Sir William Dunn School of Pathology, University of Oxford South Parks Road, Oxford OX1 3RE, UK
Viruses, Plagues, and History
by Michael Oldstone
Oxford University Press, $25 , 288 pp
ISBN: 0-19511-723-9, 1998
I enjoyed reading this book. It provides a vivid description of several terrible viral diseases that have in some cases been controlled by vaccination to the point of extinction (e.g. smallpox), while in others rage unchecked causing misery to countless millions (e.g AIDS). The book brings together not just a description of these diseases and how they have affected our history and behavior, but also narrates the search for the causative agents, explaining how they are transmitted, how research led to the development of vaccines, and how these vaccines have controlled specific diseases. Most importantly, the book introduces the scientists involved in these endeavors, so that the reader is left with an understanding of the characters and lives of those whose research has been of great benefit to mankind, and who in some cases paid the ultimate price in their work.
The author has made a clear effort to make the subject understandable to those outside biomedical research and he has achieved this goal. Thus the book will be of general interest to many without detailed knowledge of viruses, the immune system or vaccines. Yet the book is also an excellent read for health care workers, biomedical students, scientists, virologists, immunologists and those interested in the history of man's battle with infectious disease.
After a general introduction there are short chapters about the principles of virology and immunology, including explanations of how viruses replicate, how our immune system controls and eliminates viral infections and how some viruses have evolved countermeasures to escape immune detection. This section is followed by chapters about smallpox, yellow fever, measles and poliomyelitis. These illustrate how the development of vaccines led to the control and even eradication of virus diseases: smallpox is eradicated, polio and measles are scheduled for eradication by 2000 and 2013, respectively. Although there are no prospects that the yellow fever virus will be eradicated, due to its presence in other hosts that can re-introduce it into man, it too has been largely contained by vaccination.
Subsequent chapters switch to virus diseases which are causing epidemics or pandemics beyond our control. Some cause terrifying outbreaks with explosive onset and high mortality, such as the haemorrhagic fevers caused by ebola, lassa fever and hantavirus, while others, like HIV, produce an insidious infection that may take a decade or more to overcome our defenses, but from which no one has yet been cured once an infection is established. Before the final chapter on influenza virus there is a description of prions that cause transmissible spongiform encephalopathies such as kuru, scrapie, BSE and new variant CJD. This chapter might be considered out of place in a book otherwise devoted to virology, for the great weight of evidence now indicates that the causative infectious agent is not a virus but an infectious protein or prion. The last chapter, devoted specifically to influenza, reminds us of the continuing threat from this virus which killed more than 20 million people in 1918-19 and which may return to cause pandemics in the future.
The book contains very few blemishes, but one notable one which as a poxvirologist I feel duty bound to point out concerns the nature of the smallpox vaccine. Oldstone states that the vaccine was attenuated (in a similar way to that for other live virus vaccines). While it is true that later in the smallpox eradication campaign several workers attempted to produce attenuated vaccines, these played an insignificant role in the eradication program. Importantly, the smallpox vaccines were not derived from the pathogenic parent organism (variola virus), as was the case for polio, yellow fever and measles, but rather from a related but distinct poxvirus species called vaccinia. Also the difference between the vaccine used by Jenner (cowpox virus) and the twentieth century smallpox vaccines (vaccinia virus, a poxvirus species distinct from cowpox) might have been appropriate for a book about the history of virus vaccines, since the unknown origin and natural host of vaccinia remain unsolved enigmas of virology. Another minor criticism is that some of the illustrations in the book have suffered from printing at rather too small a size.
But overall this is an excellent book which I heartily recommend to a wide readership.
