The method used in this study to compare morbidity and mortality resulting from various diseases is described and illustrated in Chapter 4. Total disease burden values (TDBVs) for N. gonorrhoeae are calculated using estimates from Table L.4 and infant mortality equivalence values based on a median of committee member perspectives or on an age-neutral perspective. TDBVs thus obtained are 534 (committee median perspective) and 13,814 (age-neutral perspective). The large difference between these two values arises from the use in the age-neutral perspective of an IME value that equates first-trimester fetal deaths (in ectopic pregnancies) with all other deaths. If the IME value for these deaths were changed to 100 (as it is in the committee median perspective), the age-neutral TDBV would become 350.

Identification of the target population for a gonococcal vaccine is complicated somewhat by lack of knowledge about the length of protective immunity that could be conferred by any specific vaccine. The most reasonable approach is to assume that the vaccine should be administered as shortly as possible before the age at which the incidence of disease begins to rise—sometime in the late teens. For this report, the target population at steady-state utilization is considered to be all 15-year-old teenagers. (immediately after introduction of an effective vaccine, older individuals probably would receive the vaccine as well.)

Disease incidence rates among military personnel are greater than those for civilians. Thus, this group or others, such as individuals presenting at clinics with sexually transmitted diseases, could be considered as potential high-risk target populations for vaccination.

Despite the availability of antibiotics, gonorrhea inflicts a considerable burden of illness. In women, its occurrence may not be recognized until after the onset of a pattern of chronic complications.