New Vaccine Development: Establishing Priorities: Volume I, Diseases of Importance in the United States

Attachment 2

Age Related Morbidity and Mortality “Trade-offs”

			Column
			1	2	3	4	5	6
	Category	Unit	Under 1 Year	1–4 Years	5–14 Years	15–24 Years	25–59 Years	60 Years and Over
A.	Moderate localized pain and/or mild systemic reaction or impairment requiring minor change in normal activities.	Days
B.	Moderate pain and/or moderate impairment requiring moderate change in normal activities, e.g., housebound or in bed	Days
C.	Severe pain, severe short term impairment, or hospitalization	Days
D.	Mild chronic disability (not requiring hospitalization, institutionalization or other major limitation of normal activity)	Cases
E.	Moderate to severe chronic disability (requiring hospitalization, special care or other major limitation of normal activity)	Cases
F.	Total impairment	Cases
G.	Reproductive impairment resulting in infertility	Cases
H.	Death	Cases	1	1	1	1	1	1
	Deaths		1

balance the disutility of one death in the age group being assessed. We expect that these units will be very large because we are measuring relatively mild consequences in terms of days spent experiencing them, you might find it helpful to bear in mind that a child under 5 years has a life expectancy of more than 25,000 days. If a day in the morbidity state is equivalent to the loss of a modest fraction of a day of life, then the number of days in the morbidity state judged to be

Table of Contents

Front Matter R1-R14

1. Summary 1-16

2. Priority Setting for Health Related Investments: A Review of Methods 17-27

3. Overview of the Analytic Approach 28-38

4. Comparison of Disease Burdens and Costs 39-58

5. Predictions on Vaccine Development 59-66

6. Assessing the Likely Utilization of New Vaccines 67-91

7. Calculation and Comparison of the Health Benefits and Costs Associated with Candidate Vaccines 92-120

8. Additional Issues in the Selection of Priorities for Accelerated Vaccine Development 121-126

9. Findings, Conclusions, and Recommendations 127-148

Appendix A: Some Examples of the Application of Project Selection Method 149-152

Appendix B: Pathogenic Agents for Which Accelerated Vaccine Development Does Not Appear Appropriate 153-170

Appendix C: Prospects for Immunizing Against Bordetella pertussis 171-182

Appendix D: Prospects for Immunizing Against Coccidioidomycosis 183-197

Appendix E: Prospects for Immunizing Against Cytomegalovirus 198-234

Appendix F: Prospects for Immunizing Against Hemophilus influenzae type b 235-251

Appendix G: Prospects for Immunizing Against Hepatitis A Virus 252-260

Appendix H: Prospects for Immunizing Against Hepatitis B Virus 261-279

Appendix I: Prospects for Immunizing Against Herpes Simplex Viruses 1 and 2 280-312

Appendix J: Prospects for Immunizing Against Herpesvirus varicellae 313-341

Appendix K: Prospects for Immunizing Against Influenza Viruses A and B 342-364

Appendix L: Prospects for Immunizing Against Neisseria gonorrhoeae 365-384

Appendix M: Prospects for Immunizing Against Parainfluenza Viruses 385-396

Appendix N: Prospects for Immunizing Against Respiratory Syncytial Virus 397-409

Appendix O: Prospects for Immunizing Against Rotavirus 410-423

Appendix P: Prospects for Immunizing Against Streptococcus group B 424-439

Appendix Q: Questionnaire for Assessing Morbidity-Mortality Trade-Offs 440-443

Appendix R: Technical Notes 444-444

Appendix S: Biographical Notes on Committee Members 445-449

Appendix T: Additional Sources of Advice to the Committee 450-452

Index 453-458