Roberts, Jennifer A

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Roberts, J (2002) Public health systems and the emerging infections -assessing the capabilities of the public and private sectors. Eds. J.R.Davies and X. Lederberg. National Academy Press 2001. ?16.45.[Book Review]. Epidemiology and infection, 128 (2). pp. 351-352.ISSN 0950-2688Downloaded from: http://researchonline.lshtm.ac.uk/18415/Usage GuidelinesPlease refer to usage guidelines at http://researchonline.lshtm.ac.uk/policies.html or alterna-tively contact researchonline@lshtm.ac.uk.Available under license: Copyright the publishersEpidemiol. Infect. (2002), 128, 351–353. # 2002 Cambridge University PressPrinted in the United KingdomBook ReviewsDOI: 10.1017}S0950268802217094Meningococcal Vaccines: Methods and Protocols. Eds.A. J. Pollard and M. C. J. Maiden. Humana Press,2001. Pp. 416. $120.00.The meningococcus, causing meningitis and septicaemia, isa leading infectious cause of childhood death in indus-trialized countries and results in major epidemics in thecountries of the ‘Meningitis Belt’ of sub-Saharan Africa.Meningococcal outbreaks in Northern Europe, some areasof the United States and more recently New Zealand haveheightened the sense of alarm expressed by both the public,the press and the healthcare professions. This undercurrenthas resulted in considerable pressure on national immuniza-tion agencies to implement a meningococcal vaccineprogramme.The development of polysaccharide-conjugate vaccinesfor some serogroups such as C, A, Y and W-135 is likely tohave a dramatic impact on the incidence of the disease.Nonetheless, these vaccines may require further modifica-tion, we will need the necessary tools to monitor the long-term immunological response to these vaccines, and it willbe necessary to conduct surveillance to ensure that sero-group replacement by a non-vaccine strain does not takeplace. A vaccine that provides widespread protection againstthe serogroup B meningococcus remains remarkably elusive.With the completion of several of the meningococcalgenome sequencing projects, many new candidate serogroupB vaccines will require pre-clinical and clinical testing, andagain we will need the necessary tools to assess them.Although the burden of meningitis and septicaemia in theworld has attracted considerable research effort in definingthe epidemiology, cellular and molecular pathogenesis andvaccinology of these diseases, to date there has been no textwhere the technical aspects have been addressed. InMeningococcal Vaccines, the first of two companion vol-umes, Andrew Pollard and Martin Maiden have gatheredtogether an outstanding group of clinical and laboratoryscientists to provide a comprehensive set of protocols for thedevelopment and evaluation of meningococcal vaccines. In28 chapters, the book covers everything from the immuneresponse to vaccine implementation, and from capsularpolysaccharide or outer membrane vesicle purification to T-cell epitope mapping.The strength of this text is that it provides a key referencesource, enabling researchers in the field to avoid re-inventingthe wheel. The text also provides the basis for thedevelopment of new ideas. Each chapter takes a step-by-stepapproach with clearly set out notes highlighting the problemareas. All the chapters have comprehensive bibliographies,and are well structured. The text is easily accessible and isrecommended to those who are seeking to critically appraisethe field of meningococcal vaccines.r. s. heydermanDepartment of Pathology and Microbiology,Uniersity of BristolDOI: 10.1017}S0950268802227090ABC of AIDS, 5th edn. Ed. M. W. Adler. BMJ 2001.Pp. 118.This is the fifth edition of this popular book, based on aseries of the same name originally published almost 15 yearsago in the British Medical Journal. It is aimed at non-specialist doctors and medical students working in the UK,and provides a clear, readable and authoritative account ofthe clinical aspects of HIV disease and their management. Itis well illustrated and attractively produced, making gooduse of boxes in which key points can be identified at aglance. It does not fit in the pocket, being of A4 size, but isconcise (110 pages), and as up to date as a textbook can bein this fast-moving field. It covers the epidemiology, virologyand immunology of HIV infection, and contains chapterson prevention and counselling; but it is primarily a clinicalbook, with chapters on HIV related tumours, HIV and thelung, gut and nervous system; natural history and treat-ment; and HIV in children, injecting drug users and thedeveloping world. The chapters are all written by wellrespected authorities in their fields, mostly in the UnitedKingdom. This new edition is the first since 1997, and willno doubt ensure that the ABC of AIDS remains as popularand useful as ever.david mabemLondon School of Hygiene and Tropical MedicineDOI: 10.1017}S0950268802237097Public Health Systems and the Emerging Infections –Assessing the Capabilities of the Public and PriateSectors. Eds. J. R. Davis and X. Lederberg. NationalAcademy Press 2001. £16.45.This volume gives a timely and disturbing account of frontline public health facilities in the USA. It reports on the352 Book Reviewsdiscussions of the fourth workshop of the Forum onEmerging Infections that was founded in 1996 in responseto a request from the Centers for Disease Control andPrevention (CDC) and the National Institutes of Health.The Forum attempts to provide and exchange informationand to bring neglected issues to the attention of policymakers. The themes raised have a resonance in othersystems and reinforce some of our fears about possibleweaknesses that may result from current trends and struc-tural developments in the health sector. With the exceptionof the inclusion of Canada (in the context of Toronto’sparticipation in FoodNet), however, this is a totally paro-chial account of public health in the USA and there are nocomparisons with other countries many of which would haveprovided good exemplars ; maybe this will be remedied bythe fifth workshop on international aspects.The first theme concentrates upon the ways in whichtraditional public health concerns with infectious diseaseand its control was supplanted in developed countries withconcerns about chronic illnesses and preventive measuresthat involve life style modifications. At the same time thepopulation expected a high quality of personal health care.Delivery of health care through managed care developmentssuch as health maintenance organisations (HMO’s) becamethe preoccupation of health policy analysts who seemed notto take on board the erosion of public health facilities andthe increasingly complex health care structures that neededto be coordinated if adequate surveillance systems were tobe maintained. The public health laboratory service in theUSA has faced reorganisation and privatisation. The high-volume low-cost tests have increasingly become the task ofthe private sector whilst more complex, costly tests remainwith the public sector. At the same time the impression, notborn out by surveys of managed care institutions, was thatcompetitive pressures on health services was leading tofewer tests and more empiric treatment of disease and inconsequence less accurate and complete infectious diseasereporting.The second theme draws attention to the significant gapsin the information collected about infectious disease anddisjunctions of flows of information between states andwithin states and between private and public sectors. TheState rather than the Federal authorities have responsibilityfor public health and monitoring infectious disease. As aresult incompatible information systems have evolved. Thetimely collection and transmission of comparable infor-mation between and to states, federal agencies and otherrelevant groups is desperately needed. This involves com-mitment and resources in educating clinicians, developingmedical and laboratory record systems and training staff.In spite of the development of sentinel practices andthe introduction of FoodNet, at the instigation of CDC,the public health infrastructure is patchy and communi-cations poor. The ‘ laboratory reporting in most state healthdepartments is still surface mail, with a measured 10–14 daytime lag in some states ’ (page 23). The introduction ofelectronic communication systems is recommended.The need for resources and trained staff in local publichealth agencies is another theme highlighted. A nurse, asanitarian, a clerk, and a part-time health officer often staffthese small local agencies. These workers appear to berelatively untrained as they are said to need ‘basic investi-gative skills, questionnaire design, interviewing techniquesand collection of environmental and clinical specimens’(page 36). In addition the importance of computerization isstressed to ensure that ‘Electronic communication systemsneed to be strengthened so that outbreaks can be shared andresources for use during the outbreak can be obtained’(page 36). Such basic inadequacies give cause for concern.The writers recognize that public health surveillancesystems need development and funds. This of course requiresmore attention to raising the profile of public health atFederal and State level. The State and Federal agencies aredeemed to place a high value on public health activities butthere is inevitable competition for scarce resources and theseactivities do not have a high profile. The hidden nature ofmany public health activities and its apparent success incontrolling high profile outbreaks give the false impressionthat all is well. Ways of bringing the importance of publichealth to the attention of the public are examined includingtheir role in emerging diseases and bioterrorism.Unfortunately the profile and the improved functioningof the system have not proceeded at the pace that wasprobably needed to deal with the events that are currentlyunfolding, such as the anthrax attacks.There are undoubted jewels in the public health system inthe USA, such as the CDC, but these resources are not likelyto be sufficient to deal with complex issues that may arisethroughout the country. There is a need for well informedpractitioners, comprehensive surveillance systems and rapidcommunication systems. The present fragmentation ofservices, duplication and incompatible systems of datacollection has to be tackled. Other healthcare systems, suchas those in the UK, currently going down the path ofdeveloping Primary Health Care Trusts (not dissimilar tothe HMO’s in the USA), need to be vigilant lest theyalso lead to the dislocation of traditional public healthinformation systems and networks.This is a lively piece of work although it would havebenefited from a focused conclusion that brought togetherevidence from the various sessions and proposals for futuredevelopments. It would be easier to read if there were fewersplit infinitives. Nevertheless it provides salutary reading foranyone interested in the ability of public health servicesto protect the public from infections and environmentalhazards.jenny robertsSHTM, London School of Hygiene and Tropical MedicineDOI: 10.1017}S0950268802247093New Challenges to Health: The Threat of Virus Infec-tion. Eds. G. L. Smith, W. L. Irving, J. W. Mc Cauleyand D. J. Rowlands. Cambridge University Press,2001. Pp. 347. £70. ISBN 0 521 80614 3.Epidemics of infectious disease can have extreme socio-economic impact and we are living through an age whenemerging disease is very much in the public eye. It is fittingthen that this book should have been produced from theproceedings of a meeting that focused on the impact onhealth of emerging viral diseases. It includes a discussion of353Book Reviewsa number of important virus systems and, unusually, reviewsboth the molecular biology and epidemiology of a numberof selected systems. The chapters, each written by an expertin the field, include: surveillance of emerging viruses ;epidemiology of microparasites ; bunyaviruses and hanta-viruses ; the impact and spread of calcivirus and myxomavirus in Australia ; influenza A viruses ; hepatitis viruses ;HIV and AIDS; morbilliviruses ; prion protein; xenotrans-plantation and endogenous viruses ; herpesviruses andneoplasia ; the proteins of Marburg and Ebola viruses ;Dengue virus epidemiology; Borna disease virus andantiviral drug development.This book is an excellent reference for students andresearchers alike and scores well on topicality, authoritative-ness and accuracy. In addition it is presented in an easilyaccessible format that should encourage student attention.p. royLondon School of Hygiene & Tropical MedicineDOI: 10.1017}S095026880225709XEssentials of Antimicrobial Pharmacology. Ed. P. H.Axelsen. Humana Press, 2001. Pp. 141. $24.50 pb.ISBN 0 896 03842 4.This book is intended as a guide to antibiotics rather than atextbook, a pocket volume for reference or an adjunct tolectures. Certainly most of the topics that could fall underthe title of antimicrobial chemotherapy are packed into the121 pages of text. A background chapter on sensitivitytesting, pharmacokinetics and resistance precedes moresubstantial chapters on antibacterials, antifungals, anti-parasitics and antivirals (in that order). It ends with a shortchapter on immunomodulators and vaccines. The aims arelaudable, a succinct text that also includes lists of all drugsused including the generic and trade names, must be useful.The classes of compounds considered are comprehensiveand includes the recently marketed oxazolidinones, the firstnovel class of antibacterials to appear for decades. Itincludes short sections on investigational drugs and,although without references, is up to date.So it is a pity that the volume has editorial and factualerrors large enough to make one re-examine every sectionand prevent any recommendation. There are too manyerrors to list – but they range from mis-spelling (Shistosoma,artemisinine), to loss of format (anthelmintic agents, p. 83)and inadequate explanation of mechanisms of action[amphotericin B binds to ergosterol in the cell membranenot the cell wall (p. 65), antifolate drugs inhibit pyrimidinesynthesis and not purine synthesis (pp. 28–29)]. Attention todetail and replacement of the inadequate 12 pages onimmunisation by more on the antimicrobials and drugresistance would greatly improve this volume.s. croftLondon School of Hygiene & Tropical Medicine

Funding the global control of bird flu.

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Funding the global control of bird flu.

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