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Summary of a Report From the Institute of Medicine

Kathleen R. Stratton, PhD; Cynthia Johnson Howe; Richard B. Johnston, Jr, MD

JAMA. 1994;271(20):1602-1605.

Abstract
In September 1993, the Institute of Medicine released a report entitled Adverse Events Associated With Childhood Vaccines: Evidence Bearing on Causality. The report examined putative serious adverse consequences associated with administration of diphtheria and tetanus toxoids; measles, mumps, and measles-mumps-rubella vaccines; oral polio vaccine and inactivated polio vaccine; hepatitis B vaccines; and Haemophilus influenzae type b (Hib) vaccines. The committee spent 18 months reviewing all available scientific and medical data, from individual case reports (published and unpublished) to controlled clinical trials. The committee found that the evidence favored the rejection of a causal relation between diphtheria and tetanus toxoids and encephalopathy, infantile spasms, and sudden infant death syndrome, and between conjugate Hib vaccines and susceptibility to Hib disease. The committee found that the evidence favored acceptance of a causal relation between diphtheria and tetanus toxoids and Guillain-Barré syndrome and brachial neuritis, between measles vaccine and anaphylaxis, between oral polio vaccine and Guillain-Barré syndrome, and between unconjugated Hib vaccine and susceptibility to Hib disease. The committee found that the evidence established causality between diphtheria and tetanus toxoids and anaphylaxis, between measles vaccine and death from measles vaccine—strain viral infection, between measlesmumps-rubella vaccine and thrombocytopenia and anaphylaxis, between oral polio vaccine and poliomyelitis and death from polio vaccine—strain viral infection, and between hepatitis B vaccine and anaphylaxis. For five vaccine-related adverse events, there was no evidence identified. For the remaining 33 vaccine-related adverse events, the evidence was inadequate to accept or reject a causal relation.

(JAMA. 1994;271:1602-1605)

Author Affiliations
From the Institute of Medicine, National Academy of Sciences, Washington, DC (Dr Stratton and Ms Howe), and the March of Dimes Birth Defects Foundation, White Plains, NY, and Yale University School of Medicine, New Haven, Conn (Dr Johnston).

Footnotes
A complete list of the Institute of Medicine committee that conducted the study and associated staff appears at the end of this article.

Reprint requests to the Division of Health Promotion and Disease Prevention, Institute of Medicine, 2101 Constitution Ave NW, Washington, DC 20418 (Dorothy Majewski).

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