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March 3, 2004

Management of Chronic Obstructive Pulmonary Disease—Reply

JAMA. 2004;291(9):1066. doi:10.1001/jama.291.9.1067-a

In Reply: In reponse to Dr Ewart, Butler et al1 reported an efficacy of 57% in preventing pneumococcal sepsis or meningitis by serotypes included in the pneumococcal vaccine, and of 65% in patients with COPD. Robinson et al2 reported that 28.6% of patients with invasive pneumococcal disease were at least 65 years of age, which suggests that the beneficial effects may be even more pronounced in the elderly population. Importantly, 86% of cases in this age group were due to serotypes included in the 23-valent polysaccharide pneumococcal vaccine. Consistent with these data, in a recent Cochrane review that Ewart cites, the authors concluded that " . . . the [pneumococcal] vaccines are effective in reducing the incidence of the more specific outcome, invasive pneumococcal disease, among adults and the immunocompetent elderly (55 years and above)."3 As pneumococcal vaccines are generally safe, we recommend vaccinating patients aged 65 years or older who have COPD.

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