Pneumococcal vaccines and public health policy

Article Abstract:

The effectiveness of the pneumococcal vaccines is reviewed by assessing the incidence of pneumococcal bacteremia, the infection of the blood caused by pneumococcal bacteria, over the past 12 years. One study showed that the incidence of pneumococcal bacteremia has increased 2.3-fold, from 8.5 per 100,000 in the late 1970s to 18.7 per 100,000 more recently. This increase may reflect more aggressive diagnostic efforts applied in more recent years. Pneumococcal vaccines were initially prepared with killed whole bacteria, but later a portion of the pneumococcal bacteria called the capsular polysaccharides was used to make the vaccine. Studies of military recruits during World War II showed that vaccines prepared from four different pneumococcal types provided 85 percent protection against pneumonia. Although the vaccines became commercially available in the United States, they were not widely used or profitable and were withdrawn from the market. Research studies stimulated interest in the pneumococcal vaccine in 1964, and various types of pneumococcal vaccines were introduced between 1978 and 1979, and again in 1983. The vaccines were shown to be cost-effective, and believed to be beneficial to persons aged 65 years and older and younger persons with chronic illnesses or conditions associated with a high risk of pneumococcal disease. Pneumococcal vaccines are not very successful among patients with severe suppression of their immune or natural defense system, or with children younger than two years. The use of the pneumococcal vaccine among high-risk groups can be improved if used at hospital discharges, and by informing the elderly by way of the Social Security System of their need to be vaccinated. The variable need for the vaccine in patients with different types of chronic diseases, the effectiveness of the vaccine in patients with suppressed immune systems such as patients with human immunodeficiency virus infection, and the effectiveness of newly developed forms of the pneumococcal vaccine require further investigation. (Consumer Summary produced by Reliance Medical Information, Inc.)

Evaluation, Pneumococcal vaccine, Pneumococcal vaccines, editorial

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Pneumothorax complicating small-bore feeding tube placement

Article Abstract:

Feeding tubes are commonly used in hospitals to nourish patients who can not eat solid food. They are generally passed through the nose, down the throat and esophagus, and into the stomach. In the past, large tubes were used; they were easy to insert, but often caused complications and were uncomfortable to the patient. Recently, smaller, flexible nasogastric tubes have been used with success, but they have been associated with complications as well. During a six-month period at one hospital, three patients who had small feeding tubes inserted developed hydropneumothorax or pneumothorax (air and fluid or air only in the pleural space between the lungs and the rib cage). Apparently, the tubes became misplaced in the trachea (windpipe), which leads to the lungs. In each case, standard methods were used to insert the tube. There have been 10 other reported cases of misplacement of small feeding tubes in the pleural space over the past 4 years. Small feeding tubes should be placed by staff who are appropriately trained. Some tubes now contain internal wire stylets to make insertion easier. Once inserted, the placement of the tube (into the stomach) should be verified with a chest X-ray. If the patient subsequently develops respiratory distress, pneumothorax should be suspected. The incidence of pneumothorax following small feeding tube placement seems to be decreasing as hospital personnel are properly trained in insertion techniques. (Consumer Summary produced by Reliance Medical Information, Inc.)

Equipment and supplies, Pneumothorax, Enteral feeding, Enteral nutrition, Tube feeding

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Autosplenectomy complicating pneumococcal meningitis in an adult

Article Abstract:

The case history is presented of a 56-year-old woman with pneumococcal meningitis (inflammation of the membranes that surround the brain and spinal cord due to pneumococcal organisms) who developed a complication called autosplenectomy. In this condition, the spleen shrinks, and normal spleen tissue is replaced by fibrous (scar-like) tissue. The patient developed fever, headache, and vomiting and was diagnosed as having acute pneumococcal meningitis. Antibiotics were administered and, after an initial deterioration, the patient's condition improved. However, after approximately four weeks, the patient developed acute pain in the left side, particularly when she inhaled. Blood tests showed that her level of thrombocytes (platelets; cells essential for blood clotting to occur) was elevated, indicating a coagulation disorder (hypercoagulability). Examination of the spleen led to the diagnosis of autosplenectomy. After 51 days in the hospital, the patient was discharged and has remained in good health. Hypercoagulability is more commonly associated with sepsis (bloodborne infection) in children than in adults, and this is the first reported case of autosplenectomy in connection with pneumococcal meningitis. (Consumer Summary produced by Reliance Medical Information, Inc.)

Meningitis, Lymphatic diseases

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