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Pneumococcal Vaccine: A Different Perspective

Pneumococcal Vaccine: A Different Perspective Abstract We share the frustration of Hirschmann and Lipsky1 in the dearth of large prospective studies of pneumococcal vaccine in various populations. However, we disagree with the conclusions reached in their article. As clinicians, we must consider the risk-benefit ratio and keep in mind health care costs in our interventions. The risks of pneumococcal vaccine are extremely low. As described by the authors, the magnitude of the benefits will vary depending on the underlying immune status of the host. We would like to expand on the example cited by the authors. If 100 000 elderly subjects were immunized at $20 each for an initial cost of $2 million, only 74 cases (15 bacteremic and 59 nonbacteremic) of pneumococcal disease would be prevented. The mean length of stay for patients in our community-based pneumonia incidence study2 was 13 days for pneumococcal bacteremia and 10 days for nonbacteremic pneumococcal pneumonia (J.F.P. References 1. Hirschmann JV, Lipsky BA. The pneumococcal vaccine after 15 years of use . Arch Intern Med. 1994;154:373-377.Crossref 2. Marston BJ, Plouffe JF, Breiman RF, et al. Preliminary findings of a communitybased pneumonia incidence study . In: Barbaree JM, Breiman RF, Dufour AP, eds. Legionella: Current Status and Emerging Perspectives . Washington, DC: American Society for Microbiology; 1993:36-37. 3. Rodnick JE, Gude JK. Diagnosis and antibiotic treatment of community-acquired pneumonia . West J Med. 1991;154:405-409. 4. Marrie TJ, Durant H, Yates L. Community-acquired pneumonia requiring hospitalization: 5-year prospective study . Rev Infect Dis. 1989;11:586-599.Crossref 5. Fang GD, Fine M, Orloff J, et al. New and emerging etiologies for communityacquired pneumonia with implications for therapy: a prospective multicenter study of 359 cases . Medicine . 1990;69:307-316.Crossref 6. Plouffe JF, Breiman RF, CBPIS Group. Selection bias may interfere with interpretation of pneumonia antibiotic efficacy trials . Presented at the 94th Annual Meeting of the American Society of Microbiology; May 1994; Las Vegas, Nev . 7. Centers for Disease Control and Prevention. Drug resistant Streptococcus pneumoniae: Kentucky and Tennessee . MMWR Morb Mortal Wkly Rep. 1994;43: 23-25. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Internal Medicine American Medical Association

Pneumococcal Vaccine: A Different Perspective

Pneumococcal Vaccine: A Different Perspective

Abstract

Abstract We share the frustration of Hirschmann and Lipsky1 in the dearth of large prospective studies of pneumococcal vaccine in various populations. However, we disagree with the conclusions reached in their article. As clinicians, we must consider the risk-benefit ratio and keep in mind health care costs in our interventions. The risks of pneumococcal vaccine are extremely low. As described by the authors, the magnitude of the benefits will vary depending on the underlying immune status of...
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Publisher
American Medical Association
Copyright
Copyright © 1994 American Medical Association. All Rights Reserved.
ISSN
0003-9926
eISSN
1538-3679
DOI
10.1001/archinte.1994.00420170143018
Publisher site
See Article on Publisher Site

Abstract

Abstract We share the frustration of Hirschmann and Lipsky1 in the dearth of large prospective studies of pneumococcal vaccine in various populations. However, we disagree with the conclusions reached in their article. As clinicians, we must consider the risk-benefit ratio and keep in mind health care costs in our interventions. The risks of pneumococcal vaccine are extremely low. As described by the authors, the magnitude of the benefits will vary depending on the underlying immune status of the host. We would like to expand on the example cited by the authors. If 100 000 elderly subjects were immunized at $20 each for an initial cost of $2 million, only 74 cases (15 bacteremic and 59 nonbacteremic) of pneumococcal disease would be prevented. The mean length of stay for patients in our community-based pneumonia incidence study2 was 13 days for pneumococcal bacteremia and 10 days for nonbacteremic pneumococcal pneumonia (J.F.P. References 1. Hirschmann JV, Lipsky BA. The pneumococcal vaccine after 15 years of use . Arch Intern Med. 1994;154:373-377.Crossref 2. Marston BJ, Plouffe JF, Breiman RF, et al. Preliminary findings of a communitybased pneumonia incidence study . In: Barbaree JM, Breiman RF, Dufour AP, eds. Legionella: Current Status and Emerging Perspectives . Washington, DC: American Society for Microbiology; 1993:36-37. 3. Rodnick JE, Gude JK. Diagnosis and antibiotic treatment of community-acquired pneumonia . West J Med. 1991;154:405-409. 4. Marrie TJ, Durant H, Yates L. Community-acquired pneumonia requiring hospitalization: 5-year prospective study . Rev Infect Dis. 1989;11:586-599.Crossref 5. Fang GD, Fine M, Orloff J, et al. New and emerging etiologies for communityacquired pneumonia with implications for therapy: a prospective multicenter study of 359 cases . Medicine . 1990;69:307-316.Crossref 6. Plouffe JF, Breiman RF, CBPIS Group. Selection bias may interfere with interpretation of pneumonia antibiotic efficacy trials . Presented at the 94th Annual Meeting of the American Society of Microbiology; May 1994; Las Vegas, Nev . 7. Centers for Disease Control and Prevention. Drug resistant Streptococcus pneumoniae: Kentucky and Tennessee . MMWR Morb Mortal Wkly Rep. 1994;43: 23-25.

Journal

Archives of Internal MedicineAmerican Medical Association

Published: Sep 12, 1994

References