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Pneumococcal Vaccine: Clinical Efficacy and Effectiveness

J. SANFORD SCHWARTZ, M.D.
[+] Article and Author Information

Grant support: In part by grant 80304-3H from the John A. Hartford Foundation. Dr. Schwartz is Director, Clinical Efficacy Assessment Project, American College of Physicians; Teaching and Research Scholar, American College of Physicians; and a W.K. Kellogg National Fellow.

▸Requests for reprints should be addressed to J. Sanford Schwartz, M.D., Director; Clinical Efficacy Assessment Project, American College of Physicians, 4200 Pine Street, Philadelphia, PA 19104.


Philadelphia. Pennsylvania


© 1982 American College of PhysiciansAmerican College of Physicians


Ann Intern Med. 1982;96(2):208-220. doi:10.7326/0003-4819-96-2-208
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Streptococcus pneumoniae causes substantial morbidity and mortality. Incidence and severity are increased among populations with some chronic diseases. The currently available polyvalent polysaccharide vaccine induces antibody production among immunologically competent recipients against the 14 serotypes responsible for 80% of pneumococcal bacteremia in the United States. The vaccine is safe and has proved efficacious in clinical trials with healthy young men in epidemic conditions and in patients with sickle cell anemia. Similar trials in two other high-risk populations had inconclusive results. Decisions on vaccine use now largely rest on indirect evidence of efficacy derived from knowledge of disease incidence, severity, and antibody response to vaccination among patient groups. Findings of a literature review suggest vaccinating high-risk patients immunologically competent to produce homotypic antibodies in response to vaccination with polysaccharide antigen, while continuing investigation of disease incidence, severity, serotype distribution, and immunologic response among high-risk groups and postmarketing surveillance efforts among all vaccinated patients.

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