Annual Review of Medicine, Volume 68

View the full table of contents for the Annual Review of Medicine, Volume 68.

Fehr’s article “Middle East Respiratory Syndrome” caught my eye with a section heading that sounded like it could be an absurdist art film title: “The Camel Connection.” It actually references a transmission vector for this relatively new respiratory problem. Since reading this article, I have learned a lot more about MERS from two different podcast discussions about possible vaccines and how to keep it from spreading through larger areas. Identifying the camels as vectors has also revealed some other interesting information:

Thus, many other animals found in the Arabian Peninsula, such as goats, horses, chickens, sheep, poultry, and camels, were tested for MERS-CoV seropositivity. Only dromedary camels were found to be positive for anti-MERS-CoV antibody. Dromedary camels are present throughout Africa and the Arabian Peninsula, and camels at these sites were shown to be seropositive with rates as high as 80% in some populations (reviewed in 47). Surprisingly, serum samples from as far back as 1982 in Africa and 1992 in Saudi Arabia were positive for MERS-CoV antibodies. This suggests that MERS-CoV has infected camels for an extended period of time and raises the question of why MERS was not detected in patients in Saudi Arabia before 2012.

me68-ebola-treatment-unitsThis volume also includes two articles about Ebola—which is often mentioned as an example of a virus that has spread through a remarkably large area. The first article is an interesting look back at the recent outbreak in West Africa that we now know began in 2013. “Ebola: Anatomy of an Epidemic” by Lo et al. is a fantastic guide to the geography and timeline of the outbreak and identifies the various vectors of transmission. I particularly appreciated the discussion of the geopolitical response to the outbreak:

Following these events, Ebola suddenly seemed potentially dangerous far beyond West Africa, and the epidemic was discussed at the highest political levels internationally. Ebola was debated on the floor of the United Nations (UN), and the Security Council described it as a threat to peace and security. In September 2014, the UN Secretary General established the United Nations Mission for Ebola Emergency Response (UNMEER) to scale up the response on the ground in the heavily affected countries, coordinating the delivery of logistic, technical, and financial support. This gesture not only conveyed the perceived gravity of the situation but also lack of confidence in WHO’s organizational capacity for emergency response to the crisis. Hitherto, the only disease to have received such high-level attention internationally was AIDS, which had a specific United Nations structure (UNAIDS) established for its response.

The second article about Ebola, “Toward an Effective Ebola Virus Vaccine” by Keshwara et al., looks forward at long-term control of the virus. I always thought of vaccines as a single type of preventative, and found myself particularly interested in reading about the various kinds of vaccines being worked on by various researchers—DNA vaccines, virus-like particles and nanoparticle vaccines, adenovirus-based vaccines, etc. The authors explain why researchers are testing so many vaccines:

From a public health perspective, it is beneficial to pursue diverse vaccine strategies to increase the likelihood of creating a successful vaccine against EBOV. In the context of prevention in endemic regions, it is not always logistically feasible to rely on recurrent vaccination. An ideal vaccine would elicit desired immunity and protection from a single, unadjuvanted shot with no serious adverse effects.

Sometimes an article title catches my ear a full year before I get to see the final version. This was the case with Mamtani & Morrow’s article in this volume, “Why Are There So Many Mastectomies in the United States?” Like so many others, I have a family history with cancer, and my interest is often peaked by articles about new treatments and therapies. In this case, the article looks at a disconnect between the known benefits and risks of this treatment and the number of related surgeries, and though this article doesn’t offer answers it does a great job of providing context for the questions:

Patients at high risk for multiple primary breast cancers, such as those discussed above, are considered medically appropriate candidates for bilateral mastectomy. However, an increasing number of average-risk women are choosing both unilateral mastectomy and CPM. Although high mastectomy rates were initially attributed to surgeons failing to offer BCT to patients, an increasing body of evidence indicates that patient choice is the major determinant of mastectomy rates.

The comment section is open, and I’d love to hear what articles you found interesting!

Suzanne K. Moses is Annual Reviews’ Senior Electronic Content Coordinator. For 15+ years, she has played a central role in the publication of Annual Reviews’ online articles. Not a single page is posted online without first being proofed and quality checked by Suzanne.