Download Beyond Anthrax: The Weaponization of Infectious Diseases

Beyond Anthrax:
The Weaponization
of Infectious Diseases
Edited by Larry I. Lutwick
and Suzanne M. Lutwick
Towata, NJ: Humana Press, 2009.
374 pp $149.00 (hardcover).
When did infectious diseases become weaponized, as the title of Beyond Anthrax:
The Weaponization of Infectious Diseases
suggests? Why is this relevant to the busy
clinician dealing with Mother Nature’s infections on a daily basis? The 2001 anthrax
attacks not only reminded us that germs
can still be used as weapons but demonstrated that random clinicians will be the
first to see and recognize cases of infection
caused by bioterrorism.
Although there have been scores of
publications on anthrax since 2001, relatively few have been written on other microbes of concern. Beyond anthrax, a compilation written by multiple academic,
government, and organizational experts,
seeks to address this gap. After an introductory first chapter on the history of bioterrorism, approximately one-half of the
book (Chapters 2–10) reviews specific
Category A and B agents, with most chapters introduced by emblematic cases. Often missing in texts on bioterrorism and
comprising one-quarter of this book,
Chapters 11–15 speak to public health implications in policy, law, surveillance, psychosocial management of events, and
communication with the media. Finally,
the book concludes with 2 individual
chapters on rapid detection and plant
pathogens.
Each chapter is a stand-alone summary.
Chapter 1, written by Pro-MED’s Stuart
Handysides, broadly defines bioterrorism
as the threat or use of infections as weapons and presents a unique historical summary from ancient times to the present.
Chapters 2–6 make up approximately
one-third of Beyond anthrax and review
the relatively less-covered Category A
agents: smallpox, plague, tularemia, botulism, and viral hemorrhagic fever pathogens. Although all chapters touch on epidemiology, microbiology, diagnosis, treatment, prevention, and possible biowarfare
use, each varies in depth, ranging from 6
text-filled pages (tularemia) to 30 pages
(smallpox, viral hemorrhagic fever).
Chapter 2, “Smallpox and Bioterrorism,”
is the most comprehensive of the group.
It supplements commonly published information on diagnostic criteria and vaccination with sections on monkeypox, use
of vaccine in human immunodeficiency
virus, similarities to severe acute respiratory syndrome, and genetic and immunologic scenarios. Chapter 6 provides excellent tables of viral hemorrhagic fever
viruses associated with bioterrorism that
list differences in transmissibility, infectious dose, vaccine availability, and historical use.
Chapters 7–10 address selected Category B microbes and intentional food and
water contamination. Whereas Chapter 7
focuses on the naturally occurring “Vietnam time bomb” melioidosis, so-called
because disease is caused by reactivation
years after exposure in an endemic area,
Chapter 8 cites the stability and aerosolizability of Rickettsia prowazekii in epidemic typhus fever and its likelihood for
substantial spread in a louse-infested population. Chapter 9 groups together commonly-occurring Staphylococcus aureus
enterotoxin B with Clostridium perfringens
epsilon toxin and relatively rare ricin in
its overview of Category B biotoxins.
In Chapters 11–15 on public health policy and bioterrorism response, Washington Post Science Writer David Brown’s examination of “The Role of the Media in
Bioterrorism” stands out as a compelling
and candid advisory to public health officials. Written before the 2009 H1N1 pandemic, it cites specific examples from the
anthrax letters of 2001 and offers concrete,
constructive suggestions regarding communication of scientific facts in real time.
The legal and surveillance chapters that
follow discuss quarantine in the context
1462 • CID 2009:49 (1 November) • BOOK REVIEWS
of bioterrorism and the logistics of bioterrorism data collection and interpretation, respectively. Chapter 16 focuses on
rapid identification methods that use serology, antigen-non-antibody target interactions, and genomics.
All in all, Beyond anthrax, which is intended to be a “primer for clinicians and
epidemiologists on a variety of agents, organisms, or toxins…of potential use in a
biologically attack…,” provides much
more in its 17 chapters and 374 pages.
With its substantial section on public
health applications and inclusion of food,
water, and plant bioterrorism and the capacity for standardization and expansion
of chapter content, it would make a useful
overview text on bioterrorism for medical,
public health, and post-doctorate students. Newcomers to bioterrorism may
also find it helpful to view the Centers for
Disease Control and Prevention and National Institutes of Health Web sites on
bioterrorism agent categorization for additional background. For clinicians with
more time who are still coming to terms
with “countermeasures” parlance and who
have many preparedness workshops under their belts, Beyond anthrax offers a
thoughtful review of germs not-to-be-forgotten and why they matter. In short, Beyond anthrax moves us beyond anthrax.
Mary E. Wright
Division of Clinical Research,
National Institute of Allergy and Infectious Diseases,
National Institutes of Health,
Bethesda, Maryland
Animalcules: The Activities,
Impacts, and Investigators
of Microbes
By Bernard Dixon
Washington, DC: ASM Press, 2009.
358 pp. $39.95 (hardcover).
Animalcules is a compilation of essays by
Bernard Dixon that have appeared in the
American Society for Microbiology journal Microbes. As a result, one can read this
book in a number of manners. In a somewhat academic manner, one could theoretically scan the table of contents for a
topic and learn something about Botox,
frescoes, or Gerhard Domagk. I fear that
this would miss the point in an era when
PubMed and Google Scholar can readily
uncover articles on most any subject with
a few keystrokes followed by a click of a
search button. Instead, I would recommend a less directed read, such as flipping
through essays on evolution by Stephen
Jay Gould or reflections on biology by
Lewis Thomas. One option is to open the
book at random and enjoy a 4–5-page rumination on some microbiological topic
that has likely never occurred to you (bedtime reading). Alternatively, one can read
the book in its entirety, to get a sense of
the common conceptual themes that recur
(holiday reading).
The book is divided into 5 loose categories, with a more general introductory
set of articles followed by essays on ecology, the human context, microbiologists,
and, finally, the conduct of microbiological investigation. Although the topics are
eclectic, the consistent theme throughout
is Dixon, who shapes each chapter with
his own personal touch on different levels.
On the most scientific level, the author
takes you along to a variety of venues,
painting a fast-pass portrait of highlights
from this particular meeting or that. Beneath this level, one learns of the author’s
respect for enquiry and rejection of unproven dogma. This was nicely articulated
in a chapter that listed untruths authoritatively taught by his schoolteacher that
have been subsequently disproven. On a
still more personal level, one encounters
a scientist sharing his excitement at having
his work cited many years after the fact
and a patient who discusses his own symptomatic experience with strep throat. Because of the different levels that play out,
I recommend reading the book en bloc
over a few days, to best reveal some of the
common themes that pop up across sections and stories.
Given that the book represents a com-
pilation of different ideas written about at
different times, one cannot expect each
chapter to resonate in the same manner
with each reader. My personal bias favors
2 types of chapters: the biographies of unheralded pioneers in microbiology and the
rhetorical essays that end with an apparently simple statement followed by a question mark. Chapters on some of the great
microbiologists not to be recognized in a
full-length biography not only outline the
context for some of the seminal contributions in microbiology but also beg the
question of whether the work itself or the
biographer was the key determinant in a
scientist’s ultimate standing. This theme
returns in an essay on the citation game.
Chapters on specific questions remind
me of the first article I read by the author,
on whether Mycobacterium avium subsp.
paratuberculosis is to blame for Crohn disease [1]. The typical ingredients in these
essays are (1) a defined question, (2) a
willingness to comb through old and new
articles, (3) a reasoned summation of the
current state of the literature, and (4) a
concluding question, often presented as a
statement, followed by a short question.
Many chapters end along the lines of
“Given the techniques available, you
would think the answer could be quite
readily determined. So why are we still
asking this question?” The essays span sociological questions (should we be publicizing experiments that generate more potent toxins?) and fundamental questions
(what is virulence?). In each case, the message is that many questions are unanswered, partially answered, or poorly answered. As a result, a key message that
permeates this book is that many core issues in microbiology and infectious diseases that were defined in the 19th century
are still unresolved in the 21st century.
This book therefore provides reassurance for those already committed to microbiology and can serve as an inspiration
to the next generation of scientists who
might be wondering whether there is job
security in microbiology. The answer
would appear to be yes. In either case,
Animalcules presents a conceptual approach through example. Start with good
questions, add a dollop of scepticism to
what is “known,” read the literature critically, and consider the value of new tools
for old questions. I suspect that each niche
in microbiology could benefit from a 4page essay by Dixon to remind us of where
we are, where we are not, and where we
might consider directing our efforts. There
is indeed job security for Dixon as he reflects on our efforts.
Marcel A. Behr
Department of Medicine,
McGill University Health Centre,
Montreal, Canada
Reference
1. Dixon B. The mystery MAP. Lancet Infect Dis
2002; 2:316.
New Books Received
Brunette G. CDC Health Information for
International Travel 2010. Philadelphia,
PA: Mosby Elsevier, 2009. 540 pp. $29.95
(softcover). ISBN: 978-0-7020-3481-7.
Cooper AF, Kirton JJ. Innovation in Global
Health Governance. Burlington, VT: Ashgate Publishing Company, 2009. 380 pp.
$114.95 (hardcover). ISBN: 978-0-75464872-7.
Cornely O, Bangard C. A Clinical Atlas of
Radiography of Invasive Fungal Disease.
München, Germany: Urban & Vogel,
2008. 112 pp. i22.95 (paperback). ISBN:
978-3-89935-254-2.
Dworkin MS. Outbreak Investigations
around the World. Sudbury, MA: Jones
and Bartlett Publishers, 2009. 456 pp.
$64.95 (paperback). ISBN: 978-0-76375143-2.
Fratamico PM, Smith JL, Brogden KA. Sequelae and Long-Term Consequences of
Infectious Diseases. Washington, DC:
ASM Press, 2009. 534 pp. $149.95 (hardcover). ISBN: 978-1-55581-430-4.
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