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recommendation urged NIAID and other responsible agencies to improve the epidemiological data that are used to compare diseases. The variable quality of the data in some areas and the total absence of data in others were serious impediments to the development of a comprehensive prioritization scheme.

PRIORITIES OF THE IOM COMMITTEE IN 1985

Table 2–1 presents the 1985 committee’s final list of pathogens for which vaccines were analyzed. For several pathogens two different forms of vaccine were considered (e.g., attenuated live virus or glycoprotein). By varying different assumptions (e.g., utilization, discount rates), vaccines against the first five pathogens retained highest priority. The committee stated that an improved pertussis vaccine (acellular antigens) merited unique treatment because of its potential for restoring public confidence in all immunization programs. Indeed, since the report was issued, a number of acellular pertussis vaccines and new combinations of acellular pertussis vaccines with other antigens have been licensed in the United States. Initially, acellular pertussis vaccines were recommended only for the fourth and fifth doses of the childhood immunization schedule, but acellular pertussis vaccines are now recommended for all doses in the immunization schedule beginning at 2 months of age. Their diminished local reactivity and systemic manifestations have rendered them highly acceptable to both health care providers and parents. This has greatly restored confidence in childhood immunizations, which had been eroded previously by concerns about whole-cell pertussis vaccines. The hepatitis B virus (HBV) vaccine, prepared by recombinant technology, has also been licensed for use and is recommended and incorporated into the infant immunization schedule. Additionally, it is widely used for various high-risk adult populations including health care workers.

Conjugate vaccines against Haemophilus influenzae type b (Hib) have been the remarkable success of the past 8 years. With their widespread use in infancy, the annual rates of invasive disease caused by this organism among U.S. children under 5 years of age have been reduced from 40 to 1 per 100,000 population. Varicella-zoster virus vaccine was licensed in the spring of 1995 and is recommended for infants at 1 year of age. Physicians in practice are beginning to use the vaccine, and a number of states provide it in their public health programs. Of the remaining candidate vaccines included in the 1985 analysis, only hepatitis A virus (HAV) vaccine (1995) and rotavirus vaccine (1998) have been licensed. Vaccination against HAV has been recommended for groups at special risk.

Over half of the candidate vaccines analyzed in the 1985 report on vaccine priorities have not yet been licensed. Several are still 15 years from licensure, in this committee’s opinion. Although the committee did not analyze in depth each unlicensed candidate vaccine from 1985, obvious factors hindering progress



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