New and resurgent infections: Prediction, detection and management of tomorrow's epidemics. The Seventh Annual Public Health Forum

Abstract

Edited by B. Greenwood and K. De Cock The Wiley Series of London School of Hygiene and Tropical Medicine Annual Public Health Forums. John Wiley and Sons Ltd (http://www.wiley.com), Chichester, 1998. 220 pp, £45, ISBN 0 471 98174 5. This publication is the report of the first large-scale meeting in Europe, held in 1997, examining emerging, resurgent and persisting infections in developed and developing countries. The international nature of the conference is mirrored in the participation of authors from Europe, USA, Ethiopia, India and Thailand, most of whom are working for the WHO, CDC and other international Public Health institutions. Although based on papers presented at the conference, the book reads as an entity because of the excellent editing by Greenwood and De Cock. The aims of the meeting were to review the subject of new and resurgent infections, to assess the preparedness for addressing emerging infections, to consider future prospects and to define the appropriate public health response and research. After De Cock's preface, it is worthwhile reading the last chapter written by Brian Greenwood before the rest of the book and re-reading it afterward, as it provides a very useful summary of the many diverse topics covered. The first three chapters review the role of local, global, environmental and sociological factors in the emergence of new infections, illustrating this with a myriad of well-chosen and well-presented examples. Responsible factors for emergence are clearly very diverse (global warming, ecological changes, agricultural developments and ensuing impact by rodents and arthropod vectors; demographic factors, the role of human sexual behaviour, etc.). It is also pointed out how relatively minor local changes of one, but mostly a combination of several factors, can dramatically increase the risk for developing certain infectious diseases. The role of biological variability in viral pathogens (using HIV and influenza as examples), the problem of antimicrobial drug resistance and the variety of environmental factors which can disturb the integrity of the immune system are discussed in three chapters. Examples of new and resurgent diseases such as malaria, ebola, CJD/BSE, Escherichia coli 0157:H7 and other causes of food poisoning, are set out in another five chapters, providing first-hand information written by authorities in the respective fields. The example of malaria is used to describe in detail the role of agricultural practices in changing its epidemiology in some regions of Ethiopia and Thailand. The chapter on dengue gives a lucid analysis of the influence of demographic and behavioural changes (the role of population growth, urbanization, the massive increases in trade and travel, transport, etc.) on the global extension of this mosquito-borne infection. Chapter 13 discusses several critical issues in performing economic analyses for food-borne pathogens, using as an example the emerging pathogen E. coli O157:H7, one of 30–40 other identified food-borne pathogens. In the following chapter some important aspects of health economics of infectious diseases (not limited to emerging or resurgent ones) in developing countries are highlighted. Finally, the preparedness and the response to the problem of new and resurgent infections are analysed. Chapter 12 discusses the co-ordination of international responses to epidemics. In chapters 15 (written by a collaborator of the CDC) and 16 (written by collaborators of the WHO) the current public health response and global response to emerging infectious diseases is described, emphasising the need for early detection and response to outbreaks, for prevention and for further research, and also describes the efforts already being made for international collaboration in all these domains. This important publication will certainly increase the awareness, and offer guidance to, reducing threats to public health from new and resurgent infections. A 220-page book cannot cover every aspect of emerging infections, but it merits a place with the other recently published volumes and journal articles on this subject. It will indeed be of interest (as mentioned on the back cover) ‘to all public health specialists, epidemiologists, microbiologists, virologists, ministries of health and international health agencies concerned with the increasing problem of emerging infectious diseases.’ But as this book is clearly written, it is a didactic instrument for students and all those concerned, including clinician nonspecialists, who seek to be better informed or updated, since ‘the world is not in equilibrium and we must be prepared for the inevitability of surprises; the human species will continue to be vulnerable to large scale-infections’ (R. Berkelman in chapter 15). A. Van Gompel