There are many situations in clinical medicine where the evidence to support one or other approach is incomplete and the efficacy of pneumococcal vaccinations is one such example. This contrasts with the published evidence for other vaccines(e.g. for polio) where the efficacy is such that a firm recommendation for universal immunisation constitutes sound public health policy.
The Thoracic Society of Australia and New Zealand invited one of its members, Dr Paul Torzillo, to review the published literature on pneumococcal vaccine.
1 There view found that the efficacy of pneumococcal vaccine was insufficient to justify comprehensive vaccination of all individuals in all the at risk groups, but the published reports implied that patients with severe disease in the designated categories would probably gain some protection.
Against this background of incomplete published data, recommendations for vaccination cannot be absolute. It is an inevitable consequence of producing summary recommendations which have been derived from a careful analysis of the literature (without publishing the review article itself) that some of the nuances will be lost. I would commend Dr Torzillo's article to those readers who wish to obtain amore detailed appreciation of the background to these recommendations.
In our constant quest for evidence based clinical practice, we must be careful not to over interpret the findings of published papers in the interests of simplicity. To do so would be to move down the road towards 'cook book' medicine.
