and prospects The US Centers for Disease Control and Prevention recommends vaccination against Streptococcus pneumoniae for all people age 65 and older and also for younger people at high risk. However, experts continue to debate the efficacy of the vaccine; most observational studies found it beneficial, while clinical trials were inconclusive as a group. Although pneumococcal vaccination may or may not protect against pneumonia or death from any cause, it does significantly decrease the risk of invasive pneumococcal disease and is worthwhile for this reason. ■ KEY POINTS The 23-valent vaccine induces an antibody response but not a T-cell-mediated or memory response. Antibodies persist for at least 5 years; hence, the interval between doses can be at least this long. Serotype replacement (emergence of S pneumoniae serotypes not covered by the current vaccine) is a worrisome trend. Physicians can boost their vaccination rates by setting up reminder systems and by writing standing orders. Experimental pneumococcal vaccines do not target the polysaccharides contained in the current vaccine but rather bacterial proteins. C URRENT VACCINES against Streptococcus pneumoniae may not be ideal, but they are worthwhile to give to elderly patients and others at risk, such as people with chronic cardiovascular disease, chronic pulmonary disease, diabetes mellitus, or those without a spleen. Pneumococcal disease imposes a considerable burden in terms of deaths, hospitalizations, and health care costs. Whether vaccinating elderly people reduces the rate of death or even of pneumonia is not conclusively proven, but it does reduce the rate of invasive pneumococcal disease and for this reason is cost-saving. In this paper we review the recommendations, trends, and future prospects regarding pneumococcal vaccination in adults
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