The Boy in the Bubble (novel)

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The Boy In The Bubble is a children's novel written by Ian Strachan and published in 1993. [1] The novel follows the story of Adam, a child born with severe combined immunodeficiency (SCID), and lived his life in an oxygen tent to prevent him from falling ill, and a schoolgirl named Anne who chooses to base her school project on Adam. The novel won the Red House Children's Book Award and was the 1994 Lancashire Book of the Year.

Contents

Plot summary

The story follows Anne, a girl who while coming home from school one day meets Adam, who suffers from SCID. Due to his illness, Adam has no functional immune system, and must be shielded from the world in a plastic oxygen tent lest he becomes deathly ill. Anne visits Adam frequently and their relationship develops.

The two become romantically involved, but Adam worries he is cheating Anne out of a more fulfilling relationship, as he cannot leave his oxygen tent. He expresses his concern to Anne, who misunderstands and breaks up with Adam, thinking he has lost interest in her.

Anne starts seeing someone else but realizes she misses Adam and goes to his house to apologize. When Anne arrives, Adam's mother informs her that Adam is undergoing a bone marrow transplant, a procedure that will strengthen his immune system if successful, but if unsuccessful, may be fatal. After the operation, Adam is able to live outside his sterilized bubble and embrace Anne and his family, but two weeks after Christmas, Adam dies.

Background

SCID, abbreviated for severe combined immunodeficiency and dubbed 'bubble boy disease' is a birth defect where the newborn lacks T- and B-lymphocyte systems. This lack of immune cells causes even common infections to be frequent, oftentimes severe and deadly. Weakened strains of bacteria and viruses used in vaccines are also ineffective and dangerous to patients with SCID due to lack of immune cells to combat the pathogens. [2]

The term 'bubble boy disease' is derived from the 1970s and 1980s when the story of David Vetter, a child with SCID, lived within a sterile containment for 12 years. [3]

An example of the bubble an SCID patient would live in. David Vetter and John R. Montgomery.JPG
An example of the bubble an SCID patient would live in.

Today, SCID is curable upon early diagnosis. SCID could be cured through a stem cell transplant, otherwise known as a bone marrow transplant. Stem cells from a healthy individual could be used to morph into immune cells the patient lacks, and transfused into the patient's bloodstream so the patient develops an immune system. This treatment is most likely to be effective the earlier the disease is diagnose, thus immediate diagnosis is crucial to curing the child. [4]

Critical reception and awards

The Boy In The Bubble has won multiple awards for its story on the impact of SCID on a young person's life. Among these awards include the Lancashire Book of the Year award in 1994, where young judges elect the winners of the award run by the Lancashire County Council. The novel has also won the Long Novel and Overall Award in the Red House Children's Book Award in 1994, run by The Federation of Children's Book Groups, which recognizes books that particularly impact children.

Background on author

There is not much clear information on Ian Strachan's background. From what is known, Ian Strachan is a British novelist who writes young adult fiction. Strachan was born in 1939 and is still alive today. Strachan wrote multiple books on children struggling with disease and disability, and became a Nominee for the Angus Book Award, an award given by the Angus Council in Scotland, and won multiple prizes for his books. [5]

Related Research Articles

<span class="mw-page-title-main">Severe combined immunodeficiency</span> Genetic disorder leading to severe impairment of the immune system

Severe combined immunodeficiency (SCID), also known as Swiss-type agammaglobulinemia, is a rare genetic disorder characterized by the disturbed development of functional T cells and B cells caused by numerous genetic mutations that result in differing clinical presentations. SCID involves defective antibody response due to either direct involvement with B lymphocytes or through improper B lymphocyte activation due to non-functional T-helper cells. Consequently, both "arms" of the adaptive immune system are impaired due to a defect in one of several possible genes. SCID is the most severe form of primary immunodeficiencies, and there are now at least nine different known genes in which mutations lead to a form of SCID. It is also known as the bubble boy disease and bubble baby disease because its victims are extremely vulnerable to infectious diseases and some of them, such as David Vetter, have become famous for living in a sterile environment. SCID is the result of an immune system so highly compromised that it is considered almost absent.

Immunodeficiency, also known as immunocompromisation, is a state in which the immune system's ability to fight infectious diseases and cancer is compromised or entirely absent. Most cases are acquired ("secondary") due to extrinsic factors that affect the patient's immune system. Examples of these extrinsic factors include HIV infection and environmental factors, such as nutrition. Immunocompromisation may also be due to genetic diseases/flaws such as SCID.

Adenosine deaminase deficiency is a metabolic disorder that causes immunodeficiency. It is caused by mutations in the ADA gene. It accounts for about 10–15% of all cases of autosomal recessive forms of severe combined immunodeficiency (SCID) among non-inbred populations.

<span class="mw-page-title-main">David Vetter</span> American sufferer of severe combined immunodeficiency (1971–1984)

David Phillip Vetter was an American boy who was a prominent person with severe combined immunodeficiency (SCID), a hereditary disease which dramatically weakens the immune system. Individuals born with SCID are abnormally susceptible to infections, and exposure to typically innocuous pathogens can be fatal. Vetter was referred to as "David, the bubble boy" by the media, as a reference to the complex containment system used as part of the management of his SCID. Vetter's surname was not revealed to the general public until 10 years after his death in order to preserve his family's privacy.

<span class="mw-page-title-main">Wiskott–Aldrich syndrome</span> Medical condition

Wiskott–Aldrich syndrome (WAS) is a rare X-linked recessive disease characterized by eczema, thrombocytopenia, immune deficiency, and bloody diarrhea. It is also sometimes called the eczema-thrombocytopenia-immunodeficiency syndrome in keeping with Aldrich's original description in 1954. The WAS-related disorders of X-linked thrombocytopenia (XLT) and X-linked congenital neutropenia (XLN) may present with similar but less severe symptoms and are caused by mutations of the same gene.

<span class="mw-page-title-main">Omenn syndrome</span> Medical condition

Omenn syndrome is an autosomal recessive severe combined immunodeficiency. It is associated with hypomorphic missense mutations in immunologically relevant genes of T-cells such as recombination activating genes, Interleukin-7 receptor-α (IL7Rα), DCLRE1C-Artemis, RMRP-CHH, DNA-Ligase IV, common gamma chain, WHN-FOXN1, ZAP-70 and complete DiGeorge syndrome. It is fatal without treatment.

<span class="mw-page-title-main">X-linked agammaglobulinemia</span> Medical condition

X-linked agammaglobulinemia (XLA) is a rare genetic disorder discovered in 1952 that affects the body's ability to fight infection. As the form of agammaglobulinemia that is X-linked, it is much more common in males. In people with XLA, the white blood cell formation process does not generate mature B cells, which manifests as a complete or near-complete lack of proteins called gamma globulins, including antibodies, in their bloodstream. B cells are part of the immune system and normally manufacture antibodies, which defend the body from infections by sustaining a humoral immunity response. Patients with untreated XLA are prone to develop serious and even fatal infections. A mutation occurs at the Bruton's tyrosine kinase (Btk) gene that leads to a severe block in B cell development and a reduced immunoglobulin production in the serum. Btk is particularly responsible for mediating B cell development and maturation through a signaling effect on the B cell receptor BCR. Patients typically present in early childhood with recurrent infections, in particular with extracellular, encapsulated bacteria. XLA is deemed to have a relatively low incidence of disease, with an occurrence rate of approximately 1 in 200,000 live births and a frequency of about 1 in 100,000 male newborns. It has no ethnic predisposition. XLA is treated by infusion of human antibody. Treatment with pooled gamma globulin cannot restore a functional population of B cells, but it is sufficient to reduce the severity and number of infections due to the passive immunity granted by the exogenous antibodies.

Hypogammaglobulinemia is a problem with the immune system in which not enough gamma globulins are produced in the blood. This results in a lower antibody count, which impairs the immune system, increasing risk of infection. Hypogammaglobulinemia may result from a variety of primary genetic immune system defects, such as common variable immunodeficiency, or it may be caused by secondary effects such as medication, blood cancer, or poor nutrition, or loss of gamma globulins in urine, as in nonselective glomerular proteinuria. Patients with hypogammaglobulinemia have reduced immune function; important considerations include avoiding use of live vaccines, and take precautionary measures when traveling to regions with endemic disease or poor sanitation such as receiving immunizations, taking antibiotics abroad, drinking only safe or boiled water, arranging appropriate medical cover in advance of travel, and ensuring continuation of any immunoglobulin infusions needed.

Lymphoproliferative disorders (LPDs) refer to a specific class of diagnoses, comprising a group of several conditions, in which lymphocytes are produced in excessive quantities. These disorders primarily present in patients who have a compromised immune system. Due to this factor, there are instances of these conditions being equated with "immunoproliferative disorders"; although, in terms of nomenclature, lymphoproliferative disorders are a subclass of immunoproliferative disorders—along with hypergammaglobulinemia and paraproteinemias.

Enzyme replacement therapy (ERT) is a medical treatment which replaces an enzyme that is deficient or absent in the body. Usually, this is done by giving the patient an intravenous (IV) infusion of a solution containing the enzyme.

<span class="mw-page-title-main">ZAP70 deficiency</span> Medical condition

ZAP70 deficiency, or ZAP70 deficient SCID, is a rare autosomal recessive form of severe combined immunodeficiency (SCID) resulting in a lack of CD8+ T cells. People with this disease lack the capability to fight infections, and it is fatal if untreated.

<span class="mw-page-title-main">X-linked severe combined immunodeficiency</span> Medical condition

X-linked severe combined immunodeficiency (X-SCID) is an immunodeficiency disorder in which the body produces very few T cells and NK cells.

<span class="mw-page-title-main">Nezelof syndrome</span> Medical condition

Nezelof syndrome is an autosomal recessive congenital immunodeficiency condition due to underdevelopment of the thymus. The defect is a type of purine nucleoside phosphorylase deficiency with inactive phosphorylase, this results in an accumulation of deoxy-GTP which inhibits ribonucleotide reductase. Ribonucleotide reductase catalyzes the formation of deoxyribonucleotides from ribonucleotides, thus, DNA replication is inhibited.

Primary immunodeficiencies are disorders in which part of the body's immune system is missing or does not function normally. To be considered a primary immunodeficiency (PID), the immune deficiency must be inborn, not caused by secondary factors such as other disease, drug treatment, or environmental exposure to toxins. Most primary immunodeficiencies are genetic disorders; the majority are diagnosed in children under the age of one, although milder forms may not be recognized until adulthood. While there are over 430 recognized inborn errors of immunity (IEIs) as of 2019, the vast majority of which are PIDs, most are very rare. About 1 in 500 people in the United States are born with a primary immunodeficiency. Immune deficiencies can result in persistent or recurring infections, auto-inflammatory disorders, tumors, and disorders of various organs. There are currently limited treatments available for these conditions; most are specific to a particular type of PID. Research is currently evaluating the use of stem cell transplants (HSCT) and experimental gene therapies as avenues for treatment in limited subsets of PIDs.

Bubble boy, boy in the bubble or boy in the plastic bubble may refer to:

The severe combined immunodeficiency (SCID) is a severe immunodeficiency genetic disorder that is characterized by the complete inability of the adaptive immune system to mount, coordinate, and sustain an appropriate immune response, usually due to absent or atypical T and B lymphocytes. In humans, SCID is colloquially known as "bubble boy" disease, as victims may require complete clinical isolation to prevent lethal infection from environmental microbes.

JAK3 deficiency is a dysfunction in cytokine receptor signalling and their production of cytokines.

<span class="mw-page-title-main">T cell deficiency</span> Medical condition

T cell deficiency is a deficiency of T cells, caused by decreased function of individual T cells, it causes an immunodeficiency of cell-mediated immunity. T cells normal function is to help with the human body's immunity, they are one of the two primary types of lymphocytes(the other being B cells).

<span class="mw-page-title-main">Reticular dysgenesis</span> Medical condition

Reticular dysgenesis (RD) is a rare, inherited autosomal recessive disease that results in immunodeficiency. Individuals with RD have mutations in both copies of the AK2 gene. Mutations in this gene lead to absence of AK2 protein. AK2 protein allows hematopoietic stem cells to differentiate and proliferate. Hematopoietic stem cells give rise to blood cells.

Autologous CD34+ enriched cell fraction that contains CD34+ cells transduced with retroviral vector that encodes for the human ADA cDNA sequence, sold under the brand name Strimvelis, is a medication used to treat severe combined immunodeficiency due to adenosine deaminase deficiency (ADA-SCID).

References

  1. "ZoekBoekverslag.nl: Ian Strachan: The Boy In The Bubble". www.zoekboekverslag.nl. Retrieved 2020-10-31.
  2. "Severe Combined Immunodeficiency (SCID) | Diagnosis and Treatment | Boston Children's Hospital". www.childrenshospital.org. Retrieved 2020-10-31.
  3. "Severe Combine Immune Deficiency". www.scid.net. Retrieved 2020-10-31.
  4. "Severe Combined Immunodeficiency (SCID) | Diagnosis and Treatment | Boston Children's Hospital". www.childrenshospital.org. Retrieved 2020-10-31.
  5. "MacNeil, Angus". International Year Book and Statesmen's Who's Who. Retrieved 2020-10-31.