Viral Haemorrhagic Fevers

This book is a small volume in the series “Perspectives in Medical Virology.” It seeks to provide an overview of all of the viruses that have been associated with hemorrhagic disease. The chapters cover epidemiology, clinical disease, immunology and pathology, molecular virology, diagnosis, and all other aspects of the science and threat to public health of a disparate group of viral infections. A compendium of information of this kind is a useful concept for those who need an overview of and an introduction to the field of viral hemorrhagic fevers. The author has also added general chapters about safety and perspectives on bioterrorism, diagnostic techniques, vaccine development, and other topics. The early history of each viral disease discussed is well covered. The author’s considerable background in molecular virology allows some useful, in-depth discussion of viral structure, replication, and functions of the various molecular components of viral hemorrhagic fevers. These discussions are mostly in text, and it would have greatly increased understanding (particularly for the general reader) to have had many more illustrations. The author is clearly less comfortable with epidemiology and ecology of the viruses; both topics are rather underserved by this book. For example, aerosol transmission of Lassa fever is discussed, even though this means of transmission has been exclused in most published articles. The importance of Marburg virus is dismissed, and the author fails to mention the major outbreak that occurred in the Democratic Republic of Congo in the late 1990s. This omission is important in light of the major outbreak in Angola in 2004– 2005. Also of much concern is the misnaming of countries. The Democratic Republic of Congo (formerly Zaire) is referred to as “Congo,” which has never been its name. Lack of attention to detail in this respect seems unnecessary and is unsettling. In general, many of the concepts presented are dated and fail to address much of the most recent literature, which has changed and advanced the concepts presented in this book. In addition, there are many errors and unsubstantiated and unreferenced statements that are misleading, at best. For instance, ticks are described as breeding in stagnant pools, and nonhuman primate species are misnamed. Descriptions of human infection with Whitewater Arroyo virus are treated as fact but are unreferenced—for the excellent reason that definitive articles were never published, possibly because of inability to confirm the authenticity of isolation. Other articles that present irreproducible data, such as the report of reverse transcriptase activity associated with arenaviruses, are quoted uncritically. Disappointingly, even the section on diagnostic techniques is out of date. Today, RT-PCR is widely available, even in developing countries, so discussions about immunofluorescent antibody assays—the staple of diagnostic techniques during the 1970s and 1980s—being the primary approach are overemphasized to the detriment of newer approaches. Even some sections that discuss molecular virology are seriously out of date, particularly those concerning filoviruses. Many major articles about filovirus that have been published during the past few years are not referenced; complete bodies of work from some of the current leading experts have been omitted. The problem of not including findings from the most recent literature are compounded when discussing pathophysiology (particularly, immunopathology). Much of what is discussed is limited to old articles about histopathology. The author states that cellular immunity is not important in Lassa virus infections, but it has been clearly shown for many years that immune protection is almost entirely T cell–dependent and that hyperimmune globulin is quite ineffective as treatment. Major advances in the understanding of the innate and acquired immune responses in Ebola virus infections are ignored. This is a disappointing volume that could have been useful, but, because of inaccurate statements and the lack of upto-date information, it is much less so.