ity of independent investigators, to integrate rigorously executed laboratory techniques into well-designed epidemiologic studies and surveillance systems, and to complement short-term studies with long-term follow-up. It also will be necessary to develop funding mechanisms that recognize the value of such crosscutting efforts.

Helena Mäkelä described the recent advances that are raising promise for the development of vaccines to fight chronic diseases, either by preventing acute infection or by curing established persistent infection. The possibility of developing a vaccine to fight cardiovascular disease, one of the major killers in the United States and worldwide, served as an example. The vaccine would target Chlamydia pneumoniae, which has been linked to atherosclerosis by several lines of evidence, though its causative role has not been conclusively established. Among efforts to date, researchers have developed an experimental model of C. pneumoniae in the mouse, and work with this system is yielding fundamental lessons. Also, a number of candidate vaccines have been prepared and tested for prevention of acute infection, and several of them have proved to afford at least partial protection.

Siobhán O’Conner presented a blueprint for the strategic approach that will be needed to integrate laboratory research, epidemiology, and surveillance. This blueprint is based on several basic tenets that stress the importance of standardized or comparable case definitions—for the infection as well as the outcome—and universally high standards of specificity, sensitivity, and reproducibility of laboratory assays. As the field advances, a number of crosscutting issues also will require continuous attention. One such issue will be the need to provide adequate medical education (both academic training and continuing education) so that health professionals will be able to capitalize on the benefits afforded by confirmed and newly discovered links between infectious agents and chronic diseases, while at the same time protecting the well-being of their patients. O’Connor concluded that although the links between microbial infections and chronic diseases can be complex and multifactorial, they can be characterized—and beneficial interventions against infection can be designed.


P. Helena Mäkelä, M.D., Ph.D.*

National Public Health Institute, Helsinki, Finland

The potential of vaccination as an intervention is undeniable. Vaccines have


I wish to thank warmly colleagues whose contribution to this paper have been essential: Jenni M. Vuola, Mirja Puolakkainen, Tuula Penttilä, Anne Sarén, Anu Haveri, and Laura Mannonen from the Institute or Department of Virology, Haartman Institute, University of Helsinki.

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