Overview and horizons in prevention of some human infectious diseases by vaccination.

The present measles problem in the United States, an estimated 918,500 cases in 1977, is attributed to the failure of the 14-year vaccination program to immunize enough children to prevent continued circulation of the virus and recurrent outbreaks. A new strategy for rapidly overcoming this problem is recommended. There appears to be no current congenital rubella syndrome problem against which the rubella vaccination program in the United States is directed. However, the continued annual infection of an estimated two million children conceivably could again bring fourth a rubella virus with a greater capacity for producing congenital rubella syndrome, and a modification of the present program is recommended. About 80 to 90% of the annual 60-70 million cases of severe enough to confine the victim to bed influenza are not caused by the influenza viruses. Except for the few thousand additional deaths directly attributed to influenza A virus during the epidemic years, mortality rates for pneumonia, heart diseases, chronic bronchopulmonary diseases, and other former "high-risk" conditions have continued to decrease in recent years, and have not risen during the 12-month periods of epidemic years. A re-evaluation of the current influenza vaccination policy is recommended. Prospects for hepatitis B and varicella-zoster vaccines are discussed.