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January 9, 1991

Pneumococcal Vaccination: When in Doubt, Go Ahead

JAMA. 1991;265(2):211. doi:10.1001/jama.1991.03460020065018

To the Editor.—  Although universal immunization against pneumococcal disease is desirable, the calls for blanket immunization presented in the September 5 issue1 do not adequately address two concerns. Notwithstanding "unfounded concerns about adverse reaction," the 1990 Physicians' Desk Reference continues to state, "Re-vaccination of adults is contraindicated... since an increased incidence and severity of adverse reactions among healthy adults receiving such re-injections have been noted." When faced with uncertainty as to whether a patient has had previous vaccination, and with such a dire warning, it is not surprising that many physicians will demur. It is unreasonable to expect the medical community to ignore this risk in today's litigious society.Because many patients are unable to give a reliable history of prior vaccination, more thought should be given to a foolproof system of documenting immunization. Use of a harmless dye in the vaccine, together with a convention that immunization always