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Pneumococcal Vaccine: A Different Perspective-Reply

Jan Hirschmann, MD; Benjamin A. Lipsky, MD
Arch Intern Med. 1994;154(17):1995-1996. doi:10.1001/archinte.1994.00420170143019.
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Our article1 pointed out that the prospective, randomized trials of the pneumococcal vaccine conducted in the United States have not demonstrated any efficacy in the groups for whom it is recommended and that even the retrospective studies, which inherently have less scientific weight but have been widely cited to support the vaccine, do not indicate an impressive effect for immunization. As an example, we suggested that, even if we accepted the numbers for vaccine efficacy derived from the largest case-control trial,2 the costs of immunizing 100 000 adults over 65 years old would substantially exceed the purported benefits. Plouffe and File argue that an analysis of this example actually reveals a cost savings for vaccination, primarily because of the great expense of hospitalizing patients with pneumococcal pneumonia. Their computations, however, rest on several incorrect or dubious premises. Their implication that all elderly patients with pneumococcal pneumonia are hospitalized is


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