Stefan H. E. Kaufmann. Haus Publishing, London, 2009, 270 p., $14.95 (paperback).    

This short paperback appears to be an introduction  to infectious diseases for the  layman. It is part of the initiative "Encouraging  Sustainability" and hopes to "enable  as many people as possible to form their  own opinions about the globalization of  infectious diseases in the modern, networked  world."    

Many universities are now requiring incoming  freshmen to read challenging and  thought-provoking texts. This book well  fits that description and certainly deserves  to be considered for such programs.    

The chapters are brief but concise. They  begin with "The Invaders" and "The Defenders,"  briefly introducing the reader  to disease-producing organisms and then  discussing immune responses. A somewhat  longer chapter considers the "Coexistence  of Mankind and Microbe." The  author notes that human development, including  changes in nutrition and adaptation  away from nomadic life, as well as  animal husbandry, led to the onset of epidemics.  The chapter also discusses microbial  strategies, coexistence and symbiosis,  and the role of viral carcinogens such  as Helicobacter, human papillomavirus,  and the hepatitis B and C viruses. Many  diseases must be considered as multidimensional  systems, i.e., interaction with  environmental and genetic factors, rather  than assuming that a pathogen causes disease  simply by direct action.    

The major chapter in the book, "More  Than a Body Count: the Major Infectious  Diseases," takes up almost 100 of the less  than 300 pages of text. It begins with an  overview of respiratory, diarrheal, and  food-induced diseases, continues with the  so-called "children's diseases" and problems  with immunization, and then discusses  AIDS. The present worldwide situation  regarding this disease is elucidated,  and the societal factors involved ("A virus  by itself does not make an illness") are  considered. Suggestions for interruption  of spread, including potential vaccines, as  well as the drawbacks associated with cost  for so doing, are discussed.    

The chapter continues with an overview  of the tuberculosis problem, focusing on  South Africa and Russia, and noting that  complacency has been our worst enemy.  Almost 345 times as much money was  spent to fight HIV infection by the World  Bank in 2005 and almost 50 times as much  was focused on malaria programs in Africa.  Compounding the problem is the fact  that 15 million people are concurrently  infected with AIDS. Of course, HIV infection  compounds another problem, i.e. immunization  of immunocompromised children-  another example of "interaction."    

A brief section on malaria (and the DDT  controversy) leads the reader to a discussion  of influenza from a historical as well  as a microbial viewpoint. Avian influenza  (specifically H5N1) is discussed at length.  Unfortunately, at the time of publication,  the author did not foresee the recent outbreak  of swine flu. A brief description of  SARS is followed by a short section on  tropical diseases. I would refer the reader  to Peter Hotez's Forgotten People, Forgotten  Diseases for a true evaluation of how  unaware the Western world is of these  scourges of the developing world.    

Two short chapters deal with antimicrobials  and immunization. The latter  emphasizes modes of action, resistance,  nosocomial infections, and the problems  associated with the addition of antibiotics  to animal feed. Insofar as vaccines are  concerned, the author admits that none  of them are perfect but that they save five  million lives each year. When the diseases  against which they protect have been eradicated,  he says, then we will be able to consider  suspending immunization programs.    

A chapter entitled "Poverty and Infectious  Diseases from a Global Point of  View" emphasizes organizations and  goals. In the present worldwide economic  climate it seems that nongovernmental  foundations and organizations may prove  more effective than vague promises from  highly publicized summit meetings.    

In "Swimming against the Tide" we  learn, not surprisingly, that pharmaceutical  research emphasizes development of  drugs that will sell well in developed countries,  with only 10% targeted towards diseases  in developing countries, where 90%  of the global disease burden is concentrated.  Blockbuster drugs are what ensure  economic viability for the pharmaceutical  companies.    

What are the hot spots for old and new  epidemics? The poor and the sick, catastrophes  and conflicts, transmission from  research laboratories, climate change with  its associated localized increase in vectors  as a result of higher temperatures, excursions  into the wilderness (logging and exportation  of exotic animals, e.g. Ebola,  Marburg disease and other illnesses), animal  farms as breeding grounds for disease  through crowding, improper use of antibiotics,  the leap of animal diseases to other  species (e.g. BSE, SARS and bird flu).  Kaufman sees human-animal interaction  as the gravest threat of a new pandemic.    

In the book's conclusion, entitled "Five  To or Five Past Twelve," the author suggests  a 10-point program for the control of  infectious diseases. Some of them, such as  making intensive use of available intervention  measures, seem a little more doable  than combating poverty. Many of them  bring to my mind my father's words,  "Whatever you do, you have to remain an  optimist." We have made great strides.  The author tells us that we have to finish  the job, or at least attempt to do that.    

Fred Rosenberg    
California Lutheran University    
Thousand Oaks, Calif