Book Review

New and Evolving Infections of the 21st Century

N Engl J Med 2007; 357:627August 9, 2007

Article

New and Evolving Infections of the 21st Century
(Emerging Infectious Diseases of the 21st Century.) Edited by I.W. Fong and Ken Alibek. 375 pp., illustrated. New York, Springer, 2007. $129. ISBN: 978-0-387-32647-4

It is not a matter of if, but instead when, the next epidemic will strike. Historically, infectious diseases have inflicted much misery and, in so doing, have shaped humankind as we know it today. From past plagues, we not only have vestiges of older immunologic defenses but also still possess the genetic skeletons of some viral incursions into our genome. How will the next epidemic reveal itself, and where will it come from? This book is well timed, and it places perceived and real viral threats in perspective.

The title of the book, New and Evolving Infections of the 21st Century, may seem prophetic, given that the first decade of this century has yet to run its course. Nevertheless, the book will be a valuable contribution to education and preparedness. Its editors have called on experts in infectious diseases of the very recent past to document and compile current and recent threats, while also providing examples of evolving insidious infections that in some cases are relatively common in our population. The book is divided into three sections: “Evolving Infectious Diseases,” “Newly Recognized Human Viruses,” and “Emerging Viruses in Asia.”

The first section begins with a chapter on West Nile virus, a striking example of an established viral disease that after being transplanted to a new continent has adapted and expanded its dominion in North America. This chapter sets the stage by illustrating one of the central aspects of emerging infectious diseases — that most of them are naturally resident in animal populations and thus are of equal importance in the field of veterinary medicine. The events that culminate in the transition from an often unrecognized infection in a domestic or wild animal to a human disease are important to understand. Zoonotic diseases (those transmitted from animals to man) often have complex dynamics, occasionally leading to cross-species exposures and human infection; in some cases, a disease develops, and in even rarer cases, the disease is transmitted from human to human. Understanding the nature of these events is crucial in the prevention and control of future outbreaks. For instance, the back-to-back chapters on hantaviruses and poxviruses include descriptions of the differences between genetically promiscuous RNA viruses and viruses with more conserved DNA genomes. These contrasting chapters serve as examples to illustrate the complexities that may give rise to clinically apparent zoonotic infections when they cross the species barrier into naive human populations.

Numerous chapters in the book, including those on the severe acute respiratory syndrome and avian influenza, illustrate the shifting continuum between human medicine and veterinary medicine. The health problems these infections cause in both fields are comprehensively handled, and from the perspective of human disease and diagnosis are well presented.

There are inherent weaknesses in a multiauthored book such as this one. Most chapters cover the spectrum, from virology and epidemiology to clinical presentation and management, but they differ greatly in strength and content. However, these shortcomings are outweighed by a good number of well-written, high-quality, comprehensive chapters. This book will be a useful and relatively current resource not only for experts and researchers in public health and infectious diseases but also for veterinary and medical professionals as well as graduate students.

Jonathan L. Heeney, D.V.M., D.V.Sc.(Path.), Ph.D.
University of Cambridge, Cambridge CB3 0ES, United Kingdom
jlh66@cam.ac.uk