THE COMMENTARY on "Pneumococcus Infection in Diabetes Mellitus: Is This a Justification for Immunization?"1 raises an interesting issue. It may indeed be true that the attack rate of pneumococcal pneumonia in well-regulated diabetics is no higher than that in the nondiabetic population, although data to confirm or to refute this view are lacking. The view set forth by the author that "diabetic ketoacidosis is precipitated by infection" is widely held by those knowledgeable about diabetes mellitus. The cited COMMENTARY also states that vascular changes in the course of diabetes may affect a number of organs, including the kidneys and heart, the ultimate failure of which would be a detriment to resistance to pneumococcal infection.
Value of Prophylaxis
The question of the value of prophylaxis for pneumococcal infection may be approached from several points of view. One is to look at the incidence of such infection and to make a judgment
Austrian R, Winegrad AI. Diabetes Mellitus and the Pneumococcus. JAMA. 1980;244(14):1573-1574. doi:10.1001/jama.1980.03310140031023