Abstract The recent article on pneumococcal vaccine published in the Archives1 provides an unbalanced viewpoint on the issues of the efficacy and use of pneumococcal vaccine in the United States. The authors omit critical information from their discussion of the literature that would greatly weaken their conclusions regarding who the evidence warrants vaccinating. In their introduction, Hirschmann and Lipsky state "the only American population tested with a modern vaccine before approval of the Food and Drug Administration was..."1 and mention the study by Amman et al.2 This is incorrect, since the trials at Kaiser-Permanente and Dorothea Dix3 were conducted well before the approval was given in 1977. One can refute the authors' assertion that the studies of MacLeod et al4 were not relevant, since these studies used polyvalent purified capsular polysaccharides, virtually identical to the ones in use today, but with fewer serotypes included in the References 1. Hirschmann JV, Lipsky BA. The pneumococcal vaccine after 15 years of use. Arch Intern Med . 1994;154:373-377.Crossref 2. Amman AJ, Addiego J, Wara DW, Lubin B, Smith WC. Polyvalent pneumococcal-polysaccharide immunization of patients with sickle-cell anemia and patients with splenectomy. N Engl J Med . 1987;297:897-900.Crossref 3. Austrian R. Surveillance of Pneumococcal Infection for Field Trials of Polyvalent Pneumococcal Vaccines . Bethesda, Md: National Institutes of Health; 1980. Publication DAB-VDP-12-84. 4. MacLeod CM, Hodges RG, Heidelberger M, Bernhard WG. Prevention of pneumococcal pneumonia by immunization with specific capsular polysaccharides. J Exp Med . 1945;82:445-465.Crossref 5. Leech JA, Gervais A, Ruben FL. Efficacy of pneumococcal vaccine in severe chronic obstructive pulmonary disease. Can Med Assoc J . 1987;136:361-365. 6. Simberkoff MS, Cross AP, Al-Ibrahim M, et al. Efficacy of pneumococcal vaccine in high-risk patients: results of a Veterans Administration Cooperative Study. N Engl J Med . 1986;315:1318-1327.Crossref 7. Broome CV, Facklam RR, Frazer DW. Pneumococcal disease after pneumococcal vaccination: an alternative method to estimate the efficacy of pneumococcal vaccine. N Engl J Med . 1989;303:549-552.Crossref 8. Shapiro ED, Clemens JD. A controlled evaluation of the protective efficacy of pneumococcal vaccine for patients at high risk for serious pneumococcal infections. Ann Intern Med . 1984;101:325-330.Crossref 9. Simms RV, Steinman WC, McConville JH, King LR, Zwick WC, Schwartz JS. The clinical effectiveness of pneumococcal vaccine in the elderly. Ann Intern Med . 1988;108:653-657Crossref 10. Shapiro ED, Berg AT, Austrian R, et al. The protective efficacy of polyvalent pneumococcal vaccine. N Engl J Med . 1991;325:1453-1460.Crossref 11. Sisk JE, Riegelman RK. Cost-effectiveness of vaccination against pneumococcal pneumonia: an update. Ann Intern Med . 1986;104:79-86.Crossref 12. Gable CB, Holzer SS, Engelhart L, et al. Pneumococcal vaccine: efficacy and associated cost-savings. JAMA . 1990;264:2910-2915.Crossref 13. Marrie TJ. Durant H, Yates L. Community-acquired pneumonia requiring hospitalization: 5-year prospective study. Rev Infect Dis . 1989;11:586-599.Crossref 14. Fang GD, Fine M, Orloff J, et al. New and emerging etiologies for community-acquired pneumonia with implications for therapy: a prospective multicenter study of 359 cases. Medicine . 1990;69:307-316.Crossref 15. Rodnick JE, Gude JK. Diagnosis and antibiotic treatment of community-acquired pneumonia. West J Med . 1991;154:405-409. 16. John AB, Ramlal A, Jackson H, Maude GH, Sharma AW, Serjeant GR. Prevention of pneumococcal infection in children with homozygous sickle cell disease. BMJ . 1984;288:1567-1570.Crossref 17. Block S, Hedrick J, Wright P, et al. Drug-resistant Streptococcus pneumoniae: Kentucky and Tennessee, 1993. MMWR Morb Mortal Wkly Rep . 1994; 43:23-31. 18. Simpson EH, Carter ML, Hadler JL, et al. Prevalence of penicillin-resistant Streptococcus pneumoniae: Connecticut, 1992-1993. MMWR Morb Mortal Wkly Rep . 1994;43:216-223. 19. Advisory Committee for Immunization Practices. Pneumococcal polysaccharide vaccine. MMWR Morb Mortal Wkly Rep . 1989;38:64-68, 73-76.
Archives of Internal Medicine – American Medical Association
Published: Apr 10, 1995