Special Features Viral Haemorrhagic Fevers — Perspectives in Medical

Viral hemorrhagic fevers (VHFs) are severe clinical syndromes of humans, often resulting in extraordinarily high lethality. The diseases are characterized by initial influenza-like symptoms followed by varying degrees of capillaropathy, consumption of blood clotting factors with occasional hemorrhages from mucous membranes, and terminal multiorgan failure. VHF outbreaks are observed in distinct geographical locations consistent with the range of known animal hosts. Outbreaks occur after direct or indirect contact of humans with these animals, which are, in most cases, arthropods or rodents. All known VHF-causing agents can be classified into one of four families: Arenaviridae, Bunyaviridae, Flaviviridae, or Filoviridae. Some VHFs, such as the flaviviral diseases yellow fever or dengue fever, have or had tremendous relevance for public health because of tens of thousands of human cases per year. Other VHFs, such as that caused by the ebolaviruses or the arenaviral Lassa fever are of true interest for particular nations only, but have become known to many U.S. households because of Hollywood productions and popular science publications. At the same time, exotic VHFs such as Crimean-Congo hemorrhagic fever, Omsk hemorrhagic fever, Kyasanur forest disease, or Guanarito virus infections are largely unknown even in the scientific community despite their local importance. Depending on the presence or absence of specific antivirals or vaccines and the recorded severity, VHF agents are classified as pathogens requiring facilities certified at BSL-2 (Dengue viruses 1-4, Yellow fever virus), BSL-3 (hantaviruses), or BSL-4 (filoviruses, CrimeanCongo hemorrhagic fever virus, Lassa virus, Machupo virus, and Omsk hemorrhagic fever virus). All these viruses are considered potential agents for biological warfare and terrorism activities and hence are National Institute of Allergy and Infectious Disease Priority Pathogens ranging from Category A through C. The overall boost in research on Priority Pathogens and the increasing number of high-containment laboratories make hemorrhagic fever-causing viruses important for all biosafety and biosecurity professionals. Colin R. Howard, a well-known scientist with practical experience in the VHF field, recently published Viral Haemorrhagic Fevers, a text “aimed at healthcare workers, clinicians, and microbiologists.” This handy book contains clearly and well-written self-contained chapters describing each of the four viral families to which VHF agents have been assigned. The different viruses and diseases are treated separately and in detail in the context of history, epidemiology, molecular biology, clinical presentation, diagnosis, treatment, and prevention. Hence, the book will definitely appeal to the intended target audiences. However, reading this volume left me with mixed feelings. On the one hand, the introductory and commentary chapters at the beginning and end of the book are worthy reviews themselves, and are wonderfully written and scientifically sound. Furthermore, fascinating historical subchapters for most viruses are filled with anecdotes of research pioneers and ancient observations, all of which raised my curiosity. Especially the subchapters on yellow fever virus and dengue viruses 1-4 are recommended to the reader. The book is surprisingly current— even recently discovered exotic agents such as Alkhurma virus or Garissa virus are briefly mentioned. On the other hand, the epidemiological subchapters are sometimes incomplete or flawed. For instance, while one could not expect the very recent marburgvirus outbreak in Angola to be mentioned, Howard should have mentioned the successive outbreaks from 1998-2000. An ebolavirus fever outbreak in Sudan is mistakenly placed in 1996, when in fact it occurred in 2000; a marburgvirus fever outbreak that allegedly occurred in 1982 has never been proven; and ebolaviruses were discovered in 1976, not in 1972. Worse, the viral taxonomy used in the book is not current and Howard randomly switches between virus and disease names and italic or nonitalic typing. The author assigns “influenza” to the family “Myxoviridae” (should read influenzavirus and Orthomyxoviridae), discusses “Congo-Crimean haemorrhagic fever” (should read Crimean-Congo hemorrhagic fever virus), or states that the “various strains and isolates of LCM [lymphocytic choriomeningitis] are now considered to be a genus within the family Arenaviridae”—when in fact Arenaviridae Reviewed by Jens H. Kuhn