American Journal of Epidemiology Vol. 155, No. 7 : 680-681
Copyright © 2002 by The Johns Hopkins University School of Hygiene and Public Health
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Island Epidemics
Department of Epidemiology College of Human Medicine Michigan State University East Lansing, MI 48823
I would venture to guess that few of us in the epidemiology world have thought very much about medical geography and the ways in which this discipline might intersect with our own in investigating disease origins. The recent development of geographic information systems (GIS) software has brought the two disciplines together in the technological arena to map disease patterns and to link them visually to suspected etiologic factors, but this is far from establishing a conceptual linkage. Island Epidemics attempts to integrate information about the special spatial quality of islands with fundamental epidemiologic concepts of disease transmission to derive generalizable insights into the behavior of communicable diseases in populations.
Fundamental to the argument of Cliff, Haggett, and Smallman-Raynor, who have collaborated previously on several monographs and papers on this topic (1
–3), is that islands serve as epidemiologic laboratories in which epidemiologic hypotheses can be tested (in the usual epidemiologic way of using naturally occurring data as experimental evidence) that could not be assessed elsewhere. What makes islands interesting is their simultaneous quality of isolation and penetrability. Were they not isolated, populations with little experience of communicable diseases would not evolve; were they not penetrable, there would be no communicable disease experience to study. However, no matter how isolated a populated island is, it must eventually make contact with the outside world. These contacts, and their consequences, are the essence of the experience that Island Epidemics documents in considerable detail.
The largest number of pages are devoted to Iceland, with its remarkable system for documenting both populations and their illnesses, but attention is also paid to the spread of cholera across the Philippines, how measles got to Greenland, and the variable incidence of acquired immu-nodeficiency syndrome in the several islands of the Caribbean. The more familiar epidemiologic island stories—Panum working out the incubation period of measles in the Faroes and the disastrous experience of Fiji when it first encountered measles (it lost an estimated 25 percent of its population)—are also recounted, the latter episode in great detail.
Much of this book is descriptive, and it is a gold mine of incidents and episodes in this history of island epidemics. It is replete with imaginative maps, diagrams, and figures interspersed with occasional illustrations of sailing ships, Galapagos finches, and eminent scientists, such as Gregg, Panum, and Darwin, who have worked on islands. A section of the book develops some interesting mathematical models to explain patterns of spread, but the generalizability of some of these models remains uncertain and their value unclear. A complex mathematical model, illustrated with very intricate diagrams, suggests that increased airline travel in the Pacific has produced more efficient spread of measles between the scattered islands of that ocean. On the other hand, the use of Icelandic and other island data on measles outbreaks to work out the details of "critical community size," that is, the size of a population needed to maintain endemic measles, can surely help in projecting what is needed to eradicate this disease. Extending the work of Bartlett (4) in the United Kingdom and Black (5) in the United States, the authors add notions of accessibility of islands, population density, and the effect of vaccination to demonstrate changes in critical community size over time for measles and for several other infections as well.
Has island epidemiology been of value, or is it just another arcane academic interest? My favorite finding from island epidemiology (discussed in this book but omitted, surprisingly, from the bibliography) is ophthalmologist Norman Gregg's 1941 report from New South Wales, Australia, that prenatal rubella was linked to congenital cataract (6), thereby initiating the scientific study of viral teratogenesis. This observation was surely easier to make in a population too small and too isolated to enable rubella to become endemic.
The increased accessibility of islands by air, coupled with the use of vaccines against many of the important infections, has probably reduced the value of islands as sources of epidemiologic insights into communicable diseases. Never-theless, this book has much to teach. It delves deeply into the published literature, and it includes nearly 100 pages of references and appendices, the latter listing epidemiologic data sources and providing a bibliography of island epidemics. These features alone make it a valuable reference that should be on the bookshelf of every epidemiology department library.
NOTES
By Andrew Cliff, Peter Haggett, and Matthew Smallman-Raynor
ISBN 0-19-828895-6, Oxford University Press, Oxford, United Kingdom (Telephone: 44 1865 556767, Fax: 44 1865 267485), 2000, 562 pp., £70 (approximately US $105)
REFERENCES
- Cliff AD, Haggett P. Atlas of disease distributions: analytic approaches to epidemiologic data. Oxford, United Kingdom: Oxford University Press, 1988.
- Cliff AD, Haggett P, Smallman-Raynor M. Measles: an historical geography of a major human viral disease from global expansion to local retreat, 1840–1990. Oxford, United Kingdom: Oxford University Press, 1993.
- Cliff AD, Haggett P, Smallman-Raynor M. Deciphering global epidemics: analytical approaches to the disease records of world cities, 1888–1912. Cambridge, United Kingdom: Cambridge University Press, 1998.
- Bartlett M. Measles periodicity and community size. J R Stat Soc (A) 1957;120:48–70.
- Black FL. Measles endemicity in insular populations: critical community size and its evolutionary implication. J Theor Biol 1966;11:207–11.[ISI][Medline]
- Gregg N. Congenital cataract following German measles in the mother. Trans Ophthalmol Soc Aust N Z 1941;3:35–46.
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