The recent article on pneumococcal vaccine published in the Archives1 provides an unbalanced viewpoint on the issues of the efficacy and use of pneumococcal vaccine in the United States. The authors omit critical information from their discussion of the literature that would greatly weaken their conclusions regarding who the evidence warrants vaccinating.
In their introduction, Hirschmann and Lipsky state "the only American population tested with a modern vaccine before approval of the Food and Drug Administration was..."1 and mention the study by Amman et al.2 This is incorrect, since the trials at Kaiser-Permanente and Dorothea Dix3 were conducted well before the approval was given in 1977. One can refute the authors' assertion that the studies of MacLeod et al4 were not relevant, since these studies used polyvalent purified capsular polysaccharides, virtually identical to the ones in use today, but with fewer serotypes included in the