Vaccines for the 21st Century A Tool for Decisionmaking (2000) / Chapter Skim
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Considerations of Candidate Vaccines
Considerations of Candidate Vaccines
Pages 39-52
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From page 39... ...
The committee followed a modified delphi approach and winnowed a very long list of candidates into a manageable and meaningful list of 26 candidate vaccines (see Table 3-1~. The committee was guided in their final decisions by its charge to consider vaccines directed against conditions of domestic health importance that could be licensed within 20 years.
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From page 40... ...
Some of these infectious diseases against which vaccines were not yet considered feasible occur in healthy hosts who experience the loss of integrity of the skin or the disruption of normal intestinal barriers to microorganisms, which permits the development of secondary infections (e.g., infections caused by Clostridium perfringens or Bacteroides fragilis)
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From page 41... ...
This list of pathogenic microorganisms excluded from consideration due to lack of scientific knowledge is not intended to be exhaustive, and the following illustration for one agent is intended to provide a rationale that would be common to several others. Syphilis is a prominent example of an infection in the immunocompetent host that poses both a substantial disease burden and a substantial expenditure of public health resources in the United States, and against which the development of a vaccine seems unlikely in the near future.
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From page 42... ...
Another example of candidate vaccines that the committee chose not to include are waterborne pathogens. Again, this exclusion is not meant to discount the disease burden imposed by such agents but rather to emphasize that wellestablished and validated public health principles are available to meet the challenge of contaminated water supplies.
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From page 43... ...
ADDITIONAL CONSIDERATIONS FOR INCLUSION In addition to the explicit inclusion criteria based on the charge to discuss candidate vaccines of domestic health importance and feasibility of licensure, the committee seriously considered candidate vaccines for reasons other than judgment about disease burden and likelihood of development within 20 years.
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From page 44... ...
It was not, however, felt to be a significant source of disease in otherwise healthy individuals. Other examples of vulnerable populations considered by the committee include organ transplant patients and persons otherwise immunocompromised, such as those with AIDS.
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From page 45... ...
Therapeutic Vaccines The inclusion of therapeutic vaccines directed against autoimmune diseases such as rheumatoid arthritis or multiple sclerosis is a departure from a traditional array of candidate vaccines. Because there are no licensed therapeutic vaccines, understanding of when health benefits could be realized in the course of disease with a vaccine strategy is incomplete.
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From page 46... ...
despite the introduction of new vaccines that have further complicated the immunization schedules. Finally, to help make the receipt of multiple immunizations more convenient, some public schools have incorporated immunizations into their school health programs so that preschool-age infants and children may attend neighborhood-school health clinics where school health nurses or other personnel immunize younger cohorts who are not yet attending school.
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From page 47... ...
On the whole, relatively few patients received influenza vaccine from state or local health departments. Several studies have shown that high rates of immunization occur in the office setting whenever patients are offered vaccines during office visits (ACP, 19904.
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From page 48... ...
Such an approach has been tested and has been shown to enhance the delivery of influenza vaccine to elderly people (Bennett et al., 19943. From 1988 to 1991 internists and family practitioners in private practices in Monroe County, New York, participated in a series of demonstration studies to determine whether a target-based approach could increase the rate of influenza immunizations among elderly people.
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From page 49... ...
Potential immunization partnerships that have not been well studied include collaborations with pharmacists, chiropractors, and other health care providers who are outside the more traditional health care delivery systems. Local health departments can play a major role in coordinating comprehensive efforts at immunizing at-risk populations.
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From page 50... ...
Media efforts were targeted toward this underserved population, and special outreach clinics were staffed by members of the African-American senior citizen community. Partnerships were formed with church leaders, who publicly encouraged immunization with the influenza vaccine, distributed educational materials in church bulletins, and assisted in transporting their church members to special clinics located throughout the inner city.
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From page 51... ...
Preconceptional or adolescent encounters with the health care system are far less frequent, and efforts targeted at nonpregnancy-related health care visits would result in much lower rates of immunization than efforts targeted at pregnant women in the third trimester. Because of the exaggerated concerns about the use of vaccines during pregnancy, the most frequent suggestion is to provide immunizations prior to childbearing.
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