Book Review

Risky Trade: Infectious Disease in the Era of Global Trade

N Engl J Med 2007; 356:970-971March 1, 2007

Article

Risky Trade: Infectious Disease in the Era of Global Trade
By Ann Marie Kimball. 212 pp., illustrated. Aldershot, England, Ashgate Publishing, 2006. $59.95. ISBN: 978-0-7546-4296-1

In 1992, the Institute of Medicine published its seminal report entitled Emerging Infections: Microbial Threats to Health in the United States (Washington, DC: National Academy Press). This document outlined reasons for the emergence of new infectious diseases and suggested a series of responses to this ongoing threat to human health. The timing of the report served to highlight the emergence of a novel hantavirus in the southwestern United States in the spring of 1993. This never-before-identified hantavirus, after being transmitted from deer mice to humans, caused illness in 48 people and the deaths of 27 people from adult respiratory distress syndrome. The outbreak required all the laboratory, clinical, and public health resources available at the time in what was one of the most rapid and intensive responses to a public health crisis ever undertaken. It also set the stage for the decade that followed, during which numerous infectious diseases would emerge or re-emerge.

In Risky Trade, Ann Marie Kimball uses her extensive experience in domestic and international public health, as well her work with the Asia–Pacific Economic Cooperation, to take the discussion of emerging infections to a new level. She points out the risks of economic globalization using the metaphor of a train — the “global express.” The global express is the “trade and travel among nations” that is “amplifying and spreading new and frightening human infections.” The book carefully reviews the emergence and spread of the human immunodeficiency virus (HIV) and AIDS, the severe acute respiratory syndrome (SARS), new variant Creutzfeldt–Jakob disease, and food-borne pathogens (including salmonella, Escherichia coli O157, listeria, and cyclospora) and describes how their emergence and their effects on health are tied to global trade and travel.

This book is an excellent summary of the challenges presented by the infectious diseases that have emerged during the past two decades; it also identifies new trade- and travel-related issues. Kimball gives a compelling account of the travel-related transmission of SARS across borders worldwide. She also details the emergence of enteric pathogens from the increasingly international and consolidated food supply. These include the 1999 and 2002 outbreaks of salmonella and E. coli O157 that resulted from the use of contaminated seeds in the production of sprouts and the repeated outbreaks during the 1990s of Cyclospora cayetanensis that were caused by contaminated raspberries imported from Guatemala to the United States. Kimball also makes the case for the early spread of HIV and AIDS through contaminated commercial blood products.

The important message of Kimball's book is her call for improved collaboration between rich and poor nations and between nations with highly developed health care and economic systems and nations with less developed systems. In an era in which discussions about the emergence of a novel influenza strain with pandemic potential focus on developing countries in Southeast Asia, we must take the challenge of this book seriously — that is, leaders in government, industry, commerce, and travel should enter into discussions with leaders in public health about the potential for the spread of disease through the global express. This book should be required reading for leaders in business and travel, for ministers of health, and for public health workers in the trenches. We can ill afford to wait for the alarm to sound to heed its messages.

Allen S. Craig, M.D.
Tennessee Department of Health, Nashville, TN 37243
allen.craig@state.tn.us