Christopher P. Howson

Adverse Effects of Pertussis and Rubella Vaccines

chapters varies, as is to be expected. Some articles were clearly submitted as oral presentations and would have benefited from more severe editing. The opening section is devoted to the molecular biology of P. neruginosa and the first paper examines the use of pulsed field gel electrophoresis for taxonomic and epidemiological studies, summarising the results of various published studies. This is well complemented by an article on different typing methods and their application to strain identification in patients with cystic fibrosis. Older readers will probably be amused by the short paper on the contamination of sanitary installations and hands of hospital personnel by P. aeruginosa, and its contribution to cross-infection of patients. This is arguably not newsworthy and is certainly outside the scope of molecular biology. The molecular theme is restored by two very short papers on chromosome organisation and outer membrane porins but the reader seeking an overview of this topic will unfortunately be disappointed. The chapter on the role of phospholipase C in pathogenesis is excellent and informative, and is an appropriate introduction to the section on virulence factors. Unfortunately, the papers on P . aerugiiiosn cytotoxin seem almost esoteric and will interest few readers. The balance is restored by an authoritative account of P . aerugirioscr exopolysaccharide (alginate) examining its role as both an offensive and defensive virulence factor and discussing. briefly, its importance in treatment. The role of pseudomonas proteases in burn infections is reviewed including an evaluation of the current hypothesis that, in addition to any direct destructive effect on host proteins, these proteases may also increase the net circulating proteolytic load in the host above that caused by the burn alone. A disproportionately large section of the book is devoted to immunotherapy, both with vaccines-alginate. flagella, lipolysaccharide (LPS), toxin A-and antibodieshyperimmune globulins and monoclonal antibodies to LPS. In one of the latter studies, oral ciprofloxacin was combined with a cocktail of five human monoclonal antibodies to LPS for the treatment of mice with P. aeruginosa infections, reducing mortality from 57-6 O/ O to 25.4 YO overall. Another study demonstrated the effectiveness of the cytokine TNF-a against infection with P . aeruginosa in leukopenic mice. The book ends with four papers on chemotherapy of pseudomonas infection, two of which are noteworthy. The article on /I-lactamases is concise, and emphasises the role of class I/class C enzyme in universal P-lactam resistance in the species. The clinical perspective of quinolone resistance in P . aeruginosa is discussed from the drug company point of view but, nevertheless, it provides the reader with a reasonable insight into the problem. The price of E94.80 is unlikely to seduce many buyers and, if 1 was asked by my library committee to give an opinion as to its purchase, I would have to recommend that the money could be better spent elsewhere. T. L. PITT

The pursuit of global health: the relevance of engagement for developed countries

The globalisation of the world economy and the consequent increase in commerce, travel, and communication have brought benefits to virtually every country. But these changes also bring risks that cannot be addressed adequately within traditional national borders. These risks include emerging infectious diseases, resulting in part from increased prevalence of drug-resistant pathogens; exposure to dangerous substances, such as contaminated foodstuffs, and banned and toxic substances; and violence, including chemical and bioterrorist attack. By investing in global health, industrialized countries will not only benefit populations in desperate and immediate need of assistance, but also themselves--through protecting their people, improving their economies, and advancing their international interests. This paper describes the rationale for involvement of industrialised countries in global health, and suggests a means for its coordination.

In Her Lifetime: Female Morbidity and Mortality in Sub-Saharan Africa

Concerns about population growth in sub-Saharan Africa have led to a research emphasis on womens fertility to the neglect of other womens health issues. This report adopts a biomedical approach to female morbidity and mortality throughout the life span with emphasis on strategic points of vulnerability and the complex interplay of disease determinants manifestations and sequelae. The bulk of the report presents evidence regarding eight specific conditions: nutrition; obstetric and gynecologic health; nervous system disorders; mental health problems; selected chronic diseases; injury; occupational and environmental health; tropical infectious diseases; and sexually transmitted diseases including human immunodeficiency virus. For each of these conditions the profile at six different life stages (in utero infancy and early childhood childhood adolescence adulthood and menopause and post-menopause) is discussed. In addition recommendations are outlined for research activities in four categories: epidemiologic biomedical applied/operational and ethnographic. The report consistently calls attention to the effect of sex-specific differences on community and individual experiences of disease and the impact of life stage on health-seeking behaviors that remain unelucidated.

Mortality patterns among hypertensives by reported level of caffeine consumption

The effect of caffeine consumption on mortality was evaluated in a historical cohort study of 10,064 diagnosed hypertensive individuals participating in the Hypertension Detection and Follow-up Program from 1973 to 1979. Total caffeine intake level from beverages (coffee and tea) and certain medications, was estimated at the 1-year visit. No evidence was found supporting an association between increased level of caffeine consumption and increased all-cause mortality or cardiovascular disease mortality during the following 4 years. Cigarette smoking was significantly associated with mortality; the association being more pronounced among non- and low-caffeine consumers for all-cause mortality and among non-caffeine consumers for all cardiovascular mortality except cerebrovascular mortality.

Acute encephalopathy and chronic neurological damage after pertusis vaccine

In August 1991, the Institute of Medicine released a report entitled Adverse Effects of Pertussis and Rubella Vaccines, which examined, among others, the relation between immunization with whole-cell diphtheria-tetanus-pertussis (DTP) vaccine and both acute encephalopathy and chronic neurological damage. The committee reviewed information from a wide range of both professional and lay sources and found that the evidence is consistent with a possible causal relation between DTP vaccine and acute encephalopathy, although it is insufficient to establish causality. The range of excess risk of acute encephalopathy following DTP immunization is consistent with that estimated from the National Childhood Encephalopathy Study: 0.0 to 10.5 cases per million immunizations. The committee concluded that the evidence is insufficient to indicate either the presence or absence of a causal relationship between DTP vaccine and permanent neurological damage. The evaluative methods used by the committee are briefly described and the evidence underlying its conclusions presented.

Controlling Dangerous Pathogens: A Blueprint for U.S.-Russian Cooperation

The National Academy of Sciences (NAS) created the Committee on International Security and Arms Control (CISAC) in 1980 to bring the scientific and technical resources of the Academy to bear on urgent problems of international peace and security. The primary initial activity of CISAC was a dialogue with Soviet counterparts that helped keep communication on nuclear arms control issues open during a time of great tension in U.S.-Soviet relations. In 1986, CISAC created a special working group on biological weapons control, which focused on another critical problem—developing improved methods of verification of the Biological Weapons Convention (BWC). The group carried out bilateral discussions with a counterpart group established under the aegis of the Soviet Academy of Sciences and then supported by the Russian Academy of Sciences.