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December 28, 1984

Should the Risk of Acquired Immunodeficiency Syndrome Deter Hepatitis B Vaccination?A Decision Analysis

Author Affiliations

From the Clinical Trials Unit (Drs Sacks and Chalmers) and the Departments of Medicine (Drs Sacks, Rose, and Chalmers), Community Medicine (Dr Rose), and Biomathematical Sciences (Dr Sacks), Mount Sinai School of Medicine of The City University of New York.

JAMA. 1984;252(24):3375-3377. doi:10.1001/jama.1984.03350240021031

The current epidemic of acquired immunodeficiency syndrome (AIDS) and fear that its causative agent contaminates the currently available hepatitis B vaccine may have deterred vaccine use. We formulated a decision-analytic model that compares the risk of death from hepatitis B and AIDS in those vaccinated with the risk of death from hepatitis B alone in those who wait two years for a synthetic vaccine. For individuals with 5% annual risk of hepatitis B, the best current estimate is that vaccination now would save 25 lives per 100,000. The best current estimate of the rate of vaccine-induced AIDS is zero, and one can be 95% confident that the rate is less than eight per 100,000. The rate would have to be considerably higher before postponement of vaccination would be rational for those for whom vaccination has been recommended.

(JAMA 1984;252:3375-3377)