Who to Vax: A free online tool to identify adults for pneumococcal vaccination

Abstract

We live in an exciting but sometimes overwhelming time to be practicing medicine. The evidence base for population-based decision making is rapidly advancing and continually changing. At the same time, individual patient details and their clinical relevance may fall through the cracks in our complex integrated medical system, requiring vigilance on our part for capturing those details and for improving systems of care.1 Integrating a personal, patient-centered history and examination with evidence-based guidelines is the new art of medicine. Deciding which version of pneumococcal vaccine to give an adult patient epitomizes the complexity of this integration of personalized care and guidelines. It is now recommended that healthy adults without medical comorbidities receive any form of pneumococcal vaccination until the age of 65 years. At the same time, vaccination against disease-causing serotypes of pneumococcus is known to be an important intervention for prevention of invasive pneumococcal disease in a variety of preexisting comorbid conditions and age groups,2,3 and for these groups, there are both age- and disease-specific recommendations on which version of the vaccine to give. The Centers for Disease Control and Prevention’s (CDC) Advisory Committee on Immunization Practices (ACIP), a group of medical and public health experts who develop recommendations on use of vaccines in the civilian population of the United States, recommends pneumococcal vaccination as beneficial for patients with immunosuppressed states, cigarette smokers, patients with asthma, patients with chronic obstructive pulmonary disease, and other patients who cross our doors routinely.4 For example, patients with asthma are in a higher risk category for invasive pulmonary disease caused by pneumococcus,5–8 and remembering to vaccinate them may yield higher prevention dividends per vaccine than other groups.9