayeza okugonya amatsha aye akunciphisa ngokuphawulekayo ukwanda kwemasisi, uqilikwane nemasisi yaseJamani. Iphulo lokugonyelwa kwesifo sepoliyo, elaqaliswa ngowe-1955, laba nempumelelo gqitha nto leyo eyenza ukuba esi sifo eNtshona Yurophu nakuMntla Merika sihle sisuka kuma-76 000 ngaloo nyaka sangaphantsi kwe-1000 ngowe-1967. Ingqakaqha, isifo esibulala kakhulu, sapheliswa ehlabathini lonke.

Kule nkulungwane kuye kwaveliswa ielectron microscope, isixhobo esinamandla gqitha esenza ukuba izazinzulu zibone iintsholongwane ezincinane ngokuphindwe ngesigidi kunozipho lomnwe womntu. Iimicroscope ezinjalo, kunye nokunye ukuhambela phambili kwezobugcisa, kwenza zaqondwa kwaza kwaliwa nazo izifo ezasulelayo kunanini na ngaphambili.

Kwakubonakala Kuqinisekiwe Ngempumelelo

Ngenxa yezi zinto zifunyenweyo, abezonyango babeqinisekile. Iintsholongwane zezifo ezasulelayo zazisoyiswa ngamayeza ezi mini. Ngokuqinisekileyo iintsholongwane ziya koyiswa ngokuphawulekayo yinzululwazi, ngokungqalileyo, ngokupheleleyo! Ukuba unyago lwesifo esithile lwalungekabikho, beluya kubakho ngokukhawuleza.

Emva phayaa ngowe-1948, usosiba welizwe laseUnited States uGeorge C. Marshall waqhayisa ngelithi lalisondele ixesha lokoyiswa kwazo zonke izifo ezasulelayo. Kwiminyaka emithathu kamva, iWorld Health Organization (WHO) yathi isifo seengcongconi saseAsia kungekudala sasiya kuba sisifo “esingasengondaba-mlonyeni.” Phakathi kweyee-1960, inkolelo yokuba ixesha loobhubhani lidlule yayisasazeke gqitha nto leyo eyenza ukuba ugqirha wesizwe waseUnited States uWilliam H. Stewart axelele amagosa ezempilo ukuba yayilixesha lokuba kulityalwe ngezifo ezasulelayo.

Ukubuya Kwezifo Zakudala

Noko ke, ixesha lokuba kulityalwe ngezifo ezasulelayo ngokuqinisekileyo lalingekafiki. Iintsholongwane azizange zithi shwaka kwesi sijikelezi-langa kuba inzululwazi yavelisa amayeza nezinto zokugonya. Kunokuba zoyiswe, iintsholongwane ezibulalayo ezaziwayo zibuye ngamandla amakhulu! Ukongezelela, kuye kwavela ezinye iintsholongwane ezibulalayo—ntsholongwane ezo zazingaziwa ngoogqirha ngaphambili. Ngaloo ndlela, iintsholongwane ezindala nezintsha zivath’ iqaqa, ziyasongela, zibandezela, okanye zibulale izigidi zabantu ezingenakubalwa ehlabathini lonke.

Izifo ezibulalayo ekwakhe kwacingwa ukuba ziyalawuleka ziye zavela kwakhona, zibulala ngaphezulu kunanini na ngaphambili yaye kunzima ukuzinyanga ngamayeza. Omnye umzekelo sisifo sephepha. Kutshanje iWHO ithe: “Ukususela kowe-1944, amayeza okunyanga isifo sephepha aye asetyenziswa kakhulu eJapan, kuMntla Merika naseYurophu ukunciphisa isifo sephepha nokufa ngokuphawulekayo. Noko ke, imigudu yokulawula isifo sephepha kumazwe asakhasayo iye ayakhathalelwa, . . . nto leyo eye yenza esi sifo sabuyela kumazwe atyebileyo ngeendlela eziyingozi ngakumbi, sakwazi ukumelana namayeza amaninzi.” Namhlanje isifo sephepha, ngokuqhelekileyo esibangelwa yintsholongwane ehamba nomoya ehlala emiphungeni, sibulala abantu abamalunga nezigidi ezithathu minyaka le—abangaphezu kwama-7000 ngosuku. Ngonyaka we-2005, umlinganiselo wabafayo uya kufikelela kwizigidi ezine nyaka ngamnye.

Abanye ababulali bamandulo nabo bavuke bema ngeenyawo. Sithetha nje ikholera iyagqugqisa kwiindawo ezininzi zaseAfrika, eAsia nakuMzantsi noMbindi Merika; ithwaxa ize ibulale amanani abantu awandayo. Kuye kwavela uhlobo olutsha ngokupheleleyo eAsia.

Idengue, esasazwa yingcongconi iAëdes aegypti, nayo yanda ngokukhawuleza; sithetha nje isongela abantu abangama-2500 ezigidi kumazwe angaphezu kwe-100 ehlabathini lonke. Ukususela ngeyee-1950, kwaye kwavela isifo esitsha esibulalayo ihemorrhagic saye sasasazeka kulo lonke eLeenjiko. Kuqikelelwa ukuba sibulala abantu abamalunga nama-20 000 nyaka ngamnye. Njengezinye izifo ezininzi ezibangelwa ziintsholongwane, ayikho into yokugonyela esi sifo yaye kungekho neyeza lokusinyanga.

Isifo seengcongconi, inzululwazi eyakhe yanethemba lokusiphelisa, sithetha nje sibulala abantu abamalunga nezigidi ezibini nyaka ngamnye. Izifunxi-gazi neengcongconi ezithwele isifo seengcongconi kunzima ukuzibulala.

Izifo Ezitsha Ezitshabalalisayo

Mhlawumbi esona sifo sitsha singundaba-mlonyeni kutshanje esiye sangubhubhani ovelayo phakathi koluntu nguGawulayo obulalayo. Esi sifo singanyangekiyo sibangelwa yintsholongwane ebingaziwa kangangeminyaka emalunga ne-12 kwiminyaka edluleyo. Kanti, ngasekupheleni kowe-1994 iqela labantu ehlabathini lonke ababesulelwe yile ntsholongwane babephakathi kwe-13 ne-15 lezigidi.

Ezinye izifo ezasulelayo ezazingaziwa ngaphambili ziquka ihantavirus pulmonary syndrome. Sisasazwa ziimpuku zasendle, sabonakala kumzantsi ntshona weUnited States yaye sabonakala sibhubhisa kwiimeko ezachazwayo ezingaphezu kwesiqingatha. Iintlobo ezimbini zeehemorrhagic fever—zombini zintsha, zombini ziyabulala—ziye zavela eMzantsi Merika. Kwakhona kuye kwavela ezinye izifo ezoyikekayo—iintsholongwane ezinamagama angaqhelekanga—iLassa, iRift Valley, iOropouche, iRocio, iQ. Guanarito, iVEE, imonkeypox, iChikungunya, iMokola, iDuvenhage, iLeDantec, iKyasanur Forest brain virus, iSemliki Forest agent, iCrimean-Congo, iO’nyongnyong, iSindbis, iMarburg, iEbola.

Kutheni Kuvela Izifo Ezitsha?

Kutheni iintsholongwane ezibulalayo kubonakala kunzima gqitha ukuzoyisa, ngoxa inzululwazi yezonyango yanamhlanje inolwazi nobugcisa obungaka? Esinye isizathu kukwanda kwezithuthi kwintlalo yanamhlanje. Izithuthi zanamhlanje zinokusithwala isifo sendawo ethile zisisasaze ehlabathini lonke. Ukuhamba ngenqwelo-moya kwenza kube lula ukuhamba kwesifo esibulalayo, sizifihle phakathi komntu owasulelweyo, ukusuka kwenye indawo yehlabathi siye kuyo nayiphi na inxalenye yehlabathi ngeeyure nje.

Isizathu sesibini, esibangela ukusasazeka kweentsholongwane, kukwanda ngokukhawuleza kwabemi behlabathi—ngakumbi ezixekweni. Kakade ke, inkunkuma iveliswa ezixekweni. Inkunkuma enezingxotyana zeplastiki namatayara izaliswa ngamanzi emvula esandul’ ukuna. KweLeenjiko oko kuphumela ekwandeni ngokuphindaphindiweyo kweengcongconi ezithwele izifo ezibulalayo ezinjengesifo seengcongconi, ulubhelwana nedengue. Ukongezelela, kanye njengokuba ihlathi elishinyeneyo linokuwukhwezela umlilo, ngoko abemi abaninzi banokubangela iimeko ezintle ukuze isifo sephepha sande ngokukhawuleza, umkhuhlane nezinye izifo ezihamba nomoya.

Isizathu sesithathu sokubuya kwentsholongwane ethile sinokuthanani nokutshintsha kwendlela abaziphethe ngayo abantu. Iintsholongwane ezidluliselwa ngeentlobano zesini ziye zanda zaza zasasazeka ngenxa yokuba neentlobano zesini namaqabane amaninzi, okuye kwaxhaphaka gqitha kule nxalenye yokugqibela yenkulungwane yama-20. Ukusasazeka kukaGawulayo ngomnye umzekelo.b

Isizathu sesine esibangela ukuba kubonakale kunzima gqitha ukoyisa iintsholongwane kukuba abantu baye batshabalalisa amahlathi namahlathi eemvula. Umbhali uRichard Preston kwincwadi yakhe ethi The Hot Zone uthi: “Ukuqhambuka kukaGawulayo, iEbola nabanye oonobangela bezifo abavela kumahlathi emvula kubonakala kungumphumo wemvelo wokonakaliswa kommandla wobomi wakweleenjiko. Ezi ntsholongwane zivela kwiindawo zomhlaba ekonakaliswa indalo kuzo. Ezininzi kuzo zivela kwimida eyonakalisiweyo yamahlathi emvula . . . Amahlathi emvula akweleenjiko zizisele ezinzulu zokulondoloza ubomi kwisijikelezi-langa, aqulethe inkoliso yezityalo neendidi zezilwanyana. Kwakhona la mahlathi emvula akwazizisele zokulondoloza iintsholongwane, ekubeni zonke izinto eziphilayo zithwala iintsholongwane.”

Ngaloo ndlela abantu baye basondelelana nezinambuzane nezilwanyana ezinegazi elishushu apho zithi zihlale khona iintsholongwane zingonakalisi, zizalele zize zifele khona. Kodwa xa intsholongwane ithi “itsibele” emntwini isuka esilwanyaneni, loo ntsholongwane isenokuba yebulalayo.

Ukusikelw’ Umda Kwenzululwazi Yezonyango

Ezinye izizathu zokuba izifo ezasulelayo zibuye kwakhona zinokuthanani nenzululwazi yezonyango ngokwayo. Sithetha nje iintsholongwane ezininzi aziwakhathalelanga amayeza okubulala iintsholongwane awayekade ezibulala. Into exakayo kukuba, amayeza okubulala iintsholongwane ngokwawo aye aluncedo ekuyileni le meko. Ngokomzekelo, ukuba iyeza lokubulala iintsholongwane libulala ama-99 ekhulwini kuphela entsholongwane eyingozi kumntu owasulelweyo, isinye ekhulwini esisindileyo size simelane neyeza lokubulala izinambuzane sinokukhula size siphindaphindeke njengodidi lokhula olunamandla kwintsimi esandula ukulinywa.

Abaguli bayenza mbi ngakumbi le ngxaki xa bengawagqibi amayeza okubulala iintsholongwane abawanikwe ngugqirha wabo. Abaguli basenokuyeka ukutya iipilisi kungekudala njengoko beqalisa ukuziva bhetele. Ngoxa iintsholongwane ezibuthathaka zisenokuba zibulewe, ezomeleleyo ziyasinda zize ziphindaphindeke ngokungaqondakaliyo. Ngeeveki nje ezimbalwa, esi sifo siyabuya, kodwa ngeli xesha sesinamandla, okanye singasenakunyangwa ngamayeza. Xa ezi ntsholongwane zimelana neziyobisi zihlasela abanye abantu, kuphumela kwingxaki enzulu kwimpilo kawonke wonke.

Kutshanje iingcali kwiWHO zithe: “Ukumelana [namayeza okubulala iintsholongwane nezinye izinto zokubulala iintsholongwane] kuxhaphakile kumazwe amaninzi yaye ukumelana kwazo neziyobisi ezininzi kushiya oogqirha phantse bengakwazi ukunyanga inani lezifo elandayo. Ezibhedlele kuphela, kuqikelelwa ukuba kubakho izifo ezasulelayo ezisisigidi esinye ehlabathini lonke mihla le, yaye uninzi lwazo luyamelana namayeza.”

Utofelo-gazi, olwasetyenziswa ngokwandayo ukususela kwimfazwe yesibini yehlabathi, nalo luye lwabangela ukusasazeka kwezifo ezasulelayo. Phezu kwayo nje imigudu yenzululwazi yokugcina igazi lingachatshazelwa ziintsholongwane ezibulalayo, utofelo-gazi luye lwanegalelo kanobom ekusasazekeni kwehepatitis, icytomegalovirus, iintsholongwane ezimelana namayeza okubulala iintsholongwane, isifo seengcongconi, ulubhelushe, isifo sikaChagas, uGawulayo nezinye izifo ezininzi ezoyikekayo.

Imeko Yezinto Namhlanje

Ngoxa inzululwazi yezonyango iye yahambela phambili elwazini ebudeni bale nkulungwane, kusekho iimfihlelo ezininzi. UC. J. Peters ufundisisa ngeentsholongwane eziyingozi kwiCenters for Disease Control, eyilebhu yezempilo esemagqabini eMerika. Kudliwano-ndlebe ngoMeyi 1995, wathi ngokuphathelele iEbola: “Asisazi isizathu sokuba ibe yingozi kangaka emntwini, yaye asikwazi oko ikwenzayo [okanye] asiyazi apho ikhoyo, xa isathe cwaka ingenzi ntlekele. Asiyifumani. Asinalo olunye uhlobo lwentsholongwane . . . esingazi nto ngalo.”

Naxa ulwazi olusebenzayo lwezonyango, amayeza nezinto zokugonya zikho ukulwa nezifo, ukuzisebenzisa kwabo bazifunayo kufuna imali. Izigidi zingamahlwempu. IWHO’s World Health Report 1995 ithi: “Sisizathu esiphambili sokuba iintsana zingagonywa, sisizathu sokuba kungalungiselelwa amanzi acocekileyo kungekho nenkqubo yezindlu zangasese ezigungxulwayo, isizathu sokuba kungabikho amayeza aphilisayo nolunye unyango . . . Minyaka le kumazwe asakhasayo abantwana abazizigidi ezili-12,2 abangaphantsi kweminyaka emi-5 bayafa, abaninzi kubo babulawa zizinto ebezinokuthintelwa ngeesenti nje ezimbalwa zaseUnited States kumntwana ngamnye. Bafa kakhulu ngenxa yokungakhathali kwehlabathi, kodwa uninzi lwabo luyafa kuba luhlwempuzekile.”

Ngowe 1995, izifo ezasulelayo nezifunxi-gazi ziye zaba ngabona babulali bakhulu, zisuba imiphefumlo yabantu abazizigidi ezili-16,4 nyaka ngamnye. Okulusizi kukuba, izigidi zabantu ezingenakubalwa ziphila kwiimeko ezilungele ukuqhambuka nokusasazeka kweentsholongwane ezibulalayo. Khawucinge ngemeko elusizi namhlanje. Abantu abangaphezu kwewaka lesigidi bahlwempuzeke ngokugqithiseleyo. Isiqingatha sabemi behlabathi abalufumani ngokuthe rhoqo unyango namayeza afanelekileyo. Kwizitrato zezixeko ezikhulu ezinabemi abaninzi kukho abantwana abazizigidi abangoongqikana abangakhathalelwanga, abaninzi kubo basebenzisa iziyobisi baze bathengise ngemizimba yabo. Izigidi zeembacu zingcuchalazela kwiinkampu ezingacocekanga apho ikholera, isisu segazi nezinye izifo zizenzela unothanda khona.

Kwimfazwe ephakathi komntu nentsholongwane, ngokwandayo izinto ziye zayihambela kakuhle intsholongwane.

[Imibhalo esemazantsi]

[Amagama acatshulweyo akwiphepha 24]

“Ezibhedlele kuphela, kuqikelelwa ukuba basisigidi esinye abasulelwa zizifo ezibangelwa ziintsholongwane ehlabathini lonke mihla le, yaye uninzi lwazo ziyakwazi ukumelana neziyobisi.” World Health Organization

[Ibhokisi ekwiphepha 25]

Xa Iintsholongwane Ziziphindezela

Olona hlobo lwentsholongwane luncinane “lunobunzima nje obuziigram ezisi-0,00000000001. Umnenga oluhlaza okwesibhakabhaka unobunzima obuziingram ezili-100 000 000. Ukanti le ntsholongwane inokuwubulala umnenga.”—Bernard Dixon, 1994.

Phakathi kwezona ntsholongwane zoyikwayo ezifumaneka ezibhedlele ludidi olumelana neziyobisi oluyiStaphylococcus aureus. Olu didi luthwaxa ogulayo nobuthathaka, lubangela izifo zegazi ezasulelayo ezibulalayo, inyumoniya netoxic shock. Ngokutsho kolunye ubalo, istaph sibulala abantu abamalunga nama-60 000 eUnited States nyaka ngamnye—bangaphezu kwabo bafa kwiingozi zeenqwelo-mafutha. Kangangeminyaka, ezi ndidi zeentsholongwane ziye zamelana gqitha namayeza okubulala iintsholongwane kangangokuba ngowe-1988 lalilinye kuphela iyeza lokubulala iintsholongwane elalizibulala, iyeza eliyivancomycin. Noko ke, kungekudala kwabakho iingxelo zokuvela kodidi oluthile ehlabathini lonke olumelana nevancomycin.

Kanti, naxa amayeza okubulala iintsholongwane ewenza umsebenzi afanele ukuba ayawenza, kusenokuvela ezinye iingxaki. Phakathi kowe-1993, uJoan Ray waya esibhedlele eUnited States eyokwenza utyando oluqhelekileyo. Wayecinga ukuba uza kugoduka kwiintsuku nje ezimbalwa. Kunoko, kwafuneka ahlale esibhedlele iintsuku ezingama-322, ngokuyintloko ngenxa yokwasulelwa okwavela emva kotyando. Oogqirha balulwa olu lwasulelo ngokumngxixha ngamayeza okubulala iintsholongwane, kuquka nevancomycin, kodwa iintsholongwane zaphindezela. UJoan uthi: “Ndandingakwazi ukusebenzisa izandla zam. Ndandingakwazi ukusebenzisa iinyawo zam. . . . Ndandingakwazi nokuphakamisa incwadi ndiyifunde.”

Oogqirha bawa bevuka ukuze bafumane isizathu sokuba uJoan abe wayesagula emva kweenyanga zokunyangwa ngamayeza okubulala iintsholongwane. Iziphumo zaselebhu zabonisa ukuba ukongezelela kukwasulelwa yistaph, uJoan wayenolunye uhlobo lwentsholongwane emzimbeni wakhe—ienterococcus ekwazi ukumelana nevancomycin. Njengoko igama libonisa, le ntsholongwane ayizange yenziwe nto yivancomycin; kwakhona kwakubonakala engenakuyenza nto onke amanye amayeza okubulala iintsholongwane.

Bandula oogqirha babona enye into eyayibenza bame nematha. Intsholongwane ayimelani nje namayeza kuphela angeyibulele, kodwa ngokwahlukileyo koko bebekulindele, izisindisa ngokusebenzisa ivancomycin! Ugqirha kaJoan, ingcali kwizifo ezasulelayo, wathi: “[Intsholongwane] ifuna loo vancomycin ukuze iphindaphindeke, yaye ukuba aziyifumani azinakukhula. Ngoko, ngengqiqo ethile, zisebenzisa i-vancomycin njengokutya.”

Xa oogqirha bayekayo ukunika uJoan ivancomycin, le ntsholongwane yafa, yaye uJoan wababhetele.

[Umfanekiso okwiphepha 26]

Iintsholongwane ziyanda xa abaguli bengawasebenzisi kakuhle amayeza okubulala iintsholongwane

[Umfanekiso okwiphepha 27]

Utofelo-gazi lusasaza iintsholongwane ezibulalayo