- Email: [email protected]
International symposium on rubella vaccines
Journal of the neurological Sciences Elsevier Publishing Company, A m s t e r d a m
237 Printed in The Netherlands
Book Reviews Cerebral Vascular Diseases (Transactions of 6th Princeton Conference), by J. F. Toole, R. G. Siekert and J. P. Whisnant (Eds.), viii+280 pages, Grune and Stratton, New York, London, 1968, US $ 9.75.
This book contains the edited transcript of the 6th Conference on Cerebral Vascular Diseases held in Princeton, N.J., in January, 1968, under the auspices of the American Neurological Association and the Americal Heart Association, It was supported by the National Institutes of Health and as on previous occasions it brought together for three strenuous days a group of people with expert knowledge either of the clinical disease or of techniques relevant to its study. These Princeton Confercnces the first wasin 1954 have become something of an institution and successive proceedings have provided for those with interest in the disease useful surveys of current thinking and of research trends The 6th Conference was clearly in the tradition of it> predecessors and the book contains several interesting papers and some informative discussion
International Symposium on Rubella Vaccines (Symposia Series in Immunological Standardization, Vol. 11), by R. H. Regamey (Ed.), viii+472 pages, 112 illustrations, 193 tables, Karger, Basle, 1969, Sfr, D M 6 0 . :US$14.40;£6.--.
This symposium is the fascinating account of the development of rubella vaccines to the point where prevention of the congenital rubella syndrome is just around the corner. It is divided into 4 sections, each dealing with distinct aspects of current investigations on rubella virus. Transcripts of the formal discussion are incorporated into the text immediately following the papers to which they relate. The table of contents, author index and a list of participants (with addresses) is included at the end of the volume. Unfortunately there is no subject index which would have further enhanced the usefulness of this valuable work. The first part covers the epidemiology of rubella, with the greatest attention directed towards the susceptibility of females of child-bearing age. It is emphasised that the main problem concerning rubella virus is its effect on the foetus in utero. The risk of foetal damage approaches 100 Oo when rubella occurs in the first 8 weeks of pregnancy and drops off sharply, thereafter. The papers on serological
although inevitably some of the contributions are a little dated. It falls logically into sections dealing w~th separate aspects ofcerebralvascular disease and one of particular interest is devoted to respirator} influences on cerebral circulation and metabolism. Another deals with problems of fluid dynamics and contains papers on regional blood flow and viscosity. There is a group of three papers concerned with screening techniques directed towards the identification of the stroke patient and there are sections on primary intracerebral haemorrhage and the surgery of occlusive cerebral vascular disease. The relationship between vascular disease and dementia is discussed and there is a section de,,oted to diagnostic techniques including brain scanning and echoencephalography. As with its predecessors, much of the success of this book is attributable to editorial skill. The discussions in particular have a perfectly judged sense of immediacy that brings the proceedings to life and makes for enjoyable and informative reading. D. A. SHAVe"
surveys describe the incidence of antibodies in women of child-bearing age from urban and rural communities throughout the world. The time between epidemics and the possibility of treatment with gamma-globulin to prevent foetal infection are also discussed. Part 2 covers the laboratory techniques being used to investigate the properties of rubella virus. Different methods of assaying antibody levels are discussed, hut the significance of the determinations for protection against infection has still to he assessed. The biophysical properties of the virus are described in detail, while attention is directed towards strain differences which might be useful in detecting attenuated vaccine strains. The results of infection of pregnant laboratory animals are also summarized, The most important observation is that Japanese strains of rubella are much less virulent for the foetus than American strains the congenital rubella syndrome does not appear frequently in Japan. The 6 papers in Part 3 describe various aspects of the production of attenuated strains of rubella virus suitable for use as live virus vaccines. Passage in tissue cultures at low temperature has proved useful for rapid attenuation and all attenuated strains share in ritro markers which distinguish them from "'wild" virulent strains.
J. ncurol. Sci., 1971, 14:237 242
238
BOOK REVIEWS
Part 4 deals with the results of clinical trials of these attenuated viruses. Three vaccine strains have been examined, namely HPV-77 grown in primary African green monkey kidney cells ; Cendehill grown in primary rabbit kidney cells; and RA 27,/3 grown in WI-38 h u m a n diploid cells. In all the trials a seroconversion rate of 95 to 100 o~, has been reported in
susceptible vaccinees and the induced antibody levels remain elevated for at least 2 to 3 years. None of the vaccines gave rise to significant clinical manifestations in children or adult males, but arthritic complications were observed in adult women, especially with HPV-77. l. M. Bt~tl
Epidemiology of Cerebrovascular Disease. by J. F. Kurtzke, xv + 197 pages, 42 illustrations, Springer Berlin, 1969, D M 5 8 . - < US $14.50.
his statements may seem to fly in the face of currem orthodoxy. This is certainly true, no more so than when he is challenging the belief that the incidence of cerebrovascular disease, and particularly cerebral haemorrhage, is unusually high in Japan. However. he argues his case on controversial matters with clarity and he provides in the appendix tabulated data on which his case rests. In addition to racial influences he looks carefully at the geographical distribution of ¢erebrovascular disease and he examines incidence in relation to age and sex. He compares the various different types of clinical disorder within the overall grouping of cerebrovascula~ disease and discusses natural history in epidemiological terms. One chapter is devoted to the factors associated with cerebrovascular disease such a> hypertension, coronary artery' disease and h y p e d cholesterolaemia. There is also a short chapter describing the basic elements in epidemiological method and statistical testing. This book contains much useful information. It is supplemented by an extensive bibliography and an adequate index and it has the great merit that it t,, written in a lively and provocative style. D. A. SE~AW
One of the reasons for the success of this book is that its author is not only an epidemiologist of distinction but also a clinician with wide experience of the disease under study. As a result there is a constant relevance of the statistical enquiry to the practical problems posed by the disease and the book will be of value even to those whose interest is almost entirely clinical. Up to the present time the epidemiological approach has yielded rather less than might have been expected in such a c o m m o n and ubiquitous disease and some of the reasons for this become clear on reading Dr. Kurtzke's book. He looks critically at the validity of mortality statistics and in particular he emphasises the inadequacies of the existing coding and classification systems and the confusion that often results from them. He expresses the hope that doctors of the future will use an International Statistical Classification number "as readily as a hyphenated teutonic eponym". In his foreword the author warns that many of
Patterns of Acute Head Injury, by R. Hooper, vii + 167 pages, 100 illustrations, 1 table, 2 appendices, Arnold, London, 1969. £2.25. The author is a doyen a m o n g those ncurosurgeons whose special interest is in head injuries. For a time, he c o m m a n d e d No. 4 Mobile Neurosurgical Unit in World War II, and in Melbourne he has been very' actively concerned with the problem of head injuries since that time. This subject lacks a fullscale reference text-book a magnum opus and it is still to be hoped that someone as highly qualified as Mr. Hooper is will give us this one day. The present work is at first sight something more modest, but it is nonetheless an interesting and unusual book, and contains a very considerable a m o u n t of information. But its outstanding feature
EEG Technology, by R. Cooper, J. W. Osselton and J. C. Shaw, xiii + 186 pages, 96 illustrations, Butterworths. London, 1969, £2.80. This small volume sets out to describe the techno-
consists of the clever drawings and illustrations. most of which are excellent beautifull.,, and simply drawn by the author himself. These lessen the disappointment already expressed and ailow it to be proved that, through the mechanism of muhum in parro, th~s is indeed a magnum opus after all. ThusNo. of pictures = 331 One picture = 1000 words (old Chinese proverb} 331 pictures = 331,000 words. No. of pages (actual)= 167 Average no. of words per page ( c o n ~ r v a t i w estimate) = 250 .. No. of pages (corrected) = 1491 Mr. Hooper is to be congratulated on h~s ingenious and enjoyable achievement. _1 M. POTTI:R
logical aspects of electroencephatography (EEG) with a view to increasing the understanding and improving the technique of those who may use this form of investigation. Although written primarily for technicians it should prove a valuable companion • d. neuroL Sci., 197t, ~4' 237 242
237 Printed in The Netherlands
Book Reviews Cerebral Vascular Diseases (Transactions of 6th Princeton Conference), by J. F. Toole, R. G. Siekert and J. P. Whisnant (Eds.), viii+280 pages, Grune and Stratton, New York, London, 1968, US $ 9.75.
This book contains the edited transcript of the 6th Conference on Cerebral Vascular Diseases held in Princeton, N.J., in January, 1968, under the auspices of the American Neurological Association and the Americal Heart Association, It was supported by the National Institutes of Health and as on previous occasions it brought together for three strenuous days a group of people with expert knowledge either of the clinical disease or of techniques relevant to its study. These Princeton Confercnces the first wasin 1954 have become something of an institution and successive proceedings have provided for those with interest in the disease useful surveys of current thinking and of research trends The 6th Conference was clearly in the tradition of it> predecessors and the book contains several interesting papers and some informative discussion
International Symposium on Rubella Vaccines (Symposia Series in Immunological Standardization, Vol. 11), by R. H. Regamey (Ed.), viii+472 pages, 112 illustrations, 193 tables, Karger, Basle, 1969, Sfr, D M 6 0 . :US$14.40;£6.--.
This symposium is the fascinating account of the development of rubella vaccines to the point where prevention of the congenital rubella syndrome is just around the corner. It is divided into 4 sections, each dealing with distinct aspects of current investigations on rubella virus. Transcripts of the formal discussion are incorporated into the text immediately following the papers to which they relate. The table of contents, author index and a list of participants (with addresses) is included at the end of the volume. Unfortunately there is no subject index which would have further enhanced the usefulness of this valuable work. The first part covers the epidemiology of rubella, with the greatest attention directed towards the susceptibility of females of child-bearing age. It is emphasised that the main problem concerning rubella virus is its effect on the foetus in utero. The risk of foetal damage approaches 100 Oo when rubella occurs in the first 8 weeks of pregnancy and drops off sharply, thereafter. The papers on serological
although inevitably some of the contributions are a little dated. It falls logically into sections dealing w~th separate aspects ofcerebralvascular disease and one of particular interest is devoted to respirator} influences on cerebral circulation and metabolism. Another deals with problems of fluid dynamics and contains papers on regional blood flow and viscosity. There is a group of three papers concerned with screening techniques directed towards the identification of the stroke patient and there are sections on primary intracerebral haemorrhage and the surgery of occlusive cerebral vascular disease. The relationship between vascular disease and dementia is discussed and there is a section de,,oted to diagnostic techniques including brain scanning and echoencephalography. As with its predecessors, much of the success of this book is attributable to editorial skill. The discussions in particular have a perfectly judged sense of immediacy that brings the proceedings to life and makes for enjoyable and informative reading. D. A. SHAVe"
surveys describe the incidence of antibodies in women of child-bearing age from urban and rural communities throughout the world. The time between epidemics and the possibility of treatment with gamma-globulin to prevent foetal infection are also discussed. Part 2 covers the laboratory techniques being used to investigate the properties of rubella virus. Different methods of assaying antibody levels are discussed, hut the significance of the determinations for protection against infection has still to he assessed. The biophysical properties of the virus are described in detail, while attention is directed towards strain differences which might be useful in detecting attenuated vaccine strains. The results of infection of pregnant laboratory animals are also summarized, The most important observation is that Japanese strains of rubella are much less virulent for the foetus than American strains the congenital rubella syndrome does not appear frequently in Japan. The 6 papers in Part 3 describe various aspects of the production of attenuated strains of rubella virus suitable for use as live virus vaccines. Passage in tissue cultures at low temperature has proved useful for rapid attenuation and all attenuated strains share in ritro markers which distinguish them from "'wild" virulent strains.
J. ncurol. Sci., 1971, 14:237 242
238
BOOK REVIEWS
Part 4 deals with the results of clinical trials of these attenuated viruses. Three vaccine strains have been examined, namely HPV-77 grown in primary African green monkey kidney cells ; Cendehill grown in primary rabbit kidney cells; and RA 27,/3 grown in WI-38 h u m a n diploid cells. In all the trials a seroconversion rate of 95 to 100 o~, has been reported in
susceptible vaccinees and the induced antibody levels remain elevated for at least 2 to 3 years. None of the vaccines gave rise to significant clinical manifestations in children or adult males, but arthritic complications were observed in adult women, especially with HPV-77. l. M. Bt~tl
Epidemiology of Cerebrovascular Disease. by J. F. Kurtzke, xv + 197 pages, 42 illustrations, Springer Berlin, 1969, D M 5 8 . - < US $14.50.
his statements may seem to fly in the face of currem orthodoxy. This is certainly true, no more so than when he is challenging the belief that the incidence of cerebrovascular disease, and particularly cerebral haemorrhage, is unusually high in Japan. However. he argues his case on controversial matters with clarity and he provides in the appendix tabulated data on which his case rests. In addition to racial influences he looks carefully at the geographical distribution of ¢erebrovascular disease and he examines incidence in relation to age and sex. He compares the various different types of clinical disorder within the overall grouping of cerebrovascula~ disease and discusses natural history in epidemiological terms. One chapter is devoted to the factors associated with cerebrovascular disease such a> hypertension, coronary artery' disease and h y p e d cholesterolaemia. There is also a short chapter describing the basic elements in epidemiological method and statistical testing. This book contains much useful information. It is supplemented by an extensive bibliography and an adequate index and it has the great merit that it t,, written in a lively and provocative style. D. A. SE~AW
One of the reasons for the success of this book is that its author is not only an epidemiologist of distinction but also a clinician with wide experience of the disease under study. As a result there is a constant relevance of the statistical enquiry to the practical problems posed by the disease and the book will be of value even to those whose interest is almost entirely clinical. Up to the present time the epidemiological approach has yielded rather less than might have been expected in such a c o m m o n and ubiquitous disease and some of the reasons for this become clear on reading Dr. Kurtzke's book. He looks critically at the validity of mortality statistics and in particular he emphasises the inadequacies of the existing coding and classification systems and the confusion that often results from them. He expresses the hope that doctors of the future will use an International Statistical Classification number "as readily as a hyphenated teutonic eponym". In his foreword the author warns that many of
Patterns of Acute Head Injury, by R. Hooper, vii + 167 pages, 100 illustrations, 1 table, 2 appendices, Arnold, London, 1969. £2.25. The author is a doyen a m o n g those ncurosurgeons whose special interest is in head injuries. For a time, he c o m m a n d e d No. 4 Mobile Neurosurgical Unit in World War II, and in Melbourne he has been very' actively concerned with the problem of head injuries since that time. This subject lacks a fullscale reference text-book a magnum opus and it is still to be hoped that someone as highly qualified as Mr. Hooper is will give us this one day. The present work is at first sight something more modest, but it is nonetheless an interesting and unusual book, and contains a very considerable a m o u n t of information. But its outstanding feature
EEG Technology, by R. Cooper, J. W. Osselton and J. C. Shaw, xiii + 186 pages, 96 illustrations, Butterworths. London, 1969, £2.80. This small volume sets out to describe the techno-
consists of the clever drawings and illustrations. most of which are excellent beautifull.,, and simply drawn by the author himself. These lessen the disappointment already expressed and ailow it to be proved that, through the mechanism of muhum in parro, th~s is indeed a magnum opus after all. ThusNo. of pictures = 331 One picture = 1000 words (old Chinese proverb} 331 pictures = 331,000 words. No. of pages (actual)= 167 Average no. of words per page ( c o n ~ r v a t i w estimate) = 250 .. No. of pages (corrected) = 1491 Mr. Hooper is to be congratulated on h~s ingenious and enjoyable achievement. _1 M. POTTI:R
logical aspects of electroencephatography (EEG) with a view to increasing the understanding and improving the technique of those who may use this form of investigation. Although written primarily for technicians it should prove a valuable companion • d. neuroL Sci., 197t, ~4' 237 242