• Examination of the culture supernatant of the in vitro endospore spherule endospore cycle for the presence of high molecular weight antigen liberated from the cells.

Using acrylamide gel electrophoresis, Pappagianis and coworkers have found evidence of soluble, high molecular weight components, which appear to be at least partially protein, early in the culture cycle (Pappagianis, personal communication, 1984). The immunogenicity and protective efficacy of these components are not known.

The health belief model parameters (perceptions of risk of illness, severity, vaccination benefits, and barriers) used to predict vaccine utilization are described in Chapter 6, where scores assigned to various vaccines are displayed together to facilitate comparison.

Lay perceptions of the risk and severity of coccidioidomycosis are judged to be very low, primarily because the public is thought to be unfamiliar with the disease and because many of the persons at highest risk are migrant agricultural workers with limited access to the medical care system. The perception of benefits also is judged to be very low because of the relatively low efficacy of the vaccine and the mild or asymptomatic nature of most infections. Perceived barriers to vaccination are judged to be high because of the moderate incidence of adverse reactions to the vaccine and the predicted number of required doses (3).

Physicians in areas of the United States in which coccidioidomycosis is endemic probably have become more aware of the risk of disease and more familiar with its clinical manifestations in recent months because of clinical trials of the vaccine candidate now being conducted in Arizona and California. Their perceptions of risk and severity of disease are judged to be moderate. Perceived benefits of the vaccine are likely to be relatively high, although moderated somewhat by the relatively low predicted efficacy of the vaccine. Perceived barriers are judged to be moderate because of the moderate incidence of adverse reactions to the vaccine.

The scope and purpose of the calculations included below are described in Chapters 4 and 7. These calculations are based on