In special circumstances like the DPT-hepatitis B-Hib vaccine issue, the ACCD requests

external technical assistance to inform recommendations. WHO, for instance, was invited to carry out an independent assessment of causality in the DPT-hepatitis B-Hib and rubella vaccine incidents. The WHO assessment provided an unbiased, second opinion for the Committee to consider. The Committee discussed the findings from both the Expert Committee on AEFI and the WHO assessments – both of which found no conclusive evidence that the DPT-hepatitis B-Hib vaccine caused the deaths – before recommending that the NPI reintroduce the vaccine. Though the decision was not unanimous, the discussions that took place between the Expert Committee on AEFI and WHO further strengthened the capacity of the ACCD to arrive at practical, evidence-based conclusions regarding the future course of action for this vaccine. A similar process was used to respond to the rubella incident, check details which helped the ACCD to counter the widely held belief among the public

and health worker trade unions that it was not anaphylaxis but the inferior quality of the vaccine that caused the death of the child. The ACCD can also recommend health system improvements that will help ensure the success of immunization and other disease control measures. As demonstrated during the DPT-hepatitis B-Hib incident, one selleck screening library drawback in investigating deaths among vaccine recipients in Sri Lanka was the absence of a definitive cause of death, even for deaths in which post mortems had been performed. This was attributed to the fact that Judicial Medical Officers (JMOs), forensic experts who perform autopsies and determine cause of death in homicide cases, conducted these post mortems, but had not been trained to look for pathological causes. The ACCD was able to rectify this by mandating that consultant JMOs use a standardized autopsy protocol when conducting post mortem examinations of all deaths suspected to be immunization-related. A summary of the data required and questions to be answered before the ACCD makes a recommendation about a new vaccine is shown in Fig. 2. To second formulate policy recommendations regarding the

introduction of new vaccines, the ACCD requests a set of data from the Epidemiology Unit. The Unit then appoints a working group, consisting of experts from Ministry of Health agencies, major hospitals, universities and the private sector, to help gather and analyze relevant data concerning the disease and vaccine in question. The Epidemiology Unit may also request technical or financial support from international partners for the collection or analysis of data, in the form of, for instance, an expert, such as a health economist, financing to conduct a local clinical trial, or laboratory training for surveillance studies. The compilation of data on the burden of the disease in question in Sri Lanka is a necessity before the ACCD can approve the introduction of any new vaccine.