Abstract
A nationwide vaccination program may have direct or indirect health effects that may be anticipated or unanticipated; although these effects are, of course, intended to be beneficial, some potentially adverse ones may occur. The full range of such effects are well illustrated in the important study of the impact of widespread administration of the protein-conjugate pneumococcal vaccine PCV-7 (Prevnar, Wyeth) from the Active Bacterial Core Surveillance of the Centers for Disease Control and Prevention, reported by Kyaw et al. in this issue of the Journal.1 The most obvious direct effect of widespread vaccination of infants with protein-conjugated capsular polysaccharides . . .
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