Letters to the Editor

Pneumococcal Vaccination in Elderly and At-Risk Patients


Am Fam Physician. 1998 May 15;57(10):2346.

to the editor: The article by Drs. King and Pippin1 on initial antibiotic therapy in community-acquired pneumonia was a comprehensive review of drug therapy for patients with community-acquired pneumonia on an outpatient and inpatient basis and in younger versus older adults. However, since community-acquired pneumonia is a common infection and is the leading cause of death related to infectious disease, more emphasis could have been placed on the use of pneumococcal vaccination in controlling or preventing pneumococcal pneumonia in elderly and high-risk patients with chronic disease.

Fedson2 showed in case-control studies and indirect cohort studies that pneumococcal vaccination is effective in preventing invasive pneumococcal disease in patients who are older or who are at higher risk. The Office of Technology Assessment has also shown that pneumococcal vaccination is cost-effective in preventing pneumococcal pneumonia in elderly persons.2 The cohort study showed that patients who were discharged after being treated for pneumonia had a 6 to 9 percent probability of readmission with pneumonia within five years and that each such readmission could be prevented by immunizing discharged patients with pneumococcal vaccine. The study also showed that the costs of vaccination would equal approximately one third the costs of hospital care for unvaccinated patients who were discharged and then readmitted with pneumonia; the authors recommend that elderly patients be immunized with pneumococcal vaccine on discharge from the hospital.

Another article by Gable and colleagues3 evaluated the efficacy and cost savings of the pneumococcal pneumonia vaccine in a retrospective cohort study; the investigators concluded that the pneumococcal vaccine is effective in persons who have had pneumonia, persons who are at risk of developing pneumonia, and persons who are over 50 years of age.

Family physicians need to place greater emphasis on giving pneumococcal vaccine to the elderly and others who are at risk for pneumonia.


1. King DE, Pippin HJ Jr. Community-acquired pneumonia in adults: initial antibiotic therapy. Am Fam Physician. 1997;56:544–50.

2. Fedson DS. Pneumococcal vaccination in the prevention of community-acquired pneumonia: an optimistic view of cost-effectiveness. Semin Respir Infect. 1993;8:285–93.

3. Gable CB, Holzer SS, Engelhart L, Friedman RB, Smeltz F, Schroeder D, et al. Pneumococcal vaccine. Efficacy and associated cost savings. JAMA. 1990;264:2910–5.

Send letters to afplet@aafp.org, or 11400 Tomahawk Creek Pkwy., Leawood, KS 66211-2680. Include your complete address, e-mail address, and telephone number. Letters should be fewer than 400 words and limited to six references, one table or figure, and three authors.

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This series is coordinated by Kenny Lin, MD, MPH, Associate Deputy Editor for AFP Online.



Copyright © 1998 by the American Academy of Family Physicians.
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