Pneumococcal Vaccines and Public Health Policy

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Abstract
It is a good time to ask what has been accomplished with pneumococcal vaccines, now 12 years after their licensure. Breiman et al1 did just that by studying the incidence of pneumococcal bacteremia in Charleston County, South Carolina, for a second time. The first such study was done in the middle 1970s, a decade earlier.2 Charleston is an isolated city with a self-contained medical community and is wellsuited to population-based epidemiologic studies. Pneumococcal bacteremia is a useful sentinel for most severe forms of pneumococcal disease. It is more accurately diagnosed than are most forms of pneumococcal disease and is easier to track. See also p 1401. Surprisingly, Breiman et al found that the annual incidence of pneumococcal bacteremia appeared to have increased 2.3-fold, from 8.5/105 in the middle 1970s to 18.7/105 more recently. The recent figure for Charleston County was higher than another estimate from the