Eds Donald A Henderson, Thomas V Inglesby, Tara O'Toole

AMA Press, $29.95, pp 256 

www.ama-assn.org/ama/pub/category/7350.html

Rating:

ISBN 1 57947 280 X

Current international tensions, the destruction of the World Trade Center, and the anthrax attacks on the United States postal system in 2001 make the spectre of biological warfare waged on civilian populations increasingly haunting. This book is an antidote to fatalism and provides up to date clinical, microbiological, and public health guidance on responding to possible bioterrorist attacks.

Almost half the book describes the 2001 anthrax attacks on the US postal system and the lessons learnt managing this event. Alert clinicians in many specialties, including emergency medicine, general medicine, primary care, infectious diseases, and paediatrics, provided the first phase of response by diagnosing anthrax and initiating microbiological investigation. Together they created a remarkably effective detection system for identifying and reporting cases with the support of quality local and reference microbiology. The healthcare system was also responsible for ongoing surveillance, patient and community support, and delivery of much chemoprophylaxis.

This experience indicates that effective biodefence preparedness must be built into the routine operation of health and microbiology services and that there must be harmonious working with public health agencies. The tendency for professional demarcations and specialisation will be particularly damaging for bioterrorism preparedness and must be strongly resisted.

The second half of the book contains detailed reviews of anthrax, smallpox, plague, botulinum toxin, tularaemia, and viral haemorrhagic fevers, which first appeared as separate articles in the Journal of the American Medical Association between 1998 and 2002 and which have been updated. Clear descriptions of characteristic presentations of these agents and good quality clinical photographs are supported by clear tables and excellent references. The final chapter addresses the dangers of large-scale quarantine, which, it is argued, would be damaging and ineffective.

Contributors to this book are impressive and include Dr D A Henderson, the former director of the global smallpox eradication programme at the World Health Organization.

Ghastly though its subject is, this book teaches us that inaction is not an option because timely chemoprophylaxis or vaccination of appropriate populations could successfully limit catastrophic casualties and socioeconomic collapse, even from efficient bioterrorist attacks. Indeed the capacity for effective response might even decrease the likelihood of such attacks.

The book will be of wide interest to all clinicians, the public, and politicians. It should strengthen clinical competence, public debate, clarity of policy, and support for clinicians, microbiologists, public health professionals, and emergency planners working to secure civilian biodefence.

Mark Reacher, consultant epidemiologist. 

Public Health Laboratory Service, Communicable Disease Surveillance Centre, London m.reacher{at}phls.org.uk