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May 1996

An Errant Critique That Misses the Mark

Author Affiliations

National Immunization Program Centers for Disease Control and Prevention Atlanta, GA 30333

Arch Pediatr Adolesc Med. 1996;150(5):464-465. doi:10.1001/archpedi.1996.02170300018004

DR Brown UNFORTUNATELY seemed to have seen the trees but lost sight of the forest in his critique of our article.1 He correctly identified many of the caveats of the Vaccine Adverse Event Reporting System (VAERS), which we have discussed elsewhere2,3 and cited in this article. These shortcomings, such as underreporting, difficulty in determining causal relationship, and lack of precise denominators, are true for all such essentially passive monitoring systems for adverse events after pharmaceutic interventions. An entire new field, pharmacoepidemiology, has sprung into being during the last decade to try to address these difficult issues, which we have attempted to apply to vaccines.3 Nevertheless, almost all of the shortcomings Dr Brown identified would apply equally to VAERS reports after either whole-cell or acellular pertussis vaccinations. The final comparison in VAERS between the 2 vaccines, while not perfectly precise, should still provide accurate relative qualitative and quantitative