will be reflected in the weight-of-evidence assessments of the epidemiologic or the mechanistic data. However suggestive those assessments might be, in the end the committee concluded that the evidence was inadequate to accept or reject a causal association.

A list of all conclusions, including the weights of evidence for both the epidemiologic evidence and the mechanistic evidence, can be found in Appendix D.

SUSCEPTIBILITY

The literature supporting several of the causality conclusions discussed in the previous section indicates that individuals with certain characteristics are more likely to suffer adverse effects from particular immunizations. Individuals with an acquired or genetic immunodeficiency are clearly recognized as at increased risk for specific adverse reactions to live viral vaccines such as MMR and varicella vaccine. Age is also a risk factor; seizures after immunization, for example, are more likely to occur in young children. Thus, the committee was able at times to reach more limited conclusions that did not generalize to the entire population.

CONCLUDING COMMENT

Committee members spent an enormous amount of time reading thousands of articles. The committee makes 158 causality conclusions in this report. It tried to apply consistent standards when reviewing individual articles and when assessing the bodies of evidence. Some of the conclusions were easy to reach; the evidence was clear and consistent or, in the extreme, completely absent. Some conclusions required substantial discussion and debate. Inevitably, there are elements of expert clinical and scientific judgment involved.

The committee used the best evidence available at the time. The committee hopes that the report is sufficiently transparent such that when new information emerges from either the clinic or the laboratory, others will be able to assess the importance of that new information within the approach and set of conclusions presented in this report.

REFERENCES

IOM (Institute of Medicine). 1991. Adverse effects of pertussis and rubella vaccines: A report of the committee to review the adverse consequences of pertussis and rubella vaccines. Washington, DC: National Academy Press.

IOM. 1994. Adverse events associated with childhood vaccines: Evidence bearing on causality. Washington, DC: National Academy Press.



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