Reviewer: Breanna Marie Scorza, PhD Immunology(University of Iowa College of Public Health)
Description: This book explores the burgeoning field of immunoepidemiology in a practical and comprehensive manner. The history of the field, the component parts including immunology and epidemiology basics, and the application of immunoepidemiological tools to the study of human disease are explored in an engaging and digestible way. The contributions of the three Gs: Gender, Genes, and Geography (environmental exposures), are explored in relation to specific human diseases.
Purpose: The purpose is to define and describe the nascent field of immunoepidemiology in a comprehensive and efficient way to anyone who might consume or create research literature involving the study of immunological events among populations of people. The fleshing out and defining of this topic is necessary as there has not been a book written on the topic. The examination of immune responses on the population level is a necessary and natural evolution of the field of immunology. With the advent of high-throughput advanced sequencing technology, the availability of population-level genetic data has already facilitated great advances by identifying specific gene mutations associated with either susceptibility or resistance to a wide range of diseases and syndromes. These genetic associations would not be possible to identify by studying individuals, only through the use of epidemiological modeling and statistical analyses using large numbers of people. According to the authors, the primary learning objectives for this book are to have readers understand: variability in host responses to infections or foreign antigens in individuals and populations; genetic and environmental factors that influence this diversity; how the immune system evolves over time; and how immune dysfunction may arise or resolve in a population. The book addresses each of these objectives independently and then uses specific disease examples to explore how each topic applies in a real setting.
Audience: The book is written primarily for students pursuing their master's in public health, but others who may benefit include PhD students in epidemiology or immunology, medical students, generalists, and specialists in immunology, infectious disease, cancer, and rheumatology. It offers a very nice introduction to immunology and then transitions into the epidemiology of immunology in a way that an audience with a background in basic epidemiological methods should absorb well. The immunology introduction covers almost all of the cell types and functions that are needed to understand the immune system in a succinct manner. This section is crucial for public health or epidemiology students who have not taken immunology courses. Even if a public health or epidemiology student has had an undergraduate immunology course, having the information in the same book will no doubt be useful for referencing specific cell types or proteins described in the later chapters on the application of immunoepidemiology. Any reader with a strong foundation in immunology will likely skip the immunology basics section. Immunology students and medical students, who usually lack epidemiological training, may first need to be exposed to additional basic epidemiology method training, including study design and modeling, in place of the immunology introduction. The three authors are professors studying complex infections, immunology, or immune disorders in humans. Contributors have expertise specific to the various subsections. All authors and contributors are from the Yale School of Public Health or Yale School of Medicine and are affiliated with either the department of epidemiology of microbial diseases or the department of chronic disease epidemiology. Researchers in these fields have the appropriate expertise needed to describe the field of immunoepidemiology. Additional authors with expertise on the study of specific diseases contributed to subsections exploring topics related to each specific disease example.
Features: The first of the five sections is a short introduction to the history of the burgeoning field of immunoepidemiology. Section 2 offers a concise but inclusive review of major components of the immune system. As an immunologist by training, I found this section to be wholly accurate while acknowledging areas where the field is lacking mechanistic information or in conflict as to the function of certain cells or protein or that cells and proteins may have additional overlapping functions outside of their canonical functions. This flexibility in the immune response is critical to understanding how each piece works in concert as a system and to understand the checks and balances required to keep from developing immune-mediated disease. This section is quite exhaustive, covering the main cell types and functions of immune factors, but only the most important, broad-lens information for each topic is covered. The color figures associated with each subsection offer significantly more molecular detail on the protein-protein interactions that take place to carry out such functions, information which may not be needed to ask immunoepidemiological questions but is nice to have as a reference. Section 3 dissects the components of the immune system that may give rise to susceptibility or resistance to a variety of disease states. This section delves into the mechanisms behind how the immune system recognizes foreign antigens (or self-antigens in the case of autoimmunity) that may be subject to population-level evolutionary pressure. Allelic variants and genetic polymorphisms in different receptors leading to diversity in antigen recognition, inflammatory response to antigens, and antibody formation are discussed, as are gene mutations leading to different immunodeficiencies. Development of immune dysfunction is discussed, such as allergy and autoimmune disorders. All of these topics are sources of variation among populations of people and may be studied using immunoepidemiological approaches. The use of specific examples of mutations known to cause specific diseases in certain populations makes this section compelling and easy to understand in context. Section 4 is one of the most interesting. Each subsection has an in-depth example of historical and current applied immunoepidemiology research associated with specific diseases in the context of surveillance, correlates of protection and risk factors discovered among immunodeficient and immunocompetent populations, and considerations in study design based on immune involvement including tuberculosis, HIV, fungal infections, malaria, and cancer. The end of each subsection details where immunoepidemiology may lead each disease field, highlighting key challenges and future directions. These real-world application examples are extremely useful. Finally, section 5 discusses the details of epidemiological tools applied to the immunology field. Real-world modifiers that need to be considered when modeling of infectious disease transmission in diverse human populations is explored and different types of transmission models are considered. A subsection on vaccination explores vaccine types, developed according to the specific immune response desired, and formulations. The immunoepidemiological challenges facing vaccine developers is explored and how immunoepidemiology is critical for determining vaccine efficacy across diverse populations. Use of immunotherapy, or the use of immune system modifying drugs to treat a disease, is rising. Immunotherapeutic approaches to the treatment of cancer and autoimmunity, and how to determine which populations of people would respond to such treatments, is discussed. A short appendix has tips for performing literature searches for immunoepidemiological studies.
Assessment: This is a very good book for MPH or epidemiology students, especially if they are interested in researching the epidemiology of human disease. Students interested in this topic need to be exposed to immunobiology, and this book focuses on the aspects of the immune system most important for epidemiologists. The use of real-world examples of applied immunoepidemiology allows students to learn in a proactive manner. Many MPH and epidemiology students begin research into a human disease without knowing the immunology behind the disease and it hampers their ability to design the best studies. I will be recommending this book to epidemiologists in infectious disease labs. There are only a few books published on topics similar to the ones this book covers. Infectious Diseases of Humans: Dynamics and Control, Anderson et al. (Oxford University Press, 1991), discusses epidemiological techniques to study host-pathogen interactions among populations but lacks background immunology content. Schottenfeld and Fraumeni Cancer Epidemiology and Prevention, 4th edition, Thun et al. (Oxford University Press, 2018), examines the epidemiology and biology of different types of cancer in more detail. Infectious Disease Epidemiology, Abubakar et al. (Oxford University Press, 2016), is shorter and focuses on infectious diseases, with examples of more pathogens that this book, but it also lacks the immunology background content. This book brings all of these topics together, epidemiology of cancer, infectious disease, autoimmunity and genetic immunodeficiencies, with robust immunology groundwork all in one place, which enables readers to get more complete exposure to the field as a whole using the most up-to-date information.
