Pneumococcal Outbreaks in Nursing Homes

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Abstract
Last winter, the Texas Department of Health called me about an outbreak of pneumococcal pneumonia at a nursing home. When I mentioned the outbreak to my daughter, a third-year medical student, she asked, “How is that possible? Hadn't all the residents of the nursing home been vaccinated?”The elegant epidemiologic study of an outbreak of pneumococcal disease by Nuorti et al. in this issue of the Journal 1 forces us to address the question of why some public health recommendations that are well known to medical students are so poorly implemented. In this outbreak, nearly one quarter of the residents of . . .