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According to the 'hygiene hypothesis,' first proposed in 1989, exposure to a variety of bacteria, viruses and parasitic worms early in life helps prime a child's immune system, much like sensory experiences program his brain. Without such early instruction, the immune system may go haywire and overreact with allergies to foods, pollen and pet dander or turn on the body's own tissue, setting off autoimmune disorders.
Many of these microorganisms evolved symbiotically with humans over millions of years -- the so-called 'old friends' theory. But where they've been eradicated, a key part of human development has been thrown off.
'The vast majority of microbes are harmless. There are only a few dozen that can cause lethal infections,' says Thomas McDade, director of the Laboratory for Human Biology Research at Northwestern University.
In 1998, about 1 in 5 children in industrialized countries suffered from allergic diseases such as asthma, allergies and rashes, according to the International Study of Asthma and Allergies in Childhood, a global research initiative. The incidence of peanut allergy in the U.S. tripled between 1997 and 2008, according to a report from Mount Sinai School of Medicine in New York.
But such diseases are still relatively rare in Africa and rural Asia, as are Type 1 diabetes and multiple sclerosis.
'The geographical distribution of allergic and autoimmune diseases is a mirror image of the geographical distribution of various infections diseases,' says a report by French researchers in a March issue of the journal Clinical & Experimental Immunology devoted to the hygiene hypothesis.
Exposure to immune-stimulating germs may also lower the risk of heart disease, according to Dr. McDade. In a study of 1,700 Filipinos followed from birth to age 21 published this year in the journal Proceedings of the Royal Society, those who grew up around chicken, pigs and dogs and had bouts of diarrhea in childhood had lower rates of C-reactive protein, an inflammation marker that has been linked to cardiovascular disease, as young adults.
There are other dangers lurking in muddy water and animal feces. Nearly 70% of the 8.8 million deaths of children under age 5 world-wide in 2008 were caused by infectious diseases, most frequently pneumonia, diarrhea and malaria, according to an analysis in the Lancet last week.
Even though rural Africa and Asia have made enormous strides in public health in the past decade, infant mortality stands at 31 per 1,000 in Namibia and 34 per 1,000 in Mongolia, compared to 7 per 1,000 in the U.S. and 3 per 1,000 in Japan.
Scientists are still working on ways to separate good germs from bad ones; in the meantime, they have a few insights: Studies have shown that children who grow up with household pets have fewer allergies and less asthma than those who don't.
Michael Bell, an infectious disease specialist and deputy director of Healthcare Quality Promotion at the Centers for Disease Control and Prevention, says that people should be vigilant about wound care since bacteria can cause problems if they get into the blood stream, and he still advocates hand-washing. 'If you're not doing it 10 times a day, you're probably not doing it enough,' he says. But he and other experts say that regular soap and water are fine in most cases. Sterilizing hands is critical mainly for health-care workers and in hospitals, where disease-causing germs are prevalent and can easily spread.
Many experts advise common sense. 'We don't want to say to children, 'OK, play by the dirty river bank and catch whatever you can,'' says Dr. Weinstock. 'But we can say there's nothing wrong with kids playing in the dirt. They don't have to live in total sanitation, and they won't die from eating something off the floor. It's probably more healthy than not.'
在湖北武漢，一個(gè)小商販的孩子躺在放置于雞籠中間的嬰兒車(chē)上
參考譯文：
根據(jù)1989年首次提出的“衛(wèi)生假說(shuō)”(hygiene hypothesis)理論，孩子在成長(zhǎng)早期如果接觸多種病毒、細(xì)菌和寄生蟲(chóng)，將有利于其免疫系統(tǒng)的發(fā)展，似乎這樣能促進(jìn)大腦對(duì)其做出更好的防御準(zhǔn)備。反之，如果缺乏這類早期接觸，免疫系統(tǒng)就可能出現(xiàn)紊亂，做出過(guò)激反應(yīng)，如對(duì)食物、花粉和寵物毛屑過(guò)敏等，或者引發(fā)人體機(jī)理問(wèn)題，出現(xiàn)自身免疫失調(diào)。
數(shù)百萬(wàn)年以來(lái)，許多微生物與人類形成一種共生共棲的關(guān)系，就像我們的“老朋友”一樣；如果我們將某種微生物連根拔除，就等于錯(cuò)過(guò)了人體進(jìn)化歷程中的一個(gè)關(guān)鍵環(huán)節(jié)。
“絕大多數(shù)微生物都是無(wú)害的，只有幾十種微生物會(huì)引發(fā)致命感染。”美國(guó)西北大學(xué)(Northwestern University)人體生物研究實(shí)驗(yàn)室(Laboratory for Human Biology Research)主任麥克戴德(Thomas McDade)說(shuō)道。
“國(guó)際兒童哮喘及過(guò)敏研究”(International Study of Asthma and Allergies in Childhood)是一項(xiàng)全球性的調(diào)查，其數(shù)據(jù)顯示，1998年在發(fā)達(dá)國(guó)家中，只有約20%的孩子患有哮喘、過(guò)敏和疹子等過(guò)敏性疾病。紐約西奈山醫(yī)學(xué)院(Mount Sinai School of Medicine)的一個(gè)報(bào)告稱，從1997年到2008年，美國(guó)的花生過(guò)敏癥發(fā)病率增長(zhǎng)了兩倍。
然而，上述疾病在非洲和亞洲農(nóng)村地區(qū)依然相對(duì)罕見(jiàn)，1型糖尿病和多發(fā)性硬化也是如此。
“過(guò)敏癥和自身免疫性疾病的地域分布與各類感染性疾病的地域分布恰恰相反。”2010年一位法國(guó)研究人員在今年3月《臨床與實(shí)驗(yàn)免疫學(xué)雜志》(Clinical & Experimental Immunology)上發(fā)表的一篇文章中說(shuō)道。該雜志專門(mén)研究“衛(wèi)生假說(shuō)”理論。
麥克戴德稱，接觸那些能刺激免疫機(jī)能的微生物還可能有助于降低心臟疾病的發(fā)病率。2010年，英國(guó)《皇家學(xué)會(huì)學(xué)報(bào)》(Proceedings of the Royal Society)發(fā)表了一個(gè)報(bào)告：一項(xiàng)對(duì)1700名菲律賓人從出生到21歲的長(zhǎng)期調(diào)查顯示，那些從小在有雞鴨豬狗的生活環(huán)境中長(zhǎng)大、小時(shí)候得過(guò)幾次痢疾的人，成年后體內(nèi)C反應(yīng)蛋白的濃度較低。C反應(yīng)蛋白是一種炎癥標(biāo)志物，與心血管疾病有一定的關(guān)聯(lián)。
但臟水和動(dòng)物排泄物也潛藏著其他一些危險(xiǎn)。英國(guó)醫(yī)學(xué)雜志《柳葉刀》(Lancet)2010年五月中旬發(fā)表的一篇分析報(bào)告稱，在2008年全球880萬(wàn)5歲前夭折的孩子中，有近70%死于感染性疾病，最常見(jiàn)的是肺炎、痢疾和瘧疾。
雖然過(guò)去10年來(lái)非洲和亞洲的農(nóng)村地區(qū)在公共衛(wèi)生方面有了巨大進(jìn)步，但納米比亞的嬰兒死亡率仍高達(dá)千分之31，蒙古為千分之34，而美國(guó)和日本的嬰兒死亡率僅為千分之七和千分之三。
科學(xué)家仍在尋找辦法把好的微生物與壞的微生物區(qū)分開(kāi)來(lái)，在此過(guò)程中，他們有了幾點(diǎn)深入發(fā)現(xiàn)。研究表明，從小和家庭寵物一起長(zhǎng)大的孩子患過(guò)敏癥和哮喘病的幾率較低。
美國(guó)疾病控制與預(yù)防中心(Centers for Disease Control and Prevention)醫(yī)療質(zhì)量改進(jìn)部(Healthcare Quality Promotion)副主任及感染病專家貝爾(Michael Bell)說(shuō)，人們應(yīng)該警惕傷口感染，因?yàn)橐坏┎《厩秩胙海蜁?huì)造成各種問(wèn)題。他還是提倡人們勤洗手。“一天至少要洗10次手。”貝爾說(shuō)。不過(guò)，他和其他一些專家表示，在大多數(shù)情況下，洗手用普通的肥皂和水就行了。手部消毒主要適用于醫(yī)療工作者以及醫(yī)院場(chǎng)所內(nèi)，因?yàn)獒t(yī)院里的致病微生物較多，而且容易傳播開(kāi)來(lái)。
許多專家建議人們憑常識(shí)辦事。“我們不會(huì)對(duì)孩子們說(shuō)：‘好，去骯臟的河邊玩吧，想抓什么就抓什么。’”溫斯托克(Weinstock)醫(yī)生說(shuō)，“但可以這樣講，小孩子玩泥巴沒(méi)什么大不了的，他們不必生活在完全干凈的環(huán)境中，也不會(huì)因?yàn)槌缘舻降厣系臇|西就死掉。這樣說(shuō)不定會(huì)使他們更健康。”
