Vaccines: Preventing Disease and Protecting Health
http://www.100md.com
《新英格兰医药杂志》
From the first to the last chapter, from AIDS to zoster, this book is a gem. It covers the field of vaccines from basic to clinical science and on to public health and the implementation of vaccines, focusing on the successes but not avoiding the areas that still pose problems. As a public health tool, vaccines are the most cost-effective intervention you can buy. But most of the low-hanging fruit has been picked, and the vaccines yet to be developed pose challenges for basic science (e.g., vaccines for the human immunodeficiency virus [HIV] and malaria), for clinical science (respiratory syncytial virus), or for development because the market size and manufacturing interests for a given vaccine do not align (hookworm). To take on the task of presenting the breadth of information the field now encompasses, I cannot think of a better part of the World Health Organization than the Pan American Health Organization, owing to all of its successes in the implementation of vaccines in the region in the 20th century, nor a more competent and accomplished editor than Ciro de Quadros, who is responsible for most of the great success of the Pan American Health Organization.
Aerial View of a Crowd Surrounding a City Auditorium in San Antonio, Texas, while Awaiting Immunization against Polio in 1962.
Courtesy of the Centers for Disease Control and Prevention.
This book includes and is based on the edited proceedings of a conference titled "Vaccines, Prevention, and Public Health: A Vision for the Future" that was held in Washington, D.C., in 2002 in celebration of the 100th anniversary of the Pan American Health Organization. Between the initial sentence of Anthony Fauci's opening chapter ("As public health professionals know all too well, the threats posed by infectious diseases have not disappeared") and one of the final statements in the summation by Donald Henderson ("The challenge for us in the years ahead is to appreciate that the discovery, development, application, and regulation of vaccines have to be viewed as integral processes with each element having important, sometimes critical, implications on the other components with decisions weighed accordingly"), a cornucopia of information is packed.
Part 1 deals with the present time, covering such topics as the campaign to eradicate poliomyelitis (written by Daniel Tarantola), the prospect of the global eradication of measles (Ciro de Quadros), and the efforts to define congenital rubella syndrome and establish a vaccine-intervention program (Louis Cooper). Part 2 is called "The Cutting Edge," but this title refers primarily to the challenge of implementing vaccines (for Haemophilus influenzae type b, varicella, and hepatitis A and the pneumococcal conjugate vaccine, the chapters for which are written by the leading experts) rather than vaccine development, with the exception of a discussion by F. Marc LaForce of conjugate meningococcal vaccine for the "meningitis belt" countries in Africa.
Part 3 looks to the future, both the short term and the long term. The chapter on rotavirus, by Roger Glass and others, is excellent, but it does not fully explore the agonies associated with the introduction and withdrawal of the rhesus–reassortant vaccine (RotaShield, Wyeth) in the United States. The hullabaloo on the part of the overly cautious Centers for Disease Control and Prevention about the risk, which is still unclear, of vaccine-induced intussusception precluded the introduction of the vaccine in developing countries, where about 750,000 vaccine-preventable deaths from rotavirus occur per year among very young children. Other vaccines considered here include those for shigella, human papillomavirus (this is the second anticancer vaccine, the vaccine for hepatitis B being the first), Helicobacter pylori, and respiratory syncytial virus, among others.
Part 4 addresses the new quest for vaccines such as those for HIV (in the chapter by José Esparza), malaria (Regina Rabinovich), and hookworm (Peter Hotez). But this is not the end, for Part 5 deals with new concepts, adjuvants, and delivery systems, including authoritative reviews of DNA vaccines (Margaret Liu) and transgenic plant vaccines (Charles Arntzen). In Parts 6 through 8, the book goes on to deal with vaccines and bioterrorism, regulatory and safety issues, and disease prevention and public health. The final few pages — an epilogue — include the above-mentioned masterly summation by Henderson, in which he highlights, on the one hand, the need for targeted approaches to the development of new vaccines and, on the other hand, the regulatory approaches relevant to the benefit–risk ratio in countries with differing burdens of disease and limitations in the health care system, from finances to facilities.
Nobody who considers himself or herself literate in medicine in the 21st century can be ignorant of where we stand on vaccines, the subject of much disinformation and misinformation on the Web, promoted by certain antivaccine activist groups and some members of Congress. These proceedings are better than a textbook, because the reading is easy, considering the amount of authoritative information conveyed, and the scope is broad and oriented toward the future.
Gerald T. Keusch, M.D.
Boston University
Boston, MA 02118
keusch@bu.edu(Ciro A. de Quadros. 398 p)
Aerial View of a Crowd Surrounding a City Auditorium in San Antonio, Texas, while Awaiting Immunization against Polio in 1962.
Courtesy of the Centers for Disease Control and Prevention.
This book includes and is based on the edited proceedings of a conference titled "Vaccines, Prevention, and Public Health: A Vision for the Future" that was held in Washington, D.C., in 2002 in celebration of the 100th anniversary of the Pan American Health Organization. Between the initial sentence of Anthony Fauci's opening chapter ("As public health professionals know all too well, the threats posed by infectious diseases have not disappeared") and one of the final statements in the summation by Donald Henderson ("The challenge for us in the years ahead is to appreciate that the discovery, development, application, and regulation of vaccines have to be viewed as integral processes with each element having important, sometimes critical, implications on the other components with decisions weighed accordingly"), a cornucopia of information is packed.
Part 1 deals with the present time, covering such topics as the campaign to eradicate poliomyelitis (written by Daniel Tarantola), the prospect of the global eradication of measles (Ciro de Quadros), and the efforts to define congenital rubella syndrome and establish a vaccine-intervention program (Louis Cooper). Part 2 is called "The Cutting Edge," but this title refers primarily to the challenge of implementing vaccines (for Haemophilus influenzae type b, varicella, and hepatitis A and the pneumococcal conjugate vaccine, the chapters for which are written by the leading experts) rather than vaccine development, with the exception of a discussion by F. Marc LaForce of conjugate meningococcal vaccine for the "meningitis belt" countries in Africa.
Part 3 looks to the future, both the short term and the long term. The chapter on rotavirus, by Roger Glass and others, is excellent, but it does not fully explore the agonies associated with the introduction and withdrawal of the rhesus–reassortant vaccine (RotaShield, Wyeth) in the United States. The hullabaloo on the part of the overly cautious Centers for Disease Control and Prevention about the risk, which is still unclear, of vaccine-induced intussusception precluded the introduction of the vaccine in developing countries, where about 750,000 vaccine-preventable deaths from rotavirus occur per year among very young children. Other vaccines considered here include those for shigella, human papillomavirus (this is the second anticancer vaccine, the vaccine for hepatitis B being the first), Helicobacter pylori, and respiratory syncytial virus, among others.
Part 4 addresses the new quest for vaccines such as those for HIV (in the chapter by José Esparza), malaria (Regina Rabinovich), and hookworm (Peter Hotez). But this is not the end, for Part 5 deals with new concepts, adjuvants, and delivery systems, including authoritative reviews of DNA vaccines (Margaret Liu) and transgenic plant vaccines (Charles Arntzen). In Parts 6 through 8, the book goes on to deal with vaccines and bioterrorism, regulatory and safety issues, and disease prevention and public health. The final few pages — an epilogue — include the above-mentioned masterly summation by Henderson, in which he highlights, on the one hand, the need for targeted approaches to the development of new vaccines and, on the other hand, the regulatory approaches relevant to the benefit–risk ratio in countries with differing burdens of disease and limitations in the health care system, from finances to facilities.
Nobody who considers himself or herself literate in medicine in the 21st century can be ignorant of where we stand on vaccines, the subject of much disinformation and misinformation on the Web, promoted by certain antivaccine activist groups and some members of Congress. These proceedings are better than a textbook, because the reading is easy, considering the amount of authoritative information conveyed, and the scope is broad and oriented toward the future.
Gerald T. Keusch, M.D.
Boston University
Boston, MA 02118
keusch@bu.edu(Ciro A. de Quadros. 398 p)