Pneumococcal Vaccine for High-Risk Patients-Reply

In Reply.  —Doctors Rosner and Zarrabi raise the important issue of considering surgical splenectomy a high-risk condition for serious pneumococcal disease. We concur that such patients should receive pneumococcal vaccine and are concerned that the authors interpreted our study as excluding these patients as vaccine candidates.Our study was based on identifying high-risk patients by age and admitting diagnosis. Splenectomy was not— and is unlikely to be—an admitting diagnosis at a medical service. We included splenectomy, as well as alcoholism and cirrhosis, as high-risk conditions in our retrospective review of medical records, and we demonstrated that only 75% of high-risk patients could be identified by age and admitting diagnosis. There is no disagreement that splenectomized patients should be protected against infection by any safe and effective means available.It is important to understand that the exact risk of serious bacterial infection after splenectomy remains unknown. Thirty years have elapsed since