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Index

A

Acellular antigens, 11, 18, 20, 28, 30, 129, 446

Adenovirus, 29, 33

Adjuvants, 34–35, 372–377, 430

animal models, 373–374, 375, 376

defined, 372

diabetes, 388

Helicobacter pylori, 365–366

hepatitis C virus, 336

Histoplasma capsulatum, 358

mycobacterium tuberculosis, 352–353

papillomaviruses, 340

Administration of vaccines, see Delivery of vaccines

Adolescents, see Children

Adults, 23, 47–50, 100, 111, 112

chlamydia, 149

dengue virus, 345–346

Epstein-Barr virus, 7, 88, 177

hepatitis B, 18

hepatitis C, 189

herpes simplex virus, 196

influenza virus, 21, 224

papillomaviruses, 213

pneumonococcal vaccines, 21

polio, 24

streptococus, group B, 6, 305–306, 307, 309

Streptococcus pneumoniae, 314

see also Elderly persons; Men; Women

African Americans, 50

Age factors, 4, 435

Coccidiodes immitis, 160, 359

cost-effectiveness model, analytic approach, 60, 66, 68–69, 80–83, 84

cost-effectiveness model, detailed review, 93, 95, 98–100, 101–103, 105

diabetes mellitus, 233

ethical issues, 112

Helicobacter pylori, 181, 182

herpes simplex virus, 197

Histoplasma capsulatum, 207, 208

influenza virus, 225–226

melanoma, 239

multiple sclerosis, 245

mycobacterium tuberculosis, 252, 253

parainfluenza virus, 275

quality-adjusted life years, 58, 66, 68–69, 80–82, 84, 80–83, 84, 95, 98–99

respiratory syncytial virus, 279, 280, 281

rheumatoid arthritis, 285, 286

streptococcus, group A, 299

streptococcus, group B, 305, 306

Streptococcus pneumoniae 313, 314

see also Adults; Children; Elderly persons; Infants



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Vaccines for the 21st Century: A Tool for Decisionmaking Index A Acellular antigens, 11, 18, 20, 28, 30, 129, 446 Adenovirus, 29, 33 Adjuvants, 34–35, 372–377, 430 animal models, 373–374, 375, 376 defined, 372 diabetes, 388 Helicobacter pylori, 365–366 hepatitis C virus, 336 Histoplasma capsulatum, 358 mycobacterium tuberculosis, 352–353 papillomaviruses, 340 Administration of vaccines, see Delivery of vaccines Adolescents, see Children Adults, 23, 47–50, 100, 111, 112 chlamydia, 149 dengue virus, 345–346 Epstein-Barr virus, 7, 88, 177 hepatitis B, 18 hepatitis C, 189 herpes simplex virus, 196 influenza virus, 21, 224 papillomaviruses, 213 pneumonococcal vaccines, 21 polio, 24 streptococus, group B, 6, 305–306, 307, 309 Streptococcus pneumoniae, 314 see also Elderly persons; Men; Women African Americans, 50 Age factors, 4, 435 Coccidiodes immitis, 160, 359 cost-effectiveness model, analytic approach, 60, 66, 68–69, 80–83, 84 cost-effectiveness model, detailed review, 93, 95, 98–100, 101–103, 105 diabetes mellitus, 233 ethical issues, 112 Helicobacter pylori, 181, 182 herpes simplex virus, 197 Histoplasma capsulatum, 207, 208 influenza virus, 225–226 melanoma, 239 multiple sclerosis, 245 mycobacterium tuberculosis, 252, 253 parainfluenza virus, 275 quality-adjusted life years, 58, 66, 68–69, 80–82, 84, 80–83, 84, 95, 98–99 respiratory syncytial virus, 279, 280, 281 rheumatoid arthritis, 285, 286 streptococcus, group A, 299 streptococcus, group B, 305, 306 Streptococcus pneumoniae 313, 314 see also Adults; Children; Elderly persons; Infants

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Vaccines for the 21st Century: A Tool for Decisionmaking Aggregation ethical issues, 117–118, 119 quality-adjusted life years, 2, 56 AIDS, see Human immunodeficiency virus American Academy of Pediatrics, 45, 126 American College Health Association, 49 Americans with Disabilities Act, 112–113 Animal models, 419, 423, 425, 426–427, 436 adjuvants, 373–374, 375, 376 antigen delivery, 378–379, 380 autoimmune diseases, 386–387, 388–395, 399–403, 404–407 chlamydia, 349, 350–351 cholera, 376 Coccidiodes immitis, 357, 358–359 costimulation 408 diabetes, 386–387, 388–395 DNA vaccines, 382–383 Epstein-Barr virus, 333–334 gonorrhea, 368–369, 371 Helicobacter pylori, 365–366 hepatitis C virus, 335, 336, 337, 338 herpes simplex virus, 328–329 Histoplasma capsulatum 357–358 papillomaviruses, 340–341 programmed T-cell death, 397 streptococcus, group A, 361–362, 363 Antigens, 18, 20, 26–27, 28, 29, 30, 31, 35, 40, 377–381, 412, 417, 420–424, 432 acellular, 11, 18, 20, 28, 30, 129, 446 autoimmune disease, 35–38 chlamydia, 350–351 Coccidiodes immitis, 358–359 dengue virus, 346 diabetes, 387–388 DNA vaccines, 381–386 gonorrhea, 368–371 Helicobacter pylori, 367 hepatitis B virus, 378 hepatitis C virus, 337 Helicobacter pylori, 364 Histoplasma capsulatum 358 influenza virus, 223 multiple sclerosis, 399, 400 polio, 24 programmed T-cell death, 37, 395–399, 409, 410–411 streptococcus, group A, 360 see also B cells; T cells Apoptosis, 37, 395–399, 409, 410–411 Attenuated live viruses, 19, 20, 379 herpes simplex virus, 328–329 mycobacterium tuberculosis, 352 polio, 24–25 Attitudes physicians, 47 public complacency and fear, 9, 46, 73–74, 130 vaccine acceptance, 11, 20 Autoimmune diseases, 1, 12, 35–38, 45, 380, 399–407 animal models, 386–387, 388–395, 399–403, 404–407 antigens, 35–38 diabetes mellitus, 6, 35, 37, 37, 54, 67, 87, 90, 233–238, 386–389, 391, 392, 393–395, 403 cancer therapy, 427–429, 431 multiple sclerosis, 6, 35, 54, 87, 245–249, 397, 399–400 programmed T-cell death, 397–399 rheumatoid arthritis, 6, 35, 54, 67, 87, 285–290, 403 T cells, 35–38, 233, 245, 389–391, 392–395, 399–406 (passim) B Barriers to research and development, 11, 13, 90, 130–131 see also Litigation; Market forces B cells, 28, 32, 35, 380, 381, 436 adjuvants, 372, 376 autoimmune disease, 36, 37 diabetes, 387, 391 Epstein-Barr virus, 330, 332, 334 Helicobacter pylori, 364 streptococcus, group A, 362 see also Mucosal immunity

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Vaccines for the 21st Century: A Tool for Decisionmaking Biotechnology, 26, 30, 33–34, 90, 379, 381–386 attenuated live viruses, 19, 20, 24–25, 328–329, 352, 379 Epstein-Barr virus, 332–333, 334 hepatitis B virus, 18, 379 hepatitis C virus, 337 herpes simplex virus, 327–328 Histoplasma capsulatum 358 hybridoma, 30 monoclonal antibodies, 29–30 mycobacterium tuberculosis, 355 papillomaviruses, 339–340 risk capital, 125 Salmonella, 31–32 see also DNA; Genomes; RNA Bordetella pertussis, 11, 18, 19, 20, 28, 30, 46 Borrelia burgdorferi, 7, 44, 54, 88, 91, 100, 143–148 Burkitt’s lymphoma, 330, 331, 332, 333 C Canada, 49, 62, 66, 68, 96, 99 Cancer, 1, 12, 185, 189, 190, 194, 213–219, 381, 411, 415–433 autoimmune therapy, 427–429, 431 Epstein-Barr virus, 330–333 melanoma, 6, 54, 88, 89–90, 239–243, 421 papillomaviruses, 338–342 Caribbean region, 343 Centers for Disease Control and Prevention, 14, 28, 50, 100, 125, 126 Central nervous system, 67, 399–403 herpes simplex virus, 196–200 (passim), 202, 204, 328 multiple sclerosis, 6, 35, 54, 87, 245–249, 397, 399–400 see also Neisseria meningitidis Children, 7, 8–9, 45–47, 60, 69, 72, 80–82, 91, 99, 100, 101, 111, 130, 377 American Academy of Pediatrics, 45, 126 CDC recommendations, 28 chlamydia, 6, 88, 157 combination vaccines, 9, 18, 38, 46–47, 75, 130 contraceptive vaccines, health effects, 76 cytomegalovirus, 6, 90, 167 dengue virus, 343, 345 Epstein-Barr virus, 7, 88, 177, 179, 330–331, 333 gonorrhea, 6, 88 Helicobacter pylori, 181 herpes simplex virus, 6, 88, 196, 203, 329 influenza virus, 223–224 liability issues, 128–129 meningitis, 267 National Childhood Vaccine Injury Act, 20–21, 128–129, 258 papillomaviruses, 6, 88, 219, 342 pregnant, 51 polio, 24 record-keeping, 46, 47, 49 respiratory syncytial virus, 88, 279, 280, 281 rotavirus, 291–292 school entry immunizations, 7, 8–9, 20, 49, 90, 130 Shigella, 295 streptococcus, group A, 299, 363 streptococcus, group B, 6, 93, 310, 311–312 Streptococcus pneumoniae 313, 314, 315 Vaccines for Children Program, 47, 131 see also Infants Children’s Vaccine Initiative, 127–128 China, 334 Chlamydia, 6, 54, 67, 88, 89–90, 97, 149–158, 347–351, 368 Cholera, see Vibrio cholerae Clinical trials, 9, 19, 70, 105, 126, 406, 417, 424, 430–431, 436 djuvants, 373, 374 AIDS, 373, 379 Bordetella pertussis, 30

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Vaccines for the 21st Century: A Tool for Decisionmaking Coccidiodes immitis, 7, 19 dengue virus, 345–346 diabetes, 387 Epstein-Barr virus, 329, 333 funding, 125 gonorrhea, 371 herpes simplex virus, 327 mycobacterium tuberculosis, 352, 353–354, 355 papillomaviruses, 342 programmed T-cell death, 397–398 respiratory syncytial virus, 6, 19 streptococcus, group A, 362, 363 Cloning, 26, 36 Coccidiodes immitis, 7, 19, 44, 54, 88, 90, 91, 159–164, 356–359 Cognitive impairments, 62, 64–65 Combination vaccines, 9, 18, 38, 46–47, 75, 130, 436 elicobacter pylori, 364, 366–367 herpes simplex virus, 327 Computer technology committee’s model, application of, 13, 95 Internet, IOM, 4, 323 physician reminders, 48 Confidentiality, 47 Conjugate vaccines Haemophilus influenzae, 11 varicella-zoster virus, 11, 18 Cost and cost-effectiveness analysis, general, 2–3, 11, 12, 17, 20, 435–436, 437 age factors, analytic approach of model, 60, 66, 68–69, 80–83, 84 age factors, detailed review of model, 93, 95, 98–100, 101–103, 105 aggregation, 2, 56, 117–118, 119 children, 46 combination vaccines, 47 death rates, analytic approach of model, 61–62, 66, 68, 78–79, 80–83, 86 death rates, detailed characterization of model, 95, 97–98, 100, 103–104 defined, 56 discounting, 18, 60–61, 68–69, 74, 80, 83, 85–86, 97–98, 99, 101–103, 105–107, 114–115 ethical issues, 3–4, 58, 75, 109–122, 128, 129 licensure possibilities, scope of study at hand, 39, 40, 43 licensure process, 19–20, 54–55, 58; see also Time factors life expectancy, analytic approach of model, 57, 66, 68, 76, 120 life expectancy, detailed characterization of model, 95–96, 98, 99, 101–102, 103, 104, 106–107 mathematical formulae, 94–97, 99, 101–106 (passim) model, analytical approach, 53–92 model, detailed description, 93–108 morbidity/morbidity scenarios, analytic approach of model, 61–66, 67, 68, 69, 71, 76, 78–79, 80–85 morbidity/morbidity scenarios, detailed characterization of model, 95, 96, 97, 98, 108 opportunity costs, 74, 115–116, 130 polio, 25–26 pregnant women, 22 ranking of vaccines covered, 5–8 reasons for, 57 sensitivity analysis, 3, 57 specific diseases/pathogens/vaccines, lists of, 54–55, 87–91 review for each, 143–433; see also diseases/pathogens/vaccines found in lists utilization of vaccines, analytic approach of model, 72–73, 75, 76, 79, 80, 86, 88, 89, 91 utilization of vaccines, detailed characterization of model, 95, 107–108 see also Death rates; Efficacy of vaccines; Morbidity scenarios; Quality-adjusted life years Contraceptive vaccines, 75–76 Costimulation, 372, 373, 375, 389, 398, 399, 400, 401, 402, 407–412, 419

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Vaccines for the 21st Century: A Tool for Decisionmaking Court cases, see Liability issues; Litigation Cuba, 343 Cystic fibrosis, 33, 42 Cytokines, 27, 374, 409–411, 415, 429–433 autoimmune disease, 36, 38, 389–392, 404–405 chlamydia, 348–349 dengue virus, 344 gonorrhea, 371 Interleukin, 27, 38, 348–349, 372, 373, 374, 388, 389, 390–394, 396, 402–403, 405–406, 409, 410, 411–412, 420, 424, 430, 432 Cytomegalovirus (CMV), 6, 19, 20, 22, 54, 87, 89, 90, 165–171 D Death rates, 377 as assessment criterion, 27 model, analytic approach, 61–62, 66, 68, 78–79, 80–83, 86 model, detailed characterization, 95, 97–98, 100, 103–104 chlamydia, 149 Coccidiodes immitis, 159, 160, 162 dengue virus, 343 gonorrhea, 257 Helicobacter pylori, 181, 182 herpes simplex virus, 198 Histoplasma capsulatum, 207, 208 influenza virus, 225–226 malaria, 43 melanoma, 239 meningitis, 267, 268 mycobacterium tuberculosis, 252, 253, 351 parainfluenza virus, 273 polio, 24 papillomaviruses, 215 respiratory syncytial virus, 279, 281, 283 rheumatoid arthritis, 287 rotavirus, 291 streptococcus, group B, 305, 307, 309 Streptococcus pneumoniae 313, 321 see also Life expectancy; Quality-adjusted life years Dengue hemorrhagic fever, 342–347 Dental caries, 44–45 Delivery of vaccines, 130 adults, 47–50 antigens, various, 377–381 children, 45–47 DNA vaccines, 381–386 intranasal immunization mycobacterium tuberculosis, 354 polio, 25–26 pregnant women, 50–51 see also Noninjection routes; Utilization of vaccines; Vaccine schedules Demographic factors, 58 see also Age factors; Immigrants; Men; Race/ethnicity; Regional factors; Travelers; Urban areas; Women Dengue hemorrhagic fever, 8 Department of Health and Human Services, 20–21 Centers for Disease Control and Prevention, 14, 28, 50, 100 Food and Drug Administration, 14, 125, 126, 362, 367, 373, 374; see also Licensure, vaccines Health Care Financing Administration, 71, 106 see also National Institutes of Health; specific institutes Developing countries, 1, 17, 127–128, 173, 355, 360 Diabetes mellitus, 6, 35, 37, 54, 67, 87, 90, 233–238, 386–389, 391, 392, 393–395, 403 Diptheria, 20, 28, 30, 46, 49 Disabilities, 63–66, 68, 78–79, 86, 89, 97–98 cognitive impairments, 62, 64–65 emotional impairments, 64–65 ethical factors, 111, 112–113, 114–115

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Vaccines for the 21st Century: A Tool for Decisionmaking mobility impairments, 24, 25, 64, 126–127 sensory impairments, 62, 64, 64, 67, 236 Disability-adjusted life years, 63, 66, 111, 112 Discounting, 18, 60–61, 68–69, 74, 80, 83, 85–86, 97–98, 99, 101–103, 105–107 ethical issues, 114–115 quality-adjusted life years, 18, 60–61, 68–69, 114–115 time factors, 68–69, 86, 101 Disease burden, 7–8, 11, 12, 43–45, 86, 89, 126, 127, 129 cost-effectiveness analyses, specific diseases, 24–25, 42–43, 143–437 (passim); see also specific pathogens ethical issues, 109, 117–118, 121 malaria, 42–43 polio, 24–25 waterborne pathogens, 42 workshop summaries, specific diseases, 326–433 (passim) see also Death rates; Disabilities; Epidemiology; Incidence; Morbidity Disease scenarios, see Death rates; Incidence; Morbidity scenarios; Prevalence; Diseases of Importance in Developing Countries, 1, 11 Diseases of Importance in the United States, 1, 11, 17 DNA, 33, 34, 90, 381–386, 418, 420, 421, 422 antigen delivery, 380, 395 chlamydia, 348 Coccidiodes immitis, 358–359 dengue virus, 346 Epstein-Barr virus, 330, 331 hepatitis B virus, 379 hepatitis C virus, 335, 336, 337 HIV, 382–383 papillomaviruses, 6, 54, 88, 213–221, 338–342, 384, 433 transfection, 32, 34 tuberculosis, 383–384 see also Genomes Drug resistance, 131, 380 gonorrhea, 368 malaria, 43 mycobacterium tuberculosis, 252, 253–254, 351 E E-coli, see Escherichia coli Economic factors, 9 market forces, 9, 19, 125–126 see also Cost and cost-effectiveness analysis; Funding Efficacy of vaccines, 32, 71–72, 79, 80, 94, 95, 107–108 Borrelia burgdorferi, 145, 147 chlamydia, 157 Coccidiodes immitis, 163, 164 cytomegalovirus, 170 diabetes mellitus, 237, 238 DNA vaccines, general, 384 enterotoxigenic E. coli, 174, 176 Epstein-Barr virus, 179, 180 gonorrhea, 264, 265 Helicobacter pylori, 186–187 hepatitis C virus, 193 herpes simplex virus, 203, 204, 328, 329 Histoplasma capsulatum, 209, 210 influenza virus, 229, 230 melanoma, 242 meningitis, 271, 272 multiple sclerosis, 248 mycobacterium tuberculosis, 254, 255, 256, 351–352, 355 papillomaviruses, 219, 220 parainfluenza virus, 276 respiratory syncytial virus, 282, 283 rheumatoid arthritis, 289 rotavirus, 292–293 Shigella, 296–297 streptococcus, group A, 303–304 streptococcus, group B, 310–312

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Vaccines for the 21st Century: A Tool for Decisionmaking Streptococcus pneumoniae 320–321 see also Clinical trials; Quality-adjusted life years Elderly persons, 23, 47–48, 49, 80–82, 100, 112 Helicobacter pylori, 181 influenza, 48, 223–224 Medicare, 4, 49–50 parainfluenza, 6, 273, 275 rheumatoid arthritis, 285 respiratory syncytial virus, 279 streptococcus, group B, 6, 7, 47–48, 310 Streptococcus pneumoniae 313, 314, 316–317, 319–321 ELISA, see Enzyme-linked immunosorbent assays Emotional impairments, 64–65 Emergency departments, 49 Enterococci, 42 Enterotoxigenic E. coli, see Escherichia coli Enzyme-linked immunosorbent assays, 341, 342 Epidemiology, 12, 17, 26, 44, 435 dengue virus, 343 hepatitis C virus, 334–335 poliomyelitis, 23–26, 91–92 see also Death rates; Incidence; Morbidity; Morbidity scenarios; Prevalence Epstein-Barr virus, 7, 54, 67, 88, 177–180, 329–334 Equations, see Mathematical formulae Escherichia coli, 7, 54, 67, 88, 91, 173–176, 361, 365–366, 374, 379 Ethical issues, 3–4, 109–122, 128, 129 aggregation, 117–118, 119 committee membership, 14 confidentiality, 47 contraceptive vaccines, 75 incidence of disease, 117, 118 pregnant women, 22 quality-adjusted life years, 3–4, 58, 111, 112, 113, 114–115, 120–121, 129–130 transplants, 120–121, 122 worst-off/sickest persons, 119–120 see also Quality of life Europe, 347, 367, 377 Expanded Programme on Immunization, 127–128 Expert judgment, 3, 12 committee membership, 14, 17 list of, 437–442 morbidity scenarios, 97 survey instrument, 435–437 F Fairness, see Ethical issues Federal Advisory Committee on Immunization Practices, 45 Fertility, 62, 65, 151, 155, 259, 264 contraceptive vaccines, 75–76 Food and Drug Administration, 14, 125, 126, 362, 367, 373, 374 see also Licensure, vaccines Foreign countries, 1, 5, 8, 11, 17, 39, 42–43, 59, 110 dengue virus, 343 polio, 25 pregnant women, 21 see also Developing countries; Immigrants; Travelers; specific countries Formulae, see Mathematical formulae Funding, 8, 19, 123–126, 436 National Childhood Vaccine Injury Act, 20–21 G Gender factors, see Men; Women Genetics, 233 Epstein-Barr virus, 330–332 Helicobacter pylori, 364–365 papillomaviruses, 339–340 see Biotechnology; DNA; Genomes; RNA Genomes, 32, 395 Epstein-Barr virus, 330–331, 333–334

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Vaccines for the 21st Century: A Tool for Decisionmaking hepatitis C virus, 335 herpes simplex virus, 327, 328 influenza, 223 Geographic factors, see Developing countries; Foreign countries; Regional factors; Urban areas Glycopolymers, 374 Glycoprotein vaccines, 19, 20, 33, 223, 327, 336, 380, 382–383 Gonorrhea, see Neisseria gonorrhea Group A streptococcus, 6, 43, 54, 67, 88, 299–304, 359–363 Group B streptococcus, 6, 19, 20, 54, 67, 87, 88, 89, 90, 129, 305–312 adolescent girls, 93 pregnant women, 7, 21, 22, 23, 93 Guillain-Barré syndrome, 21 H Haemophilus influenzae (Hib), 11, 18, 19, 23, 28, 46–47, 114, 126 Health Care Financing Administration, 71, 106 Health care workers hepatitis B, 18 hepatitis C virus, 337 see also Nurses; Physicians Health departments, 46, 49 varicella-zoster virus, 18 Health insurance, 131 children, 47, 90 incentives to, 9 performance measures, 7 Health utility index (HUI), 62–68 (passim), 76, 96, 97, 98–99, 102 Borrelia burgdorferi, 143, 145, 146 chlamydia, 150, 151–152 Coccidiodes immitis, 161, 162 cytomegalovirus, 165–166, 167 diabetes mellitus, 234 enterotoxigenic E. coli, 173 Epstein-Barr virus, 177, 178 ethical issues, 117, 119 gonorrhea, 257, 258 Helicobacter pylori, 181, 182, 183 hepatitis C virus, 191 herpes simplex virus, 196, 200 Histoplasma capsulatum, 208 influenza virus, 227 melanoma, 239 meningitis, 267–268 multiple sclerosis, 246 mycobacterium tuberculosis, 252, 254 papillomaviruses, 214, 215–216 respiratory syncytial virus, 279 rheumatoid arthritis, 286 streptococcus, group A, 300, 301 streptococcus, group B, 305 Streptococcus pneumoniae 313 Heat shock proteins, 353 Helicobacter felis, 30 Helicobacter pylori, 6, 54, 67, 88, 181–188, 363–367 Hepatitis A virus, 11, 18, 19, 334, 337 Hepatitis B virus, 11, 18, 19, 28, 30, 44–44, 47–48, 114, 334, 337, 378, 379, 412–415 Hepatitis C virus, 6, 54, 88, 189–194, 334–338, 433 Herpes simplex virus, 6, 19, 22, 54, 67, 88, 195–205, 326–329, 384 Herpesvirus (Epstein-Barr), see Epstein-Barr virus Hispanics, 50 Histoplasma capsulatum 7, 44, 54, 67, 89, 91, 207–212, 356–359 Historical perspectives, 123–124 childhood immunizations, 46 hepatitis, 334 IOM studies, 1, 2, 11, 17, 123–124 litigation, 20–23 malaria, 42–43 quality-adjusted life years, 2, 56 polio, 23–26, 91–92 syphilis, 41 vaccine development, 12 Hodgkin’s disease, 330, 331 Hospitals and hospitalization, 4, 48–49, 67, 106 cost-effectiveness, general, 59, 71 chlamydia, 153–156 Coccidiodes immitis, 161, 162

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Vaccines for the 21st Century: A Tool for Decisionmaking cytomegalovirus, 166, 167, 168–169 gonorrhea, 257–263 (passim) Helicobacter pylori, 184–185 hepatitis C virus, 190, 192 herpes simplex virus, 202–203 Histoplasma capsulatum, 209, 211 influenza virus, 224, 227 melanoma, 240, 241 meningitis, 268, 269, 270 multiple sclerosis, 246, 247 mycobacterium tuberculosis, 252, 254, 255 nosocomial infections, 9, 18, 41, 42, 131 papillomaviruses, 214 parainfluenza virus, 274, 275 respiratory syncytial virus, 20, 281, 282 rheumatoid arthritis, 286, 288 streptococcus, group A, 301–302 streptococcus, group B, 306, 307, 308, 309 Streptococcus pneumoniae 318–320 HUI, see Health utility index Human immunodeficiency virus, 2, 13–14, 22, 32, 42, 43, 44, 112, 119–120, 159–160, 165, 195, 330, 368, 373, 377, 379, 380, 382–383, 386 Human papillomaviruses, see Papillomaviruses Humoral immunity, 41 adjuvants, 373 Coccidiodes immitis, 357 hepatitis C virus, 337 Histoplasma capsulatum 357 see also B cells; Mucosal immunity; T cells Hybridoma, 30, 401–402, 404–405 I Iceland, 378 Immigrants Borrelia burgdorferi, 7, 88, 145 Coccidiodes immitis, 7, 88, 159, 161, 163 Histoplasma capsulatum, 7, 89, 207, 209 Immune system, general, 26–30, 377 Coccidiodes immitis, 358–359 chlamydia, 349–351 dengue virus, 345–346 gonorrhea, 368–369 hepatitis C virus, 336 herpes simplex virus, 327, 329 Histoplasma capsulatum 357–358 mycobacterium tuberculosis, 352–353 papillomaviruses, 339 pregnant women, 22–23 streptococcus, group A, 363 see also Adjuvants; Antigens; Autoimmune diseases; B cells; Macrophages; Mucosal immunity; Peptide therapy; T cells Immunoglobin, 27, 28, 29–30, 32, 33, 378, 379–380, 408, 426 Epstein-Barr virus, 334 Helicobacter pylori, 364, 366 streptococcus, group A, 362 transplacental transport, 22–23 Impairments, see Disabilities; Morbidity Incidence, 3, 435 Bordetella pertussis, 143, 144 chlamydia, 149–152, 347 Coccidiodes immitis, 159, 160, 162, 356–357 cost-effectiveness model, analytic approach, 58, 68, 80–84 (passim), 87, 89 cost-effectiveness model, detailed review, 100 cytomegalovirus, 165–166 dengue virus, 343 diabetes mellitus, 233 enterotoxigenic E. coli, 173 Epstein-Barr virus, 177, 329–330 ethical issues, 117, 118 gonorrhea, 257, 367–368 Helicobacter pylori, 181, 182, 183, 363 hepatitis C virus, 189, 191, 334 herpes simplex virus, 196, 197, 326

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Vaccines for the 21st Century: A Tool for Decisionmaking Histoplasma capsulatum 207, 208, 356–357 influenza virus, 224, 225, 227 melanoma, 239, 240 meningitis, 267, 268 multiple sclerosis, 245 mycobacterium tuberculosis, 252, 253, 351 papillomaviruses, 213, 338 parainfluenza virus, 6, 273 polio, 24–25 respiratory syncytial virus, 279, 280 rheumatoid arthritis, 285 rotavirus, 291 Shigella, 295 streptococcus, group A, 299, 300, 360 streptococcus, group B, 305, 306 Streptococcus pneumoniae 313, 314 see also Death rates Infants, 8–9, 23, 45–47, 60, 69, 84, 100, 101 Borrelia burgdorferi, 7, 88, 145 chlamydia, 152, 153, 156, 347–348 Coccidiodes immitis, 7, 88, 161, 163 cytomegalovirus, 165–166, 168, 170 enterotoxigenic E. coli, 7, 88, 173 Haemophilus influenzae, 11, 114 Helicobacter pylori, 88 hepatitis B virus, 18, 114 herpes simplex virus, 6, 88, 199, 201, 326, 327–328 Histoplasma capsulatum 7, 89, 209 meningitis, 7, 23, 89, 267 parainfluenza virus, 6, 273, 275 respiratory syncytial virus, 6, 19, 279, 280, 281, 282 rotavirus, 6, 88, 291–292 Shigella, 7, 89, 295, 296, 297 streptococcus, group A, 6, 88, 303 streptococcus, group B, 20, 23, 88, 305, 307, 308 Streptococcus pneumoniae 314 tuberculosis, 91 varicella-zoster virus, 18 see also Pregnant women Infertility, see Fertility Inflammatory response, 35, 36, 37, 385, 390, 397, 398, 411–412, 422, 423, 428 adenoviruses, 33 central nervous system, 399, 401, 402, 403 disbetes, 233, 386, 387 gastric, 363, 264 heat shock protein, 351 macrophage activation, 372, 373 multiple sclerosis, 245 pelvic inflammatory disease (PID), 150, 153, 257, 348 peptides, 403, 404, 405, 406 rheumatoid arthritis, 285 Influenza virus, 6, 11, 19, 22, 30, 34, 48–50, 54, 59–60, 67, 87, 89, 223–231, 382, 386 litigation, 21 see also Parainfluenza virus Insert baculovirus system, 30 Insulin-dependent diabetes mellitus, see Diabetes mellitus, Insurance, see Health insurance Interferon, 351, 357, 373, 387, 388, 392, 393, 409 Interleukin, 27, 38, 348–349, 372, 373, 374, 388, 389, 390–394, 396, 402–403, 405–406, 409, 410, 411–412, 420, 424, 430, 432 International perspectives, see Foreign countries Internet, IOM, 4, 323 Intranasal delivery, 9, 28, 29–30, 33, 34, 37, 47, 130, 355, 358, 361–362, 366, 378, 380 J Japan, hepatitis C virus, 334 L Legislation, general pregnant women, 7

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Vaccines for the 21st Century: A Tool for Decisionmaking school entry immunizations, 7, 8–9, 20, 49, 90, 130 Legislation, specific Americans with Disabilities Act, 112–113 National Childhood Vaccine Injury Act, 20–21, 128–129, 258 Less-developed countries, see Developing countries Liability issues, 19, 128–129 see also Litigation Licensure, vaccines, 1, 4, 5, 11, 18–19, 39, 43, 89–91, 436 Borrelia burgdorferi, 145 chlamydia, 157 Coccidiodes immitis, 20 cytomegalovirus, 20, 167 diabetes mellitus, 234, 237 enterotoxigenic E. coli, 174 Epstein-Barr virus, 179 funding issues, 8 gonorrhea, 6, 20, 264, 265 Helicobacter pylori, 185 hepatitis A, 18 hepatitis B, 18 hepatitis C, 190 herpes simplex virus, 201 Histoplasma capsulatum, 209 influenza virus, 228 length of process, general, 19–20, 54–55, 58, 60–61, 79, 80–82, 90, 95, 108, 121, 437 melanoma, 240 meningitis, 271 multiple sclerosis, 246 mycobacterium tuberculosis, 253 papillomaviruses, 219 parainfluenza virus, 20, 276 polio, 25, 126–127 respiratory syncytial virus, 20, 280 rheumatoid arthritis, 287, 289 rotavirus, 18, 292 Shigella, 296, 297 streptococcus, group A, 302 streptococcus, group B, 20, 306–309 Streptococcus pneumoniae 317, 321 therapeutic vaccines, general, 45 varicella-zoster virus, 18 see also Animal models; Clinical trials; Time factors Life expectancy, general cost-effectiveness model, analytic approach, 57, 66, 68, 76, 120 cost-effectiveness model, detailed characterization, 95–96, 98, 99, 101–102, 103, 104, 106–107 ethical issues, 112, 113, 120 see also Quality-adjusted life years Litigation, 8, 20–23, 127, 128–129 pregnant women, 21–23 streptococcus, group B, 6 see also Liability issues Local government, see Health departments Lymphocytes, see B cells; T cells M Macrophages, 27, 28, 246, 353, 357, 372, 373, 374, 375, 377, 378, 392, 393, 399, 401, 402–403, 409, 430, 432 Major histocompatibility complex (MHC), 26–27, 32–37 (passim), 344, 350, 358, 373, 381, 390, 399–400, 404, 406, 407, 410–422 (passim), 430, 432, 433 Malaria, 8, 42–43 March of Dimes, 24 Market forces, 9, 19, 125–126 Mathematical formulae, 94–97, 99, 101–106 (passim) Measles, 20, 28, 49, 131, 386 Medicaid, 118 Medicare, 4, 49–50 Melanoma, 6, 54, 88, 89–90, 239–243, 421 Men, 68, 97, 98–99 chlamydia, 97, 149–153 (passim), 155–156, 347 gonorrhea, 257, 258, 260, 263, 264–265 herpes simplex virus, 326 papillomaviruses, 214, 216, 218–219

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Vaccines for the 21st Century: A Tool for Decisionmaking Meningitis, see Neisseria meningitidis Microspheres, 378–379, 380 Migration, see Immigrants Military personnel, 330, 356 Minority groups, see Race/ethnicity Mobility impairments, 64 polio, 24, 25, 126–127 onoclonal antibodies, 29–30 herpes simplex virus, 327 Mononucleosis, see Epstein-Barr virus Monophosphoric lipid-A, 373 Morbidity, 61–66, 67, 68, 78–79, 108 as assessment criterion, 27, 39, 80–82, 95, 96 health utility index, general, 62–68 (passim), 76, 96, 97, 98–99, 102 scenarios, see Morbidity scenarios; specific diseases listed under Health utility index chlamydia, 347–348 Coccidiodes immitis, 356 dengue virus, 342–343 Epstein-Barr virus, 330 gonorrhea, 368 hepatitis C virus, 334 Helicobacter pylori, 363–364 Histoplasma capsulatum 356 malaria, 43 papillomavirus, 338–339 streptococcus, group A, 359–360 see also Disabilities; Quality-adjusted life years Morbidity scenarios, 69, 71, 78, 80–85, 95, 96, 97, 98 Bordetella pertussis, 143–144, 146 chlamydia, 150, 151–152 Coccidiodes immitis, 162 cytomegalovirus, 165–166, 167 diabetes mellitus, 234 enterotoxigenic E. coli, 173 Epstein-Barr virus, 177 gonorrhea, 257, 259 Helicobacter pylori, 182–183, 363–364 hepatitis C virus, 190, 191 herpes simplex virus, 196, 198–199 Histoplasma capsulatum, 208, 210 influenza virus, 224, 227 melanoma, 239–240, 241 meningitis, 267–269 multiple sclerosis, 246 mycobacterium tuberculosis, 252, 254 papillomaviruses, 214, 215–216 parainfluenza virus, 273, 274 respiratory syncytial virus, 279, 281 rheumatoid arthritis, 285–286, 287 rotavirus, 291 Shigella, 295 streptococcus, group A, 299–300 streptococcus, group B, 305–306, 307 Streptococcus pneumoniae 313, 315–317 see also Health utility index Mortality, see Death rates Mucosal immunity, 27, 28–30, 32, 33, 47 adjuvants, 374–375, 376 antigen delivery, 377, 378, 380 autoimmune disease, 35, 37 chlamydia, 348 Epstein-Barr virus, 333 Helicobacter pylori, 365 papillomaviruses, 338–339, 341 streptococcus, group A, 362 see also B cells; Intranasal delivery Multiple sclerosis, 6, 35, 54, 87, 245–249, 397, 399–400 Mumps, 20, 28, 49 Mycobacterium tuberculosis, 6, 54, 88, 89–90, 91, 100, 251–256, 351–355, 383–384, 386 N Nasal delivery, see Intranasal delivery National Cancer Institute, 339–341 National Center for Health Statistics, 14 National Childhood Vaccine Injury Act, 20–21, 128–129 National Foundation for Infantile Paralysis-March of Dimes, 24 National Health Interview Survey, 50

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Vaccines for the 21st Century: A Tool for Decisionmaking National Institute of Allergy and Infectious Diseases, 17, 18, 110, 124–125, 126 National Institute of Child Health and Development, 125 National Institute of Occupational Safety and Health, 356–357 National Institutes of Health hepatitis C virus, 334, 336 HIV research, 13–14 papillomaviruses, 339–341 study at hand, methodology, 14, 110 National Vaccine Injury Compensation Program, 20–21, 128–129 Neisseria gonorrhea, 6, 20, 54, 67, 88, 100, 257–265, 367–372 Neisseria meningitidis, 7, 19, 23, 54, 66, 67, 89, 200, 251, 267–272 streptococcus, group B, 20, 23, 88, 305, 307, 308–309 Streptococcus pneumoniae 313–320 (passim) Neonates, see Infants; Pregnant women New Vaccine Development: Establishing Priorities, 1, 11, 17 Noninjection routes, vaccines, 9, 25, 29, 31–34, 47 diabetes, 387–388 intranasal administration, 9, 28, 29–30, 33, 34, 37, 47, 130, 355, 358, 361–362, 366, 378, 380 oral administration, 9, 28, 29, 31–32, 37, 130, 378, 380 polio, 20, 25–26, 28–29, 32 tuberculosis, 354, 355 particulate vaccines, 30–34 rotavirus, 20–29 Nosocomial infections, 9, 18, 41, 42, 131 Nurses, 49, 255 O Occupational health, see Health care workers Older persons, see Elderly persons Ontario Health Survey, 96 Opportunity costs, 74, 115–116, 130 Oral administration, 9, 28, 29, 31–32, 37, 130, 378, 380 diabetes, 387–388 Helicobacter pylori, 366 mycobacterium tuberculosis, 354, 355 polio vaccine, 20, 25–26, 28–29, 32 Organ transplants, see Transplants (organs) P Pain, 62, 65, 260–261 Pan-American Health Organization, 25 Panel on Cost-Effectiveness in Health and Medicine, 56, 85 Papillomaviruses, 6, 54, 88, 213–221, 338–342, 384, 433 Parainfluenza virus, 6, 19, 20, 54, 88, 273–277 Particulate vaccines, 30–34 Pasteur Institute, 340 Peptide therapy, 26–27, 33, 35–36, 37, 358, 395, 396, 410, 411, 412–432 (passim) adjuvants, 373, 374, 375 autoimmune diseases, 399–401, 403–407 chlamydia, 350 dengue virus, 344 Epstein-Barr virus, 333, 334 gonorrhea, 369, 370 hepatitis B virus, 412–415 multiple sclerosis, 399, 300 streptococcus, group A, 362 Pertussis acellular vaccine, 11, 18, 20, 28, 30, 129 Physicians, 17, 47–48 Borrelia burgdorferi, 145 chlamydia, 153–156 Coccidiodes immitis, 161, 162 cytomegalovirus, 166, 168–169 diabetes mellitus, 234, 235–236 enterotoxigenic E. coli, 174 Epstein-Barr virus, 178, 179 gonorrhea, 260–264 (passim)

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Vaccines for the 21st Century: A Tool for Decisionmaking Helicobacter pylori, 184 hepatitis C virus, 192 herpes simplex virus, 202–203 Histoplasma capsulatum, 211 influenza virus, 228 melanoma, 240, 241 meningitis, 270 multiple sclerosis, 246, 247 mycobacterium tuberculosis, 252, 255 papillomaviruses, 214, 215, 217–219 parainfluenza virus, 274, 275 respiratory syncytial virus, 282 rheumatoid arthritis, 286, 288 Shigella, 295–296, 297 streptococcus, group A, 302 streptococcus, group B, 306, 308, 309 Streptococcus pneumoniae 318–320 varicella-zoster virus, 18 Poliomyelitis, 20, 23–26, 28–29, 32, 91–92 Poverty ethical issues, 115–116, 118 Medicaid, 118 see also Developing countries Pregnant women, 7, 21–23, 50–51, 69, 91, 101, 128–129 chlymadia, 154, 347–348 contraceptive vaccines, 75–76 fertility, 62, 65, 151, 155, 259, 264 gonorrhea, 259, 368 hepatitis C virus, 334 herpes simplex virus, 326–327 meningitis, 22 parainfluenza, 88 streptococcus, group B, 20, 90, 93, 306, 307, 309, 310–311 Streptococcus pneumoniae 22 tetanus toxoids, 23 time of delivery, 20, 23, 51 various pathogens, 22 Prevalence cost-effectiveness model, analytic approach, 68 cost-effectiveness model, detailed description, 100 see also Incidence Privacy, see Confidentiality Private sector, 8, 19, 105, 125, 436 market forces, 9, 19, 125–126 papillomaviruses, 342 streptococcus, group B, 6 see also Health insurance; Litigation Pseudomonas aeruginosa, 42, 44, 128 Psychological factors, see Attitudes; Cognitive impairments; Emotional impairments Psychomotor impairments, see Mobility impairments Puberty, see Children Public Health Service, 56 Public opinion, see Attitudes Q Quality-adjusted life years, 2, 57, 58, 61–69, 76–89, 95–99 102–104, 106, 107–108 age and, 58, 66, 68–69, 80–82, 84, 80–83, 84, 95, 98–99 aggregation, 2, 56 average population health states, 66, 68 definitional issues, 2, 56, 58, 61–62, 86, 95 disability-adjusted life years, 63, 66, 111, 112 discounting, 18, 60–61, 68–69, 114–115 ethical issues, 3–4, 58, 111, 112, 113, 114–115, 120–121, 129–130 mathematical formulae, 95, 96, 99 see also Life expectancy Quality-adjusted life years, specific vaccines Borrelia burgdorferi, 147 chlamydia, 157, 158 Coccidiodes immitis, 163–164 cytomegalovirus, 167, 170–171 diabetes mellitus, 237, 238 Enterotoxigenic E. coli, 174, 176 Epstein-Barr virus, 179–180 gonorrhea, 264–265 Helicobacter pylori, 186–187

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Vaccines for the 21st Century: A Tool for Decisionmaking hepatitis C virus, 193–194 herpes simplex virus, 204 Histoplasma capsulatum, 210, 211 influenza virus, 229–230 melanoma, 241, 242–243 meningitis, 271, 272 multiple sclerosis, 248, 249 mycobacterium tuberculosis, 254, 256 papillomaviruses, 220 parainfluenza virus, 276, 277 ranking of vaccines covered, 5–7 respiratory syncytial virus, 282–283 rheumatoid arthritis, 289 rotavirus, 293 Shigella, 296, 297 streptococcus, group A, 301, 303, 304 streptococcus, group B, 307, 310–312 Streptococcus pneumoniae 315, 320—321 Quality of life, general, 15 Quality of Well-Being Scale, 63, 66 R Race/ethnicity, 50 syphilis, 41 see also specific racial/ethnic groups Receptor-centered regulation, 22, 26, 29, 30–31, 36, 37–38, 407, 418, 426 chlamydia, 349, 350 dengue virus, 343–344 gonorrhea, 369, 370–371 hepatitis B virus, 412–413 streptococcus, group A, 360 virus-like particles, 30–31 Record-keeping, 46, 47, 49 Regional factors, 7, 44, 71, 88, 89, 91, 93, 105, 128 Borrelia burgdorferi, 144, 145 chlamydia, 347 Coccidiodes immitis, 159 dengue virus, 343 gonorrhea, 257, 367–368 Histoplasma capsulatum 207, 209, 356–357 mycobacterium tuberculosis, 352, 355 see also Developing countries; Foreign countries; Immigrants Respiratory syncytial virus, 6, 19, 20, 22, 23, 43, 54, 88, 90, 279–284 Rheumatoid arthritis, 6, 35, 54, 67, 87, 285–290, 403 RNA dengue virus, 342–347 diabetes, 388 Epstein-Barr virus, 330 gonorrhea, 368 hepatitis C virus, 335, 336 Rotavirus, 6, 11, 18, 19, 22, 28–29, 54, 88, 291–294 Rubella, 20, 28 S Salmonella, 31–32 Schedules, see Vaccination schedules School entry immunizations, 7, 8–9, 20, 49, 90, 130 Sensitivity analysis, 3, 57 Sensory impairments, 62, 64, 64, 67, 236 Sex differences, see Men; Women Sexually transmitted diseases, 7 chlamydia, 6, 54, 67, 88, 89–90, 149–158, 347–351, 368 hepatitis C virus, 334–335 herpes simplex virus, 6, 19, 22, 54, 67, 88, 195–205, 326–329, 384 gonorrhea, 6, 20, 54, 67, 88, 100, 257–265, 367–372 human immunodeficiency virus, 2, 13–14, 22, 32, 42, 43, 44, 112, 119–120, 159–160, 165, 195, 330, 368, 373, 377, 379, 380, 382–383, 386 papillomaviruses, 6, 54, 88, 213–221, 338–342, 384, 433 syphilis, 41 Shigella, 7, 43, 54, 100, 295–297, 379 Socioeconomic status, see Poverty; Race/ethnicity Southeast Asia, 339, 343 Staphylococcus aureus, 42

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Vaccines for the 21st Century: A Tool for Decisionmaking State public health programs, see Health departments Streptococcus, see Group A streptococcus; Group B streptococcus; Streptococcus mutans; Streptococcus pneumoniae Streptococcus mutans, 44–45 Streptococcus pneumoniae 6, 21, 43, 47–48, 49, 54, 60, 88, 89, 313–322 Syncytial virus, see Respiratory syncytial virus Syphilis, 41 T Target populations, see Age factors; Immigrants; Men; Race/ethnicity; Women T cells, 26–35, 408–409, 410, 415–433 (passim), 436 adjuvants, 372–373, 374, 376 antigen-induced programmed cell death, 37, 395–399, 409, 410–411 autoimmune disease, 35–38, 233, 245, 389–391, 392–395, 399–406 (passim) chlamydia, 348–349, 350 cholera, 375 Coccidiodes immitis, 357 dengue virus, 344–345, 346, 347 diabetes mellitus, 233, 387–389, 391, 392, 393–395 Epstein-Barr virus, 330, 331, 332, 333 DNA vaccines, 378, 380, 381, 382, 383, 385 Helicobacter pylori, 364 hepatitis B virus, 412, 413–415 hepatitis C virus, 335, 337–338 herpes simplex virus, 329 Histoplasma capsulatum 357 mycobacterium tuberculosis, 353–355 papillomaviruses, 342 Tetanus, 20, 23, 28, 30, 46, 49 Time factors, 68–69, 79, 86 Bordetella pertussis, 145 chlamydia, 156 Coccidiodes immitis, 161 cytomegalovirus, 167 development/licensure process, 19–20, 54–55, 58, 60–61, 79, 80–82, 90, 95, 108, 121, 437 diabetes mellitus, 234, 237 enterotoxigenic E. coli, 174 Epstein-Barr virus, 179 gonorrhea, 264 Helicobacter pylori, 185 hepatitis C, 190 herpes simplex virus, 201 Histoplasma capsulatum, 209 influenza virus, 228 melanoma, 240 meningitis, 271 multiple sclerosis, 246, 248, 249 mycobacterium tuberculosis, 252, 254 papillomaviruses, 219, 220 parainfluenza virus, 276, 277 respiratory syncytial virus, 280, 282–283 rheumatoid arthritis, 287, 289 rotavirus, 292, 293 Shigella, 296, 297 streptococcus, group A, 302, 304 streptococcus, group B, 306, 311 Streptococcus pneumoniae 317, 321 discounting, 68–69, 86, 101 licensure possibilities, scope of study at hand, 39, 40, 43 patient time costs, 74 patterns of vaccine use, 60, 93–94 pregnant women, 20, 23, 51 Tobacco, 379–380 Tourists, see Travelers Transfection, 32, 34, 416, 418, 423–424 Transplants (organs), 391 cytomegalovirus, 165, 169 Epstein-Barr virus, 330 ethical issues, 120–121, 122 hepatitis C virus, 334 Travelers, 105 E. coli, 7, 88, 173, 174 malaria, 42–43 Shigella, 7, 89, 295, 296, 297 Treponema pallidum, 41

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Vaccines for the 21st Century: A Tool for Decisionmaking Tuberculosis, see Mycobacterium tuberculosis Tyler’s murine encephalomyelitis, 399 Typhoid, 29, 30, 47 U Urban areas influenza, 50 syphilis, 41 Utilization of vaccines, 9, 39, 45, 130 Borrelia burgdorferi, 147 chlamydia, 157 Coccidiodes immitis, 163, 164 complacency and fear, 9, 46, 73–74 [ALL] cost-effectiveness model, analytic approach, 72–73, 75, 76, 79, 80, 86, 88, 89, 91 cost-effectiveness model, detailed review, 95, 107–108 cytomegalovirus, 170 diabetes mellitus, 237, 238 E. coli, 174, 176 Epstein-Barr virus, 179, 180 gonorrhea, 264, 265 streptococcus, group B, 6 Helicobacter pylori, 186–187 hepatitis C virus, 193, 194 herpes simplex virus, 204 Histoplasma capsulatum, 210 influenza virus, 229, 230 melanoma, 242, 243 meningitis, 271, 272 multiple sclerosis, 248, 249 mycobacterium tuberculosis, 253–254, 255, 256 papillomaviruses, 219, 220 parainfluenza virus, 276, 277 respiratory syncytial virus, 281, 282, 283 rheumatoid arthritis, 289 rotavirus, 292–293 school entry immunizations, 7, 8–9, 20, 49, 90, 130 Shigella, 296–297 specific vaccines, various, 53 streptococcus, group A, 303–304 streptococcus, group B, 310–312 Streptococcus pneumoniae 320–321 see also Attitudes; Barriers to research and development; Delivery of vaccines V Vaccine Injury Compensation Program, 20–21, 128–129 Vaccine schedules, 45–46, 431–432 Borrelia burgdorferi, 145, 147 chlamydia, 157 Coccidiodes immitis, 163 cytomegalovirus, 170 diabetes mellitus, 237 enterotoxigenic E. coli, 174 Epstein-Barr virus, 179 gonorrhea, 264 Helicobacter pylori, 186 hepatitis C virus, 193, 336 herpes simplex virus, 203, 329 Histoplasma capsulatum, 209 influenza virus, 229 melanoma, 242 meningitis, 271 multiple sclerosis, 248 mycobacterium tuberculosis, 254 papillomaviruses, 219 parainfluenza virus, 276 respiratory syncytial virus, 282 rheumatoid arthritis, 289 rotavirus, 292 Shigella, 296 streptococcus, group A, 303 streptococcus, group B, 310 Streptococcus pneumoniae 320 Vaccines for Children Program, 47, 131 Varicella-zoster virus, 11, 18, 19, 28 Vector-borne pathogens, 8, 42–43, 342–347 Vibrio cholerae, 30, 31, 35, 374, 375–376, 378 Virus-like particulates, 30–34

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Vaccines for the 21st Century: A Tool for Decisionmaking Visting Nurse Assocations, 49 W Waterborne pathogens, general, 42 World Bank, 63 World Health Organization, 21, 25, 63 Women, 68, 98–99 chlymadia, 97, 149, 150–152, 153, 154 contraceptive vaccines, 75–76 fertility, 62, 65, 151, 155, 259, 264 gonorrhea, 257, 258, 259–265 papillomaviruses, 214, 215, 217, 338–342 respiratory syncytial virus, 6, 280, 281 streptococcus, group B, 6, 88, 309, 307, 310 syphilis, 41 see also Pregnant women World Wide Web, see Internet