Dr Nair also asserts that pneumococcal bacteremia rarely causes significant morbidity except for meningitis or immunocompromised patients. Yet, pneumococcus is the leading cause of bacterial meningitis in the United States, and meningitis due to pneumococcus is usually more severe than that caused by other organisms. In addition, pneumococcus is the most common bacterial cause of community-acquired pneumonia in young children. Finally, it is becoming increasingly resistant to antibiotics.
Dr Nair’s third concern was equivocal cost-benefit analyses; we agree that the price seems high. We previously discussed societal economic priorities. Regarding psychological burden to the parents, we note from the poliovirus vaccine issue that most parents were willing to accept additional injections to prevent a remote risk of vaccine-associated paralytic polio (1 in 2.4 million distributed doses). We suspect that most parents would be willing to have their child receive an additional injection to prevent the most common cause of bacterial meningitis and pneumonia in young children.
Richard K. Zimmerman MD, MPH
Ilene T. Burns MD, MPH
University of Pittsburgh School of Medicine
Pennsylvania
- OS, Farley M, Harrison LH, Lefkowitz L, McGeer A, Schwartz B. Risk factors for invasive pnuemococcal disease in children: a population-based case-control study in North America. Pediatrics 1999; 103:E28.
- for Disease Control and Prevention. Active bacterial core surveillance (ABCs) report: Emerging Infections Program Network: Streptococcus pneumoniae, 2000. Atlanta, Ga: Emerging Infections Program Network; 2000.
- JP, Butler JC, Farley MM, et al. Cigarette smoking and invasive pneumococcal disease. N Engl J Med 2000; 342:681-89.