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TABLE 1.4 Ranking of Diseases by Total Disease Burden Values

Disease

Total Disease Burden Value (IME units)a

Streptococcus pneumoniae

6,612,261

Hepatitis B virus

2,394,256

Plasmodium spp.

2,111,795

Salmonella typhi

1,308,121

Escherichia coli

978,248

Rotavirus

925,042

Shigella spp.

828,068

Streptococcus Group A

811,477

Mycobacterium leprae

657,349

(Escherichia coli)

(550,248)b

(Rotavirus)

(488,542)b

Hemophilus influenzae type b

471,336

Vibrio cholera

229,217

Respiratory syncytial virus

183,326

Parainfluenza virus

145,954

Neisseria meningitidis

68,252

Rabies virus

67,821

Dengue virus

34,365

Yellow fever virus

32,887

Hepatitis A virus

30,229

Japanese encephalitis virus

18,075

aInfant mortality equivalence units.

bValues represent the anticipated disease burden from certain diarrheal pathogens if a plausible increase in oral rehydration therapy is assumed (see Appendix C) .

categories if different, plausible assumptions are adopted, the assignments in Table 1.6 should not be regarded as definitive.

Most of the vaccines that consistently rank low (as compared with the other candidates in this assessment) would prevent diseases that, although often serious, are found in relatively small regions of the developing world. In such areas they may have considerable benefit relative to the more widespread diseases that rank higher when the developing world is considered as a whole.

Final decisions on the number of vaccines to be selected for accelerated development and on the ultimate choices should be addressed in a broader political/public policy forum, after consideration of the issues identified above and discussed in Chapters 8 and 9.

Scientific opinion differs on some of the judgments incorporated into the proposed method, and uncertainty surrounds certain data (e.g., on disease incidence) or the predictions (e.g., of efficacy). When data are unavailable, expert judgments are required. The attempt to be explicit about certain estimates should not be interpreted as indicating that a high degree of precision, unanimity, or certainty in



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