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March 6, 1981

Pneumococcal Vaccination in Diabetes-Reply

JAMA. 1981;245(9):921. doi:10.1001/jama.1981.03310340012010

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In Reply.—  The comments of Dr Beam are appreciated. He has drawn different conclusions from the literature, but he does admit "the incidence of pneumococcus disease in this country is unknown." Before anyone advocates a vaccination program, he should have good data about the incidence of the disease and the costeffectiveness of the program. The swine flu fiasco is an example of the hazards of a massive campaign against a nonexistent disease.The benefits of a vaccination program must be weighed against the danger and the cost of the vaccine. The hazard of polyvalent pneumococcal polysaccharide vaccine is small. However, the cost is too large for the entire population to be immunized. The effort to select high-risk groups is based on old literature and not on modern clinical studies. Infectious diseases specialists who work in teaching hospitals commonly see diabetic derelicts with chronic malnutrition, hyperglycemia, and ketosis. They have no