Pneumococcal Vaccines

We recently published an article in The Medical Letter (October 29, 2012) on Pneumococcal Vaccines for Adults. The main point of the article was that the US Advisory Committee on Immunization Practices recommends that a pneumococcal vaccine first developed for use in young children should now be used in adults as well. Not all adults, though. A substantial part of the article deals with which adults should receive which vaccine, and when. We write a lot about vaccines. Our Treatment Guidelines article on Adult Immunizations (last published in December, 2011) has just about all the information any health care provider would need, and there too we pay a lot of attention to who exactly should receive each particular vaccine. We worry about the harm we could do if we gave one more vaccine to one more person for whom it might not be cost-effective.

One sentence in our Medical Letter article on pneumococcal vaccines stands out for me: “None of the pneumococcal vaccines available in the US have had any significant toxicity.” I have a lot of respect for pneumococci. I remember in bacteriology lab when I injected several million of them into the peritoneal cavity of a mouse and came back the next day to check on the effects, its little paws were pointing at the ceiling. Before penicillin, pneumococcal pneumonia was the leading cause of death in the US, and we still see patients who don’t get around to seeking treatment for it until it’s too late. Pneumococcal meningitis is a devastating illness in children and adults alike. Everyone seems to agree that even the old unconjugated pneumococcal vaccine can prevent pneumococcal bacteremia. Maybe we should worry a little less about giving out too many doses of these vaccines, and worry a little more about not giving enough.

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