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Book Review
The Vaccine Book
Barry R. Bloom and Paul-Henri Lambert
Academic Press, imprint of Elsevier Science, 2003, ISBN: 0121072584, Pages:
436, Price: US $59.95; UK £37.50
Suggested citation
for this article:
Weniger BG. The vaccine book. [book review]. Emerg Infect Dis [serial
on the Internet]. 2004 Jul [date cited]. Available from: http://www.cdc.gov/ncidod/EID/vol10no7/03-0910.htm
Few fields in medical science involve as wide a range of specialties
and expertise as vaccinology. It encompasses the research, development,
and manufacturing processes of vaccines, their incorporation into immunization
programs, and the logistic and clinical aspects of their use. Commissioning
experts to write chapters with a minimum of jargon, minutiae, and redundancy
for a book with a target audience of immunologists, microbiologists, clinical
trial specialists, epidemiologists, economists, policy-setting public
health officials, and practitioners who administer the resulting products
and provide follow-up care, is challenging. But the experienced editors
of this book have achieved this goal. Dr. Bloom was previously a Mycobacterium
immunologist at the Albert Einstein School of Medicine and is now dean
of the Harvard School of Public Health. Dr. Lambert is a vaccine immunologist
at the University of Geneva.
The Vaccine Book first covers the impact of disease, including chapters
on vaccine economics and finance policy, and the potential for widespread
vaccination to change the epidemiology of the target disease. One example
is the herd effect of childhood rubella vaccination, which postpones infection
in nonimmunized women into their childbearing years. The next section
reviews the immune system, and here lies the book's greatest disappointment.
Its chapter on basic immunology is confusing and presumes familiarity
with terms and concepts without antecedent explanation. It lacks a logical
flow in describing what is yet known of the (infinitely?) complex immune
system and its many "up-" and "down-regulating" feedback
loops. Readers hoping for a chapter-length "Immunology 101"
course would be advised to turn elsewhere (1,2)
The phased stages of clinical trials are covered in excellent chapters
by accomplished authors with practical insights. Another section shows
how knowledge of microbial pathogenesis can affect vaccine design, including
Rolf Zinkernagel's well-written chapter on immunologic memory. Another
chapter on parasite pathogenesis, however, delves too deeply into the
immunity of Leishmania as a case study.
Stanley Plotkin's thoughtful overview of the 11 disease-specific chapters
annotates new vaccine technologies as well as current issues of debate,
such as replacing the live oral polio vaccine worldwide with injectable,
inactivated polio vaccine once the eradication program breaks the chain
of wild-virus circulation, to avoid reverse mutations and resulting vaccine-associated
paralysis. Plotkin also provides a comprehensive table of vaccine types
currently available or in active clinical development.
Remaining sections of The Vaccine Book cover the ethics of research and
use of vaccines, their safety and controversies, and their introduction
into healthcare systems. The editors conclude with major future challenges,
such as circumventing microbial escape, vaccines for chronic and autoimmune
diseases, and maintaining public support of immunization in the face of
anti-vaccine movements.
The breadth of vaccinology inevitably requires leaving out some topics.
There is no chapter on measles vaccines, used universally for a major
cause of childhood death and disability. Manufacturing steps such as fermentation,
purification, formulation, fill, and finish are not described. There is
little on quality assurance and regulation, such as the investigational
new drug application process and current good manufacturing practice,
although good clinical practice is mentioned. Despite these gaps, compared
to this field's authoritative encyclopedia (3), at three
times The Vaccine Book's mass and four times its pages, this handy 1.1-kg
compilation is a more comfortable read, indeed.
Bruce G. Weniger*
*Centers for Disease Control and Prevention, Atlanta, GA, USA
References
- Abbas AK, Janeway CA Jr. Immunology:
improving on nature in the Twenty-first Century. Cell. 2000;100:129–38.
- Robles DT, Eisenbarth GS. Immunology
primer. Endocrinol Metab Clin North Am. 2002;31:261–82.
- Plotkin SA, Orenstein, editors. Vaccines. 4th ed. Philadelphia: W.B.
Saunders Company; 2004.
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