Childhood immunization is one of the major public health measures of the 20th century and is now receiving special attention from the Clinton administration. At the same time, some parents and health professionals are questioning the safety of vaccines because of the occurrence of rare adverse events after immunization. This volume provides the most thorough literature review available about links between common childhood vaccines?tetanus, diphtheria, measles, mumps, polio, Haemophilus influenzae b, and hepatitis B?and specific types of disorders or death. The authors discuss approaches to evidence and causality and examine the consequences?neurologic and immunologic disorders and death?linked with immunization. Discussion also includes background information on the development of the vaccines and details about the case reports, clinical trials, and other evidence associating each vaccine with specific disorders. This comprehensive volume will be an important resource to anyone concerned about the immunization controversy: public health officials, pediatricians, attorneys, researchers, and parents. Table of Contents Front Matter 1 Executive Summary 2 Causality and Evidence 3 Neurologic Disorders 4 Immunologic Reactions 5 Diphtheria and Tetanus Toxoids 6 Measles and Mumps Vaccines 7 Polio Vaccines 8 Hepatitis B Vaccines 9 Haemophilus influenzae Type b Vaccines 10 Death 11 Need for Research and Surveillance APPENDIX A Executive Summary from Adverse Effects of Pertussis and Rubella Vaccines APPENDIX B Strategies for Gathering Information APPENDIX C Glossary APPENDIX D Committee and Staff Biographies Bibliography Index

Vaccines have made it possible to eradicate the scourge of smallpox, promise the same for polio, and have profoundly reduced the threat posed by other diseases such as whooping cough, measles, and meningitis. What is next? There are many pathogens, autoimmune diseases, and cancers that may be promising targets for vaccine research and development. This volume provides an analytic framework and quantitative model for evaluating disease conditions that can be applied by those setting priorities for vaccine development over the coming decades. The committee describes an approach for comparing potential new vaccines based on their impact on morbidity and mortality and on the costs of both health care and vaccine development. The book examines: Lessons to be learned from the polio experience. Scientific advances that set the stage for new vaccines. Factors that affect how vaccines are used in the population. Value judgments and ethical questions raised by comparison of health needs and benefits. The committee provides a way to compare different forms of illness and set vaccine priorities without assigning a monetary value to lives. Their recommendations will be important to anyone involved in science policy and public health planning: policymakers, regulators, health care providers, vaccine manufacturers, and researchers. Table of Contents Front Matter Executive Summary Introduction Progress in Vaccine Development Considerations of Candidate Vaccines Overview of Analytic Approach and Results Review of the Analytical Model Ethical Considerations and Caveats Observations References Appendix 1: Borrelia burgdorferi Appendix 2: Chlamydia Appendix 3: Coccidioides Immitis Appendix 4: Cytomegalovirus Appendix 5: Enterotoxigenic E. coli Appendix 6: Epstein-Barr Virus Appendix 7: Helicobacter pylori Appendix 8: Hepatitis C Appendix 9: Herpes Simplex Virus Appendix 10: Histoplasma capsulatum Appendix 11: Human Paillomavirus Appendix 12: Influenza A and B Appendix 13: Insulin-Dependent Diabetes Mellitus Appendix 14: Melanoma Appendix 15: Multiple Sclerosis Appendix 16: Mycobacterium tuberculosis Appendix 17: Neisseria gonnorrhea Appendix 18: Neisseria meningitidis Appendix 19: Parainfluenza Virus Appendix 20: Respiratory Syncytial Virus Appendix 21: Rheumatoid Arthritis Appendix 22: Rotavirus Appendix 23: Shigella Appendix 24: Streptococcus, Group A Appendix 25: Streptococcus, Group B Appendix 26: Streptococcus pneumoniae Appendix 27: Information on accessing Electronic Spreadsheets Appendix 28: Summary of Workshops Appendix 29: Questions Posed to Outside Experts and List of Responders Index