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Details a study which examined the prevalence of nosocomial klebsiella infections at the Veterans Administration Hospital in Denver, Colorado. Incidence of nosocomial klebsiella infections; Methodology; Information on multidrug-resistant klebsiella; Factors responsible for perpetuating the gastrointestinal reservoir of klebsiella.

Editorial. Emphasizes the importance of pneumococcal vaccine in U.S. adults. Effectiveness of pneumococcal vaccine; Results of a Veterans Administration Cooperative Study on pneumococcal vaccine; Increase in the immunogenicity of Haemophilus influenzae polysaccharide.

Editorial. Explores the efficacy of pneumococcal pneumonia vaccine in the U.S. Results of field trials; Approach in measuring vaccine efficacy; Recommendations on the use of pneumococcal vaccine.

Background: Although the vaccine research and development network in the United States remains vibrant, its continued success requires maintaining harmonious interaction among its many components. Changing one component is likely to affect the system overall. An examination of case studies of the development of selected vaccines would allow an examination of the network as a whole. This article presents conclusions drawn from the case study review undertaken., Objective: Successful development of vaccines is a time-intensive process requiring years of commitment from a network of scientists and a continuum of regulatory and manufacturing entities. We undertook this work to shed light on how well the vaccine development system in the United States performs., Method: The National Vaccine Advisory Committee examined the research and development pathways of several vaccines that reached licensure expeditiously (hepatitis B vaccine, Haemophilus influenzae type b conjugate vaccines); some that became licensed only after considerable delay (oral typhoid Ty21a vaccine, varicella vaccine); some that are at the point of imminent or recent licensure (reassortant Rhesus rotavirus vaccine, which was licensed by the Food and Drug Administration on August 30, 1998) or near submission for licensure (intranasal cold adapted influenza vaccine); and one for which clinical development is slow because of hurdles that must be overcome (respiratory syncytial virus vaccines)., Results: Some common themes emerged from the reviews of these vaccine "case histories": the expediting influence of a strong scientific base and rationale; the need for firm quantitation of disease burden and clear identification of target populations; the critical role played by individuals or teams who act as "champions" to overcome the inevitable obstacles; availability of relevant animal models, high-quality reagents and standardized assays to measure immune response; the absolute requirement for well designed, meticulously executed clinical trials of vaccine safety, immunogenicity, and efficacy; postlicensure measurements of the public health impact of the vaccine and a track record of the vaccine's safety and acceptance with large-scale use; and the critical need for international collaborations to evaluate vaccines against diseases of global importance that are rare in the United States (eg, typhoid fever). It was clear that the critical step-up from bench scale to pilot lots and then to large-scale production, which depends on a small group of highly trained individuals, is often a particularly vulnerable point in the development process., Conclusions: One fundamental lesson learned is that within the varied and comprehensive US vaccine development infrastructure, multiple and rather distinct paths can be followed to reach vaccine licensure. The National Vaccine Advisory Committee review process should be conducted periodically in the future to ascertain that the US vaccine development network, which has been enormously productive heretofore and has played a leadership role globally, is adapting appropriately to ensure that new, safe, and efficacious vaccines become available in a timely manner.

Physicians seldom ask adult patients about basic immunizations or seek to determine whether the patient's occupation, lifestyle, or travel may warrant additional vaccine coverage. Yet more than 30,000 lives could be saved every year in the United States if adult immunization recommendations were implemented. Strategies for improving delivery are reviewed and information on specific vaccines is updated.

The history of airborne nosocomial infections is reviewed, and current beliefs about such infections are placed into their historical context. Possible sources, both animate and inanimate, of airborne nosocomial infections in the hospital environment are identified. Viruses, bacteria, and fungi that have been important causes of airborne nosocomial infections in the past are discussed, and examples of key studies that have confirmed an airborne route of transmission are presented. Where relevant, measures that have been used to control airborne transmission of nosocomial pathogens are discussed. Although outbreaks of airborne nosocomial infection have been uncommon, airborne transmission appears to account for about 10% of all endemic nosocomial infections.

Can the successes of pediatric immunization programs be matched in adults? The question relates both to infections due to waning immunity and to those primarily acquired in adulthood. It is given urgency by rising prevalence of vaccine-preventable diseases in adults. Strategies with available vaccines are reviewed, and vaccines in development are discussed.