Lessons learned from making and implementing vaccine recommendations in the U.S.

Abstract

After publication of certain vaccine recommendations made by the Advisory Committee on Immunization Practices, several unexpected events have occurred during implementation of these recommendations. These have included changes in recommendations following adverse events involved with a particular vaccine and the conferral of community protection as an offshoot of vaccination of a specific population. Vaccine shortages and hesitancy have also been proven impediments to full implementation, and vaccine recommendations have not gone unaffected by either public perception of a vaccine or by cost considerations.

Questions regarding the safety and duration of immunity following live yellow fever vaccination

“…Based on this evidence, the Advisory Council on Immunization Practices (ACIP) began recommending the reintroduction of IPV starting in 1997 [88], with an IPV-only schedule adopted by 2000 [93]. Similar to OPV, the first rotavirus vaccine, RotaShield®, represents another example of an attenuated live virus vaccine that was eventually deemed unsafe for routine clinical use [94]. RotaShield was licensed for US markets in 1998, but following an unexpectedly high rate of intussusception reports, ACIP recommendations were rescinded by November of 1999 and the product was removed from the market.…”

“…RotaShield was licensed for US markets in 1998, but following an unexpectedly high rate of intussusception reports, ACIP recommendations were rescinded by November of 1999 and the product was removed from the market. More highly attenuated rotavirus vaccines (Rotarix® and RotaTeq®) only became available 7–10 years later [94]. Retrospective analysis indicates that the increased risk of intussusception from RotaShield was approximately 90–214 excess cases per million vaccinated children [95,96], and the vaccine may have been associated with one death out of an estimated 1.5 million doses administered (<1 per million doses) [97].…”