Faculty Bibliography

A new collaborative model of research is needed to increase resources, to prioritize the R (ii) to increase the pace, reduce the overlap, and more systematically explore the elements of and delivery systems for vaccines; (iii) to use common standards for the prompt comparative testing of vaccine candidates; (iv) to expand resources for manufacturing vaccine candidates to speed their use in human trials; and (v) to increase the capacity for international clinical trials and to focus this effort toward quickly measuring the effectiveness of vaccine protection as prototype vaccine candidates are identified.

OBJECTIVES: To update the WHO global and regional estimates of the prevalence and incidence of syphilis, gonorrhoea, chlamydia, and trichomoniasis. METHODS: Prevalence estimates for syphilis, gonorrhoea, chlamydia, and trichomoniasis were generated for each of the nine UN regions for males and females between the ages of 15 and 49 in 1995 based on an extensive review of the published and unpublished medical literature since 1985. Incidence estimates were based on the prevalence figures and adjusted to take into account the estimated average duration of infection for each disease in a particular region. The latter was assumed to depend upon a number of factors including the duration of infection in the absence of treatment, the proportion of individuals who develop symptoms, the proportion of individuals treated, and the appropriateness of treatment. RESULTS: In 1995 there were over 333 million cases of the four major curable STDs in adults between the ages of 15 and 49--12 million cases of syphilis, 62 million cases of gonorrhoea, 89 million cases of chlamydia, and 170 million cases of trichomoniasis. Geographically, the vast majority of these cases were in the developing world reflecting the global population distribution. CONCLUSIONS: STDs are among the most common causes of illness in the world. Estimates of the global prevalence and incidence of these infections are limited by quantity and quality of data available from the different regions of the world. Improving global STD estimates will require more well designed epidemiological studies on the prevalence and duration of infection.

In March-April 1985, toxic shock syndrome (TSS) developed in three male military trainees at one base secondary to infected blisters acquired while marching during basic combat training. One trainee died. Staphylococcus aureus was isolated from the blisters in all three patients, and the two strains available for testing both produced toxic shock syndrome toxin-1 (TSST-1). A culture survey identified carriage of S. aureus in 44% (145/333) of the trainees; carriage rates did not differ between the company with two ill trainees and a control company. Carriage was more frequent in the nose than foot (41% versus 9%, p less than 0.0001). White trainees were more likely to carry S. aureus than black trainees (47% versus 28%, p = 0.013), although the same proportion of strains was positive for TSST-1 in both races. The two strains obtained from the patients had similar but not identical phage typing patterns, but had identical antibiograms, and neither strain carried any plasmids. Based upon phage typing of the TSST-1 positive S. aureus strains isolated in the study, widespread carriage of the case strain(s) in other trainees was not found nor was clustering noted by barrack room. It is possible that differences in carriage rates may partially explain the low rate of TSS in blacks.