LEADER 11635nam 2200745Ia 450 001 9910960560903321 005 20251017110129.0 010 $a9786610191840 010 $a9780309174985 010 $a0309174988 010 $a9781280191848 010 $a1280191848 010 $a9780309564434 010 $a0309564433 035 $a(CKB)110986584751938 035 $a(OCoLC)70773575 035 $a(CaPaEBR)ebrary10068346 035 $a(SSID)ssj0000285219 035 $a(PQKBManifestationID)11193820 035 $a(PQKBTitleCode)TC0000285219 035 $a(PQKBWorkID)10278691 035 $a(PQKB)10015213 035 $a(MiAaPQ)EBC3377114 035 $a(Au-PeEL)EBL3377114 035 $a(CaPaEBR)ebr10068346 035 $a(OCoLC)923268352 035 $a(Perlego)4734006 035 $a(DNLM)935930 035 $a(EXLCZ)99110986584751938 100 $a20000229d2000 uy 0 101 0 $aeng 135 $aurcn||||||||| 181 $ctxt 182 $cc 183 $acr 200 10$aVaccines for the 21st century $ea tool for decisionmaking /$fKathleen R. Stratton, Jane S. Durch, and Robert S. Lawrence, editors ; Committee to Study Priorities for Vaccine Development, Division of Health Promotion and Disease Prevention, Institute of Medicine 205 $a1st ed. 210 $aWashington, D.C. $cNational Academy Press$dc2000 215 $a1 online resource (472 p.) 300 $aBibliographic Level Mode of Issuance: Monograph 311 08$a9780309056465 311 08$a0309056462 320 $aIncludes bibliographical references and index. 327 $aVaccines for the 21st Century -- Copyright -- Acknowledgments -- Contents -- Executive Summary -- THE ANALYTIC FRAMEWORK -- ETHICAL ISSUES -- RESULTS -- OBSERVATIONS -- 1 Introduction -- CONSIDERATIONS RELATED TO THE MODEL AND THE STUDY -- ORGANIZATION OF THE REPORT -- Charge to the Committee -- Committee Membership and Meetings -- Organization of the Report -- 2 Progress in Vaccine Development -- PRIORITIES OF THE IOM COMMITTEE IN 1985 -- LITIGATION AS A BARRIER TO VACCINE DEVELOPMENT -- Immunization of Pregnant Women -- A CASE STUDY OF SUCCESS -- Disease Burden -- Polio Vaccine Development -- Advantages of Evolving Vaccine Strategies -- ADVANCES IN BIOTECHNOLOGY AND MOLECULAR IMMUNOLOGY AND NEW OPPORTUNITIES FOR VACCINES -- Fundamental Understanding of Helper T Cells for Antibody Versus CMI Responses, and for Cytotoxicity -- Major Advances in Mucosal Immunity -- Mucosal Immune System Organization -- Molecular Aspects of Virulence and Design of Recombinant Protein Vaccines -- Novel Vaccine Delivery Systems -- Recent Advances in Development of Novel Adjuvants -- Scientific Rationale for Vaccines against Autoimmune Diseases -- Immune Tolerance Induction -- Immune Deviation -- Receptor-Centered Regulation -- Targeting Cytokines or Their Receptors -- Viral Vectors in Autoimmune Therapy -- Preventive Vaccines for Autoimmune Diseases -- 3 Considerations of Candidate Vaccines -- EXCLUSION CRITERIA -- Insufficient Basic Science Information -- Existence of Appropriate Prevention Interventions -- International Burden of Disease -- ADDITIONAL CONSIDERATIONS FOR INCLUSION -- Therapeutic Vaccines -- Programmatic Considerations -- Delivery of Vaccines to Children -- Delivery of Vaccines to Adults -- Delivery of Vaccines to Pregnant Women -- 4 Overview of Analytic Approach and Results -- A COST-EFFECTIVENESS APPROACH. 327 $aReasons for Using Cost-Effectiveness Analysis -- Limits of Cost-Effectiveness Analysis -- Ethical Issues -- Analytic Perspectives -- Time Horizon and Discounting -- MODEL OVERVIEW -- Health Benefits: The Denominator -- Quality Adjustments: Weighting -- Morbidity Scenarios -- Quality Adjustments for Average Population Health States -- Disease Incidence and Death Rates -- Time Intervals -- QALYs Gained with Vaccine Use -- Costs: The Numerator -- Cost of Research and Development -- Cost of Vaccine Use -- Health Care Costs -- Vaccine Efficacy and Utilization -- Cost-Effectiveness Ratios -- Exclusions from the Analysis -- EXAMPLES: HYPOTHETICAL VACCINE X -- Target Population -- Program Considerations -- Disease Severity -- Discounting -- An Idealized Scenario -- Summary -- RESULTS -- Challenges -- 5 Review of the Analytic Model -- UNIT OF ANALYSIS -- IMPLEMENTING THE ANALYSIS -- Basic Model -- Performing the Analysis -- CALCULATION OF HEALTH BENEFITS -- Quality-Adjusted Life Years -- Quality-Adjustment Weights Based on the Health Utilities Index -- Steps in the Calculation of Anticipated Health Benefits from Vaccine Use -- Develop Morbidity Scenarios -- Calculate Quality-Adjustment Weights -- Calculate Discounted Quality-Adjusted Life Expectancies -- Establish Age-Specific Incidence and Death Rates -- Calculate Time Intervals for Discounting Future Health Benefits -- Calculate Condition-Related Life Expectancies -- Adjust for the Underlying Health Status of the Population -- Calculate Discounted QALYs for Each Health State -- Calculate Total QALYs Gained with Vaccine Use -- COST FACTORS -- Vaccine Development -- Vaccine Use -- Cost of Care -- VACCINE EFFICACY AND UTILIZATION -- COST-EFFECTIVENESS RATIOS -- 6 Ethical Considerations and Caveats -- ETHICAL AND VALUE JUDGMENTS BUILT INTO THE MODEL -- All QALYs Count Equally. 327 $aYears of Life at Different Ages Are Weighted by Quality -- The Value of Life Extension with and without Disabilities -- Discount Rates for Costs and Benefits -- Which Benefits and Costs Should Be Counted in the Prioritization Process? -- CONSIDERATIONS OF JUSTICE -- Small Benefits to Many Versus Large Benefits to a Few -- What Priority Should Be Given to the Worst-Off or Sickest? -- Fair Chances Versus Best Outcomes -- CONCLUSION -- 7 Observations -- THE FUNDING OF RESEARCH -- NEGLECTED OPPORTUNITIES FOR VACCINE R& -- D -- International Considerations -- Small Target Populations -- Liability Concerns -- QUALITATIVE JUDGMENTS -- VACCINE PROGRAM CONCERNS -- References -- APPENDIX 1 Borrelia burgdorferi -- DISEASE BURDEN -- Epidemiology -- Disease Scenarios -- COST INCURRED BY DISEASE -- VACCINE DEVELOPMENT -- VACCINE PROGRAM CONSIDERATIONS -- Target Population -- Vaccine Schedule, Efficacy, and Costs -- RESULTS -- READING LIST -- APPENDIX 2 Chlamydia -- DISEASE BURDEN -- Epidemiology -- Disease Scenarios: Women -- Disease Scenarios: Men -- Disease Scenarios: Infants -- COSTS INCURRED BY DISEASE -- VACCINE DEVELOPMENT -- VACCINE PROGRAM CONSIDERATIONS -- Target Population -- Vaccine Schedule, Efficacy, and Costs -- RESULTS -- READING LIST -- APPENDIX 3 Coccidioides immitis -- DISEASE BURDEN -- Epidemiology -- Disease Scenarios -- COST INCURRED BY DISEASE -- VACCINE DEVELOPMENT -- VACCINE PROGRAM CONSIDERATIONS -- Target Population -- Vaccine Schedule, Efficacy, and Costs -- RESULTS -- READING LIST -- APPENDIX 4 Cytomegalovirus -- DISEASE BURDEN -- Epidemiology -- Disease Scenarios -- COST INCURRED BY DISEASE -- VACCINE DEVELOPMENT -- VACCINE PROGRAM CONSIDERATIONS -- Target Population -- Vaccine Schedule, Efficacy, and Costs -- RESULTS -- READING LIST -- APPENDIX 5 Enterotoxigenic E. coli -- DISEASE BURDEN -- Epidemiology -- Disease Scenarios. 327 $aCOST INCURRED BY DISEASE -- VACCINE DEVELOPMENT -- VACCINE PROGRAM CONSIDERATIONS -- Target Population -- Vaccine Schedule, Efficacy, and Costs -- RESULTS -- READING LIST -- APPENDIX 6 Epstein-Barr Virus -- DISEASE BURDEN -- Epidemiology -- Disease Scenarios -- COST INCURRED BY DISEASE -- VACCINE DEVELOPMENT -- VACCINE PROGRAM CONSIDERATIONS -- Target Population -- Vaccine Schedule, Efficacy, and Costs -- RESULTS -- READING LIST -- APPENDIX 7 Helicobacter pylori -- DISEASE BURDEN -- Epidemiology -- Disease Scenarios -- COST INCURRED BY DISEASE -- VACCINE DEVELOPMENT -- VACCINE PROGRAM CONSIDERATIONS -- Target Population -- Vaccine Schedule, Efficacy, and Costs -- RESULTS -- READING LIST -- APPENDIX 8 Hepatitis C -- DISEASE BURDEN -- Epidemiology -- Disease Scenarios -- COST INCURRED BY DISEASE -- VACCINE DEVELOPMENT -- VACCINE PROGRAM CONSIDERATIONS -- Target Population -- Vaccine Schedule, Efficacy, and Costs -- RESULTS -- READING LIST -- APPENDIX 9 Herpes Simplex Virus -- DISEASE BURDEN -- Epidemiology -- Disease Scenarios -- Oral Infections -- Ocular Infections -- Central Nervous System Infections -- Genital Infections -- Neonatal Infections -- COST INCURRED BY DISEASE -- Oral and Ocular Infections -- Central Nervous System Infections -- Genital Infections -- Neonatal Infections -- VACCINE DEVELOPMENT -- VACCINE PROGRAM CONSIDERATIONS -- Target Population -- Vaccine Schedule, Efficacy, and Costs -- RESULTS -- READING LIST -- APPENDIX 10 Histoplasma capsulatum -- DISEASE BURDEN -- Epidemiology -- Disease Scenarios -- COST INCURRED BY DISEASE -- VACCINE DEVELOPMENT -- VACCINE PROGRAM CONSIDERATIONS -- Target Population -- Vaccine Schedule, Efficacy, and Costs -- RESULTS -- READING LIST -- APPENDIX 11 Human Papillomavirus -- DISEASE BURDEN -- Epidemiology -- Disease Scenarios -- COST INCURRED BY DISEASE -- VACCINE DEVELOPMENT. 327 $aVACCINE PROGRAM CONSIDERATIONS -- Target Population -- Vaccine Schedule, Efficacy, and Costs -- RESULTS -- READING LIST -- APPENDIX 12 Influenza A and B -- DISEASE BURDEN -- Epidemiology -- Disease Scenarios -- COST INCURRED BY DISEASE -- VACCINE DEVELOPMENT -- VACCINE PROGRAM CONSIDERATIONS -- Target Population -- Vaccine Schedule, Efficacy, and Costs -- RESULTS -- READING LIST -- APPENDIX 13 Insulin-Dependent Diabetes Mellitus -- DISEASE BURDEN -- Epidemiology -- Disease Scenarios -- COST INCURRED BY DISEASE -- VACCINE DEVELOPMENT -- VACCINE PROGRAM CONSIDERATIONS -- Target Population -- Vaccine Schedule, Efficacy, and Costs -- RESULTS -- READING LIST -- APPENDIX 14 Melanoma -- DISEASE BURDEN -- Epidemiology -- Disease Scenarios -- COST INCURRED BY DISEASE -- VACCINE DEVELOPMENT -- VACCINE PROGRAM CONSIDERATIONS -- Target Population -- Vaccine Schedule, Efficacy, and Costs -- RESULTS -- READING LIST -- APPENDIX 15 Multiple Sclerosis -- DISEASE BURDEN -- Epidemiology -- Disease Scenarios -- COST INCURRED BY DISEASE -- VACCINE DEVELOPMENT -- VACCINE PROGRAM CONSIDERATIONS -- Target Population -- Vaccine Schedule, Efficacy, and Costs -- RESULTS -- READING LIST -- APPENDIX 16 Mycobacterium tuberculosis -- DISEASE BURDEN -- Epidemiology -- Disease Scenarios -- COST INCURRED BY DISEASE -- VACCINE DEVELOPMENT -- VACCINE PROGRAM CONSIDERATIONS -- Target Population -- Vaccine Schedule, Efficacy, and Costs -- RESULTS -- READING LIST -- APPENDIX 17 Neisseria gonorrhea -- DISEASE BURDEN -- Epidemiology -- Disease Scenarios -- COST INCURRED BY DISEASE -- VACCINE DEVELOPMENT -- VACCINE PROGRAM CONSIDERATIONS -- Target Population -- Vaccine Schedule, Efficacy, and Costs -- RESULTS -- READING LIST -- APPENDIX 18 Neisseria meningitidis B -- DISEASE BURDEN -- Epidemiology -- Disease Scenarios -- COST INCURRED BY DISEASE -- VACCINE DEVELOPMENT. 327 $aVACCINE PROGRAM CONSIDERATIONS. 517 3 $aVaccines for the twenty first century 606 $aVaccines$xResearch$zUnited States$xPlanning 606 $aImmunization$xResearch$zUnited States$xPlanning 615 0$aVaccines$xResearch$xPlanning. 615 0$aImmunization$xResearch$xPlanning. 676 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