The Editorial Executive Committee welcomes letters, which should be less than 250 words. Before a decision to publish is made, letters which refer to a published article may be sent to the author for a response. Any letter may be sent to an expert for comment. When letters are published, they are usually accompanied in the same issue by their responses or comments. The Committee screens out discourteous, inaccurate or libellous statements. The letters are sub-edited before publication. Authors are required to declare any conflicts of interest. The Committee's decision on publication is final.

Letter to the editor

Editor, With respect, the article 'Recommendations for pneumococcal vaccination', a policy developed by the Thoracic Society of Australia and New Zealand (Aust Prescr 1994;17:41) is not a recommendation, it is a 'negative recommendation'.

What is the prescribing doctor to make of it? It starts with 'Analysis of the data available does not support a public health strategy to vaccinate all individuals in a particular at risk group.' The article therefore advises not to immunise if a patient does not fall into an at risk group, but does not advise us to whom within the at risk groups we should offer the vaccine. That is the question that the policy should address.

C.A.W. Collin
General Practitioner
Naracoorte, S.A.

Author's comments

Professor J.P. Seale, the President of the Thoracic Society of Australia and New Zealand, comments:
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.


  1. Torzillo P. Pneumococcal vaccine: current status. Aust NZ J Med 1993;23:285-90.