Patil Rajan R
School of Public Health, SRM University, Epidemiology, Tamil Nadu, India.
Hum Vaccin. 2011 May;7(5):576-8. doi: 10.4161/hv.7.5.14621. Epub 2011 May 1.
There is a need to develop clear cut public health criteria for consideration of new vaccines for use in public health. Most of the vaccines which have become recently available or will soon be available are mostly recommended for use in clinical/office practice. A new vaccine that is highly recommended for use in clinical setting may not be effective at all for larger public health use or may even lack rationale to put it in use for public health. It is stressed that a new vaccine which is proven to be good clinical tool for preventing particular disease at individual level need not necessarily be good public health tool in combating the same disease at community level. The present paper takes a closer look at the logical basis for use of any vaccine in public health. Rabies vaccine is used as a case study to set the background to scrutinize the criteria for eligibility for considering any new vaccine to be included in routine immunization program A rough & ready algorithm is proposed as a check list for a new vaccine as a likely candidate for inclusion in Universal immunization programme.The suggested new algorithm is basically a public health criteria called as Public Health Epidemiological Logic (PHEL) Criteria. The public health debate and the arguments against inclusion of Rabies vaccine in routine national immunization programme in India is a argued in the frame work of PHEL criteria in this paper Rabies vaccine to drive home the point, that a vaccine which is a good clinical tool need not always be a good public health tool, where as a vaccine which is proven to be a good public health tool will always invariably be a good clinical tool as well.
有必要制定明确的公共卫生标准，以考虑用于公共卫生的新疫苗。最近可用或即将可用的大多数疫苗大多被推荐用于临床/门诊实践。一种在临床环境中被强烈推荐使用的新疫苗，对于更大规模的公共卫生用途可能根本无效，甚至可能缺乏用于公共卫生的合理性。需要强调的是，一种在个体层面被证明是预防特定疾病的良好临床工具的新疫苗，在社区层面对抗同一种疾病时不一定是良好的公共卫生工具。本文仔细研究了在公共卫生中使用任何疫苗的逻辑基础。以狂犬病疫苗为例进行研究，以此为背景审视将任何新疫苗纳入常规免疫规划的资格标准。提出了一种粗略但实用的算法，作为新疫苗成为通用免疫规划可能候选疫苗的检查清单。建议的新算法基本上是一种称为公共卫生流行病学逻辑（PHEL）标准的公共卫生标准。本文在PHEL标准的框架内，对印度关于将狂犬病疫苗纳入国家常规免疫规划的公共卫生辩论及反对观点进行了论证。以狂犬病疫苗为例来强调这一点，即一种是良好临床工具 的疫苗不一定总是良好的公共卫生工具，而一种被证明是良好公共卫生工具的疫苗也总是必然会是良好的临床工具。
