Evidence-Based Recommendations—GRADE

See complete list of GRADE materials linked from MMWR

About GRADE

CDC vaccine recommendations are developed using an explicit evidence-based method based on the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach.

Key factors considered in development of recommendations include balance of benefits and harms, type or quality of evidence, values and preferences of the people affected, and health economic analyses.

• Category A recommendations are made for all persons in an age- or risk-factor-based group.
• Category B recommendations are made for individual clinical decision making.
• Evidence tables are used to summarize the benefits and harms and the strengths and limitations of the body of evidence.

Resources for Learning More About GRADE

• GRADE Working Group web site
  Full description and answers to frequently asked questions about GRADE
  • GRADE online learning modules
    These online learning modules are designed to help guideline developers and authors of systematic reviews learn how to use the GRADE approach to grade the evidence in systematic reviews, to create Summary of Findings Tables and GRADE Evidence Profiles, and move from evidence to making recommendation
• Video: The GRADE Approach - An Introductory Workshop on Making Recommendations (recorded September 9, 2011).
  • Video part 1: Overview of the GRADE Approach and the Process [88:07 minutes]
  • Video part 2: Assessing the Quality of Evidence [100:62 minutes]
• Slide presentations:
  • New Framework for Developing Evidence-Based Recommendations by the ACIP [66 pages] – Dr Faruque Ahmed, CDC, December 15, 2011.
  • Guideline Development Using GRADE [5 MB, 235 pages] – Dr Holger Schünemann, McMaster University, Canada; from Introductory GRADE Workshop, Sept 9, 2011.
• Publications:
  • Ahmed F, Lindley MC, Allred N, Weinbaum CM, Grohskopf L. Effect of influenza vaccination of health care personnel on morbidity and mortality among patients: Systematic review and grading of evidence – Clinical Infectious Diseases 2014;58(1):50-7.
  • CDC. New Framework (GRADE) for Development of Evidence-Based Recommendations by the Advisory Committee on Immunization Practices. MMWR. 2012;61(18):327-327.
  • Ahmed F, Temte JL, Campos-Outcalt D, Schünemann HJ. Methods for developing evidence-based recommendations by the ACIP of the CDC – Vaccine 2011;29(49):9171-9176.
  • Matysiak-Klose D, Ahmed F, Duclos P, Falck-Ytter Y, Forland F, Houweling H, et al. Report on the 1st international workshop on procedures for the development of evidence-based vaccination recommendations, Berlin, Germany, 22-23 November 2010 – Vaccine 2012;30(14):2399-404.
• Handbook:
  • Ahmed et al. U.S. ACIP Handbook for Developing Evidence-based Recommendations [52 pages]. Version 1.2. Atlanta, GA: Centers for Disease Control and Prevention (CDC); 2013.
    Practical handbook for use by ACIP Work Groups in development of evidence-based recommendations for presentation to the Advisory Committee on Immunization Practices.
• World Health Organization Vaccine Position Papers:
  • Vaccine Position Papers
    Including Grading of Scientific Evidence documents

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