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To the Editor: In their review article on the management of chronic obstructive pulmonary disease (COPD), Dr Sin and colleagues¹ recommended that all patients be given pneumococcal vaccine. However, the 3 references they cite in support of this assertion^2-4 discussed only the use of influenza vaccine, and none supported the use of pneumococcal vaccine. A recent Cochrane review concluded that "polysaccharide pneumococcal vaccines do not appear to reduce the incidence of pneumonia or death in adults with or without chronic illness, or in the elderly."⁵

Robert M. Ewart, MD
rewart@siumed.edu
Department of Family & Community Medicine
Southern Illinois University School of Medicine
Springfield

1. Sin DD, McAlister FA, Man SFP, Anthonisen NR. Contemporary management of chronic obstructive pulmonary disease: scientific review. JAMA. 2003;290:2301-2312. FREE FULL TEXT 2. Govaert TM, Thijs CT, Masurel N, Sprenger MJ, Dinant GJ, Knottnerus JA. The efficacy of influenza vaccination in elderly individuals: a randomized double-blind placebo-controlled trial. JAMA. 1994;272:1661-1665. ABSTRACT 3. Nichol KL, Nordin J, Mullooly J, Lask R, Fillbrandt GJ, Iwane M. Influenza vaccination and reduction in hospitalizations for cardiac disease and stroke among the elderly. N Engl J Med. 2003;348:1322-1332. FREE FULL TEXT 4. Vilkman S, Keistinen T, Tuuponen T, Kivela SL. Survival and cause of death among elderly chronic obstructive disease patients after first admission to hospital. Respiration. 1997;64:281-284. ISI | PUBMED 5. Dear K, Holden J, Andrews R, Tatham D. Vaccines for preventing pneumococcal infection in adults. Cochrane Database Syst Rev. 2003;4:CD000422. PUBMED

Letters Section Editor: Stephen J. Lurie, MD, PhD, Senior Editor.

JAMA. 2004;291:1066.

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