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The unattainable criteria for new infant vaccines
Christopher J Gill1,2, Lauren Hodsdon1, Mathuram Santosham3,4
1a Department of Global Health , Boston University School of Public Health , Boston , MA , USA.
Insights
Few US infant deaths are vaccine-preventable. While meningococcal vaccines are rare causes of death, they represent a significant portion of currently preventable infant deaths, complicating policy decisions for new vaccines.
Area of Science:
- Public Health
- Immunization Policy
- Pediatric Mortality
Background:
- The US Advisory Committee on Immunization Practices (ACIP) did not recommend meningococcal vaccines for infants in 2013 due to cost-effectiveness.
- This decision prompts an examination of other vaccine-preventable causes of infant mortality in the US.
Purpose of the Study:
- To assess the proportion of US infant deaths that are vaccine-preventable.
- To evaluate the impact of meningococcal disease deaths within the context of all vaccine-preventable infant deaths.
Main Methods:
- Utilized CDC WONDER database to analyze US infant deaths from 2009-2013.
- Categorized causes of death into: currently vaccine-preventable, potentially vaccine-preventable within 10 years, and not preventable.
Main Results:
- Approximately 0.15% (181) of ~122,000 annual infant deaths were preventable with current vaccines.
- An additional 779 deaths were potentially preventable within the next decade.
- Meningococcal deaths constituted a small fraction (≤0.03%) of total infant deaths but represented 17-34% of currently vaccine-preventable deaths.
Conclusions:
- The low overall number of vaccine-preventable infant deaths in the US presents challenges for justifying the addition of new infant vaccines.
- The significant contribution of meningococcal deaths to the preventable category highlights the complexities in vaccine policy decisions.
Background:
In 2013, the US Advisory Committee on Immunization Practices (ACIP) opted against adding meningococcal vaccines to the infant schedule due to poor cost-effectiveness. This raises a policy question: if meningococcal disease is too rare to justify routine vaccination, are there other vaccine-preventable causes of US infant deaths that could be supported?
Methods:
We tabulated US infant deaths from 2009-2013 using the CDC WONDER database. These causes of death were then categorized into one of 3 categories: 1) vaccine-preventable using currently available interventions; 2) potentially vaccine-preventable within the next 10 years; and 3) not preventable.
Results:
From 19.8 million births (3.9 million/year), ∼122,000 infants died (0.62%). Of these, 181 (0.15% of all deaths) were preventable using currently available vaccines, while an additional 779 were categorized as potentially preventable in the next 10 y. By exclusion, 121,040 (99.2%) were judged 'not vaccine-preventable'. Meningococcal deaths contributed at most 0.03% of all infant deaths, but accounted for 17-34% of current vaccine-preventable deaths.
Conclusions:
The low number of vaccine-preventable deaths in the US makes it increasingly difficult to justify the introduction of any new infant vaccines.
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