The changing fate of pneumonia as a public concern in 20th-century: America and beyond

American Journal of Public Health

Volumn 95, Issue 12, 2005, Pages 2144-2154

  Podolsky, Scott H ^a,b  

^a MASSACHUSETTS GENERAL HOSPITAL   (United States)

^b NONE   (United States)

Author keywords

[No Author keywords available]

Indexed keywords

ANTIBIOTIC AGENT; ANTISERUM; PENICILLIN DERIVATIVE; PNEUMOCOCCUS VACCINE; SULFONAMIDE;

ANTIBIOTIC RESISTANCE; ANTIBIOTIC THERAPY; HOSPITAL INFECTION; HUMAN; INFECTION CONTROL; LOBAR PNEUMONIA; MYCOBACTERIUM TUBERCULOSIS; PREDICTION; PRESCRIPTION; PRIVATE PRACTICE; PUBLIC HEALTH; REVIEW; SPUTUM CULTURE; STREPTOCOCCUS PNEUMONIAE; UNITED STATES;

HISTORY, 20TH CENTURY; HISTORY, 21ST CENTURY; HUMANS; PNEUMONIA; PUBLIC HEALTH; PUBLIC HEALTH PRACTICE; UNITED STATES;

EID: 28444470860     PISSN: 00900036     EISSN: None     Source Type: Journal    
DOI: 10.2105/AJPH.2004.048397     Document Type: Review

References (139)

1. See Pneumonia: Mortality and Measures for Prevention (Washington, DC: US Treasury Department and US Public Health Service, 1938);
2. "Parran Urges Funds for War on Pneumonia," Washington Post, November 13, 1937;
3. "Progress of Programs for Pneumonia Control," Bulletin of Lederle Laboratories 6 (1938): 118-119.
4. For earlier assessments of pneumonia's brief transformation into a national public health concern, see Harry F. Dowling, "Frustration and Foundation: Management of Pneumonia Before Antibiotics," Journal of the American Medical Association 220 (1972): 1341-1345;
5. Harry F. Dowling, "The Rise and Fall of Pneumonia-Control Programs," Journal of Infectious Diseases 127 (1973): 201-206.
6. William Osler, The Principles and Practice of Medicine (New York: D. Appleton and Company, 1892), 529.
7. G. Klemperer and F. Klemperer, "Versuche uber Immunisiring und Heilung bei der Pneumokokkeninfection," Berlin Klinische Wochenschrifi 28 (1891): 833-835;
8. as discussed in Edwin A. Locke, "The Serological Treatment of Lobar Pneumonia," Boston Medical and Surgical Journal 190 (1924): 196-203.
9. A. R. Dochez and L. J. Gillespie, "A Biologic Gassification of Pneumococci by Means of Immunity Reactions," Journal of the American Medical Association 61 (1913): 727-730.
10. Cole had been influenced in this regard through visiting Fred Neufeld's laboratory in Berlin, where Neufeld had already begun such subclassification. See Rufus Cole to F. Neufeld, April 22, 1910; F. Neufeld to Rufus Cole, April 3, 1912; both in the Rufus Cole Papers, American Philosophical Society, Philadelphia (hereafter called RCP). Regarding parallel efforts by F. Spencer Lister in South Africa at the time, see Robert Austrian, "Of Gold and Pneumococci: A History of Pneumococcal Vaccines in South Africa," Transactions of the American Clinical and Climatological Association 89 (1977): 141-161.
11. Regarding the prevalence of pneumococci as agents of lobar pneumonia, see Oswald T. Avery, H. T. Chickering, Rufus Cole, and A. R. Dochez, Acute Lobar Pneumonia: Prevention and Serum Treatment (New York: Rockefeller Institute for Medical Research, 1917), 7.
12. Avery et al., Acute Lobar Pneumonia, 79.
13. Russell L. Cecil and W D. Sutliff, "The Treatment of Lobar Pneumonia With Concentrated Antipneumococcus Serum," Journal of the American Medical Association 91 (1928): 2035-2042;
14. William H. Park, Jesse G. M. Bullowa, and Milton B. Rosenblüth, "The Treatment of Lobar Pneumonia With Refined Specific Antibacterial Serum," Journal of the American Medical Association 91 (1928): 1503-1508;
15. Maxwell Finland, "The Serum Treatment of Lobar Pneumonia," New England Journal of Medicine 202 (1930): 1244-1247.
16. Regarding Metropolitan Life's involvement, see An Epoch in Life Insurance: A Third of a Century of Achievement. Thirty-Three Years of Administration of the Metropolitan Life Insurance Company (New York: Metropolitan Life Insurance Company, 1924), 226-227.
17. See also Milton J. Rosnenau to Lee K. Frankel, June 20, 1919; Lee K. Frankel to Milton J. Rosenau, June 24, 1919; both in Lee Frankel Papers, Box 13, American Jewish Historical Society.
18. Rufus Cole and A. R. Dochez, "Report of Studies on Pneumonia," Transactions of the Association of American Physicians 28 (1913): 606-616.
19. See, for example, Harlow Brooks, "The Treatment of Pneumonia," Medical Clinics of North America 5 (1922): 993-1006;
20. H. T Nippert, "Treatment of Pneumonia," Minnesota Medicine 6 (1923): 534-538;
21. LA. Nippert, "Prognosis and General Management of the Pneumonias," Journal-Lancet 41 (1921): 66-71.
22. Roderick Heffron, "Massachusetts Pneumonia Program," New England Journal of Medicine 206 (1932): 328-329.
23. For "fascinating administrative experiment," see George H. Bigelow [commissioner of the Massachusetts Department of Health], "Progress Report on Lobar Pneumonia Service Study," submitted with George H. Bigelow to Barbara Quin, October 24, 1931, Folder 1728, Box 184, RG 18.1, Rockefeller Archive Center, Sleepy Hollow, NY (hereafter called RAC). For an insightful, yet less sanguine assessment of the Massachusetts Pneumonia Study and Service than that presented here, see Harry M. Marks, The Progress of Experiment: Science and Therapeutic Reform in the United States, 1900-1990 (New York: Cambridge University Press, 1997), 60-65.
24. Roderick Heffron and Gaylord W. Anderson, "Two Years' Study of Lobar Pneumonia in Massachusetts,"Journal of the American Medical Association 101 (1933): 1286-1289.
25. George Bigelow, "The Serum Treatment of Pneumonia," New England Journal of Medicine 205 (1931): 242-246.
26. Roderick Heffron, "A Study of Lobar Pneumonia in Massachusetts: Preliminary Report," New England Journal of Medicine 207 (1932): 153-159.
27. Roderick Heifron, "Final Report of Massachusetts Pneumonia Study and Service," Commonwealth 24 (1937): 6-68. See also "The Massachusetts Pneumonia Program: A Report to the Commonwealth Fund of Eighteen Months' Progress," mailed "under separate cover" from George H. Bigelow to Barbara Quin, August 22, 1932, and received August 24, 1932, Folder 1729, Box 184, RG 18.1, RAC.
28. Frederick Lord, in Heffron, "A Study of Lobar Pneumonia in Massachusetts," 157.
29. In "The Massachusetts Pneumonia Program: A Report to the Commonwealth Fund of Approximately Three Year's [sic] Work," accompanying Henry D. Chadwick to Barbara Quin, October 13, 1933, Folder 1731, Box 184, RG 18.1, RAC.
30. See George H. Bigelow to Barbara Quin, August 22, 1932, Folder 1729, Box 184, RG 18.1, RAC.
31. Heffron and Ajiderson, "Two Years' Study of Lobar Pneumonia in Massachusetts," 1286.
32. Heffron, "A Study of Lobar Pneumonia in Massachusetts," 156.
33. Heffron, "Final Report of Massachusetts Pneumonia Study and Service," 51.
34. Ibid, 52.
35. "Plan of Pneumonia Study for 1934 and 1935," accompanying Henry D. Chadwick to Barbara Quin, October 13, 1933, Folder 1731, Box 184, RG 18.1, RAC. For the history of the treatment of poliomyelitis with antiserum, see Naomi Rogers, Dirt and Disease: Polio Before FOR (New Brunswick, NJ: Rutgers University Press, 1992), 96-105.
36. Heffron, "Final Report of Massachusetts Pneumonia Study and Service," 39.
37. Ibid, 40.
38. Roderick Heffron, "The Campaign Against Pneumonia," New England Journal of Medicine 214 (1936): 222-223.
39. See George H. Ramsey to Barbara S. Quinn [sic], September 10, 1935, as well as accompanying "Proposal for a Pneumonia Control Program in New York State," Folder 2374, Box 249, RG 18.1, RAC.
40. Marks, Progress of Experiment, 65-66; Clarence Scamman to Barbara Quin, March 14, 1936; Clarence Scamman, "Report of Attendance at New York State Pneumonia Committee Meeting at Saratoga Springs," June 23, 1936; both in Folder 2375, Box 249, RG 18.1, RAC; George Ramsey to Barbara Quin, September 24, 1936; George H. Ramsey, "Report on Pneumonia Control Program of the New York State Department of Health," August 15, 1936; Barry C. Smith to George Ramsey, September 25, 1936; Barbara S. Quin to Edward S. Godfrey, September 21, 1936; all in Folder 2376, Box 249, RG 18.1, RAC.
41. Thomas Parran to Drs. Paul Brooks, Edward Godfrey, Augustus Wadsworth, and George Ramsey, May 7, 1935, Box 16, FF 147. Thomas Parran Papers, Archives Service Center, University of Pittsburgh (hereafter called TPP).
42. James G. Burrow, A.M.A.: Voice of American Medicine (Baltimore, MD: Johns Hopkins University Press, 1963), 191-204;
43. Daniel S. Hirshfield, The Lost Reform: The Campaign for Compulsory Health Insurance in the United States From 1932 to 1943 (Cambridge, MA: Harvard University Press, 1970) ;
44. Paul Starr, The Social Transformation of American Medicine: The Rise of a Sovereign Profession and the Making of a Vast Industry (New York: Basic Books, 1982), 260-261, 270-279;
45. Jonathan Engel, Doctors and Reformers: Discussion and Debate Over Health Policy, 1925-1950 (Columbia, SC: University of South Carolina Press, 2002), 60-65.
46. Thomas Parran, "Expanding Frontiers of Health [broadcast, New York Medical Society, WABC, New York City, April 29, 1936]," Box 35, FF 408, TPP.
47. Thomas Parran, "Address [Missouri Public Health Association, May 14, 1938]." Box 38, FF 487. TPP. Pennsylvania's state pneumonia control program, among the largest in the nation, had originated in 1937.
48. Thomas Parran, "Public Health Today [address given before International Medical Assembly of the Inter-State Post-Graduate Association, St. Paul, October 14, 1936]," Box 35, FF 412, TPP.
49. Ibid. Parran had actually continued this particular speech by noting that "pneumonia control Furnishes a notable example of the need for cooperative effort."
50. See, for example, Lucy S. Heathman, O. McDaniel, and A. J. Chesley, "Pneumonia in Minnesota: What Can Be Done About It?" Minnesota Medicine 20 (1937): 2-3;
51. 66th Annual Report of the Commissioner of the Michigan Department of Health for the Fiscal Year Ending June 30, 1938 (Lansing, Ml: Franklin Dekleine Company, 1940), 75;
52. Roy L. Cleere, in Claude D. Head. "Serum Therapy in Pneumococci Pneumonia and Reduction in Pneumonia Mortality," Rocky Mountain Medical Journal 36 (1939): 22-23;
53. Illinois Department of Public Health, 22nd Annual Report of the Department of Health, July 1, 1938-June 30, 1939, 70;
54. Annual Report of State Department of Health, Commonwealth of Virginia for the Year Ending June 30, 1940 (Richmond, VA: Division of Purchase and Printing), 27-28;
55. Harrison F. Flippin, "Modern Control of Pneumonia," Journal of the Missouri State Medical Association 38 (1941): 398-400.
56. Dowling, "Rise and Fall of Pneumonia-Control Programs," 203; Annual Report of the Surgeon General of the Public Health Service of the United States for the Fiscal Year 1937 Washington, DC: US Public Health Service, 1937), 17;
57. Annual Report of the Surgeon General of the Public Health Service of the United States for the Fiscal Year 1940 (Washington, DC: US Public Health Service, 1940), 17.
58. Illinois Department of Public Health, 22nd Annual Report of the Department of Health, 7;
59. See also Howard A. Lindberg, "The Illinois Pneumonia Control Program," Illinois Medical Journal 76 (1939): 85-90.
60. Dowling, "Rise and Fall of Pneumonia-Control Programs," 203; Rufus Cole to Wheelan Sutliff, December 9, 1937; Rufus Cole to Roderick Heffron, January 30, 1937; both in RCP.
61. Roderick Heffron to Maxwell Finland, December 22, 1937, Maxwell Finland Papers, Countway Medical Library, Harvard Medical School, Boston.
62. See, for example, New Methods for Pneumonia Control: Reproduction of Charts Shown in the Scientific Exhibit at the Annual Meeting of the American Medical Association, San Francisco, June 13-17, 1938 (New York: Metropolitan Life Insurance Company, 1938);
63. Pneumonia: Some Important Facts Regarding Treatment and Control (Washington, DC: US Public Health Service, 1940).
64. "The Pneumonia Film, 'A New Day,'" Journal of the American Medical Association 110 (1938): 514;
65. "Teaching Health With Metropolitan Films," Metropolitan Underwriter 13 (October 1943): 14-15.
66. A New Day in Health Protection, 2-5, Box 160605, Metropolitan Life Insurance Company Archives;
67. Press Book: A New Day, 4-9, Box 160605, Metropolitan Life Insurance Company Archives, New York. By 1939, the film had been updated to include a potential role for sulfapyridine alongside serotherapy in the treatment of pneumonia.
68. In American Council on Education, Selected Educational Motion Pictures, a Descriptive Encyclopedia (Washington, DC: American Council on Education, 1942), 207-208.
69. Georgia, Idaho, and Kansas, for example, provided only typing services. See State of Georgia Department of Public Health, Annual Report, 1938, 64;
70. Idaho Department of Public Welfare, Division of Public Health, Biennial Report, 1937-1938, 15;
71. Biennial Report of the Department of Public Welfare of the State of Idaho, 1939-1940, 22;
72. State Board of Health of the State of Kansas, 20th Biennial Report, July 1, 1938, to June 30, 1940, 140;
73. Kansas State Board of Health, Twenty-First Biennial Report, July 1, 1940, to June 30, 1942, 75. At the other end of the spectrum of "control," in Massachusetts, by 1937, "physicians who have reported deaths from pneumonia and whose names were not found on the list of those who had requested serum, were circularized and given an opportunity to ask that a number of our staff call upon them to explain the pneumonia program."
74. In Commonwealth of Massachusetts, [23rd] Annual Report of the Department of Public Health forthe Year Ended November 30, 1937, 8.
75. Compare, for instance, the pro-serum leanings of the Massachusetts program with the pro-sulfa leanings of the Tennessee program. In Commonwealth of Massachusetts, 26th Annual Report of the Department of Public Health of Massachusetts, 51;
76. Tennessee Department of Public Health and the Tennessee State Medical Association, Pneumonia: Its Etiology, Diagnosis, and Treatment (1940), 15-16, 30-31.
77. As a representative sample, see Jesse G. M. Bullowa, Norman Plummer, and Maxwell Finland, "Sulfapyridine in the Treatment of Pneumonia," Journal of the American Medical Association 112 (1939): 570;
78. Maxwell Finland, "The Treatment of Pneumonia," Canadian Medical Association Journal 41 (1939): 554-560;
79. Norman Plummer, "The Treatment of Pneumonia," Journal of the Indiana State Medical Society 35 (1942): 608-613.
80. Norman Plummer, James Liebmann, Saul Solomon, W. H. Kammerer, Mennasch Kalkstein, and Herbert K. Ensworth, "Chemotherapy Versus Combined Chemotherapy and Serum in the Treatment of Pneumonia: A Study of 607 Alternated Cases," Journal of the American Medical Association 116 (1941): 2366-2371.
81. William S. Tillett, Margaret J. Cambier, and James E. McCormick, "The Treatment of Lobar Pneumonia and Pneumococcal Empyema With Penicillin," Bulletin of the New York Academy of Medicine 20 (1944): 142-178;
82. Norman Plummer, "The Treatment of Lobar Pneumonia," Bulletin of the New York Academy of Medicine 20 (1944): 73-86.
83. Biennial Report of the Department of Public Health, State of Tennessee, for the Fiscal Years 1943-1945, 58.
84. From 1941 to 1945, federal support of the state pneumonia control programs declined from $523 225 to $40 802. No funding was provided beyond 1945. See Annual Report of the Surgeon General of the Public Health Service of the United States for the Fiscal Year 1941 (Washington, DC: US Public Health Service, 1941), 14;
85. Annual Report of the Surgeon General of the Public Health Service of the United States for the Fiscal Year 1945 (Washington, DC: US Public Health Service, 1945), 153.
86. William Watt Graham Maclachlan, in Bernard J. McCloskey, "Five Years of Pneumonia Control in Cambria County, Pennsylvania," Pennsylvania Medical Journal 46 (1943): 478-483.
87. Elizabeth Fee, "The Origins and Development of Public Health in the United States," in Roger Detels, Walter W. Holland, James McEwan, and Gilbert S. Omenn, eds., Oxford Textbook of Public Health, Third Edition, vol. I: The Scope of Public Health (New York: Oxford University Press, 1997), 46-47.
88. Edward L. Bortz, "Therapeutics of Pneumonia on a Statewide Basis," Journal of the American Medical Association 121 (1943): 107-113.
89. Thomas Parran, "Health Is on the March [Office of War Information radio transcription, January 28, 1942]," Box 45, FF 645, TPP; Parran, "The Expanding Field of Public Health and Preventive Medicine [Annual Congress on Medical Education and Licensure, American Medical Association, February 14, 1944]," Box 45, FF 648, TPP; Parran, "State of the Nation's Health [State and Territorial Health Officers Conference, March 21, 1944]," Box 45, FF 652, TPP; Parran, "The Health of the Nation [hearings before Subcommittee on Appropriation, March 28, 1944]," Box 45, FF 653, TPP.
90. Thomas Parran, "New Frontiers in Medicine [commencement exercises, University of Utah, September 10, 1944]," Box 46, FF 681, TPP.
91. Parran, "The Expanding Field of Public Health and Preventive Medicine."
92. See Horace P. Marvin, Franklin D. Owings, and Edward K. Edelson, "Pneumonia Therapy With Sulfathiazole in Military Practice," Military Surgeon 91 (1942): 55-58;
93. Maine C. Anderson, "In View of Present Day Treatment, Are Typing and Serums Necessary?" Journal of the Omaha Midwest Clinical Society 5 (1944): 48-49.
94. See Edward Lee Copley, "Pneumonia in Virginia: A Series of Fifty-Three Cases," Southern Medicine and Surgery 104 (1942): 142;
95. Charles P. Wofford, "Present-Day Management of Pneumonia," Journal of the Tennessee State Medical Association 35 (1942): 123-125;
96. "Only Pneumonia," Science News Letter 48 (1945): 380;
97. "Pneumonia," Life Magazine, February 13, 1950, p. 13.
98. Russell L. Cecil, in Edward L. Bortz, "Pneumonia in Pennsylvania," Transactions of the American Clinical and Climatological Association 56 (1940): 103-120.
99. See, for example, David D. Rutstein to W. G. Campbell, February 7, 1939, Sulfapyridine New Drug Application, Volume III, Food and Drug Administration Records, Rockville, Md.; Roderick Heffron to Barry Smith, April 7, 1942, Folder 521, Box 36, RG 18.1, RAC.
100. William B. McIlwane, "The Use of Sulfapyridine and Sulfathiazole in General Practice," Virginia Medical Monthly 68 (1941); 410-411.
101. Wendell J. Stainsby, "Pneumonia in General Practice," Pennsylvania Medical Journal 47 (1943): 562-563;
102. O.H. Robertson, "Newer Knowledge Concerning the Inception of Pneumonia and Its Bearing on Prevention," Annals of Internal Medicine 18 (1943): 1-14.
103. W. F. Drummond, in C. P. Herrington, "Chemotherapy in Pneumonia," New Orleans Medical and Surgical Journal 93 (1941): 348-353;
104. Morton Hamburger, Jr., L. H. Schmidt, Clara L. Sesler, J. M. Ruegsegger, and Eda S. Grupen, "The Occurrence of Sulfonamide-Resistant Pneumococci in Clinical Practice," Journal of Infectious Diseases 73 (1943): 12-30;
105. Richard A. Kern, "Abuse of Sulfonamides in the Treatment of Acute Catarrhal Fever," United States Naval Academy Bulletin 44 (1945): 686-694.
106. William A. Nolen and Donald E. Dille, "Use and Abuse of Antibiotics in a Small Community," New England Journal of Medicine 257 (1957): 33-34. Upper respiratory tract infections were excluded from the list of disease entities considered appropriately treated with antibiotics, and the 3 anecdotal examples used for demonstration by the authors all entailed the use of antibiotics for upper respiratory tract infections.
107. See James Whorten, "'Antibiotic Abandon: The Resurgence of Therapeutic Rationalism," in John Parascandola, ed., The History of Antibiotics: A Symposium (Madison, Wise: American Institute of the History of Pharmacy, 1980), 129-130;
108. Maxwell Finland, "Clinical Uses of the Presently Available Antibiotics," Antibiotics Annual (1953-1954): 10-26;
109. Hobart A. Reimann, "The Misuse of Antimicrobics," Medical Clinics of North America 45 (1961): 849-856.
110. Maxwell Finland, "Increased Resistance in the Pneumococcus," New England Journal of Medicine 284 (1971): 212-214.
111. Joel Ward, "Antibiotic-Resistant Streptococcus pneumoniae: Clinical and Epidemiologie Aspects," Reviews of Infectious Diseases 3 (1981): 254-266.
112. John S. Spika, Richard R. Facklam, Brian D. Plikaytis, and Margaret J. Oxtoby, "Antimicrobial Resistance of Streptococcus pneumoniae in the United States, 1979-1987," Journal of Infectious Diseases 163 (1991): 1273-1278.
113. An ISI Essential Science Indicators search, conducted in 2003, of the "most-cited papers on antibiotic resistance in the past decade," found 3 of the top 4 papers cited to concern pneumococcal resistance. In "Antibiotic Resistance-Top Papers," available at http://www.esi- topics.com/anti-res/papers/a1. html, accessed February 2003.
114. Harold C. Neu, "The Crisis in Antibiotic Resistance," Science 257 (1992): 1064-1073;
115. MitchellL. Cohen, "Epidemiology of Drug Resistance: Implications for a Post-Antimicrobial Era," Science 257 (1992): 1050-1055.
116. See also Calvin M. Kunin, "Resistance to Antimicrobial Drugs - A Worldwide Calamity," Annals of Internal Medicine 118 (1993): 557-561.
117. Robert F. Breiman, Jay C. Butler, Fred C. Tenover, John A. Elliott, and Richard R. Facklam, "Emergence of Drug-Resistant Pneumococcal Infections in the United States," Journal of the American Medical Association 271 (1994): 1831-1835;
118. Daniel B. Jernigan, Martin S. Cetron, and Robert F. Breiman, "Minimizing the Impact of Drug-Resistant Streptococcus pneumoniae (DRSP): A Strategy From the DRSP Working Group," Journal of the. American Medical Association 275 (1996): 206-209.
119. Benjamin Schwartz, David M. Bell, and James M. Hughes, "Preventing the Emergence of Antimicrobial Resistance: A Call for Action by Clinicians, Public Health Officials, and Patients," Journal of the American Medical Association 278 (1997): 944-945;
120. Neu, "The Crisis in Antibiotic Resistance," 1072.
121. Michael S. Simberkoff, "Drug-Resistant Pneumococcal Infections in the United States: A Problem for Clinicians, Laboratories, and Public Health," Journal of the American Medical Association 271 (1994): 1875-1876;
122. Joseph F. Plouffe, Robert F. Breiman, and Richard R. Facklam, "Bacteremia With Streptococcus pneumoniae: Implications for Therapy and Prevention," Journal of the American Medical Association 275 (1996): 194-198.
123. Ralph Gonzales, John F. Steiner, and Merle A. Sande, "Antibiotic Prescribing for Adults With Colds, Upper Respiratory Tract Infections, and Bronchitis by Ambulatory Care Physicians," Journal of the American Medical Association 278 (1997): 901-904.
124. Ralph Gonzales, Daniel C. Malone, Judith H. Maselli, and Merle A. Sande, "Excessive Antibiotic Use for Acute Respiratory Infections in the United States," Clinical Infectious Diseases 33 (2001): 757-762.
125. A further study of such national data from 1997 to 1999 would find that 46% of patients with the common cold or a non-specific upper respiratory tract infection would still be given antibiotics. More than half of them were prescribed broad-spectrum agents. Michael A. Steinman, C. Sefh Landefeld, and Ralph Gonzales, "Predictors of Broad-Spectrum Antibiotic Prescribing for Acute Respiratory Tract Infections in Adult Primary Care," Journal of the American Medical Association 289 (2003): 719-725.
126. Cynthia G. Whitney, Monica M. Parley, James Hadler, et al., "Increasing Prevalence of Multidrug-Resistant Streptococcus pneumoniae in the United States," New England Journal of Medicine 343 (2000): 1917-1918. "Invasive" disease "was denned by the isolation of 5. pneumoniae from a normally sterile body site."
127. See, for example, Robert Austrian, "A Reassessment of Pneumococca) Vaccine," New England Journal of Medicine 310 (1984): 651-653;
128. Jay C. Butler, Eugene D. Shapiro, and George M. Carlone, "Pneumococcal Vaccines: History, Current Status, and Future Directions," American Journal of Medicine 107 (1999): 69S-76S.
129. Robert Austrian, "Pneumococcal Infection and Pneumococcal Vaccine," New England Journal of Medicine 297 (1977): 938-939;
130. Robert Austrian, "Some Observations on the Pneumococcus and on the Current Status of Pneumococcal Disease and Its Prevention," Reviews of infectious Disease 3 (1981): S1-S17;
131. Michael S. Simberkoff, Anne P. Cross, Mohamed Al-Ibrahim, et al., "Efficacy of Pneumococcal Vaccine in High-Risk Patients: Results of a Veterans Administration Cooperative Study," New England Journal of Medicine 315 (1986): 1318-1327.
132. Robert F. Breiman, "Editorial Response: Prevention of Pneumococcal Disease - A New Romance Begins," Clinical Infectious Diseases 26 (1998): 1124.
133. David S. Fedson, "Influenza and Pneumococcal Immunization Strategies for Physicians," Chest 91 (1987): 436-443;
134. Tammy A. Mieczkowski and Stephen A. Wilson, "Adult Pneumococcal Vaccination: A Review of Physician and Patient Barriers," Vaccine 20 (2002): 1383-1392.
135. "Trends in Morbidity and Mortality: Pneumonia, Influenza, and Acute Respiratory Conditions," American Lung Association [Best Practices and Program Services, Epidemiology and Statistics Unit, September 2002], available at www.lungusa.org, accessed September 2002.
136. Regarding clinicians, see Robert H. Pantell and Thomas J. Stewart, "The Pneumococcal Vaccine: Immunization at a Crossroad," Journal of the American Medical Association 241 (1979): 2272-2274;
137. W. R. Barclay, "Vaccination to Prevent Pneumonia," Journal of the American Medical Association 241 (1979): 2299.
138. Regarding the public, see Jane E. Sisk and Richard K. Riegelman, "Cost Effectiveness of Vaccination Against Pneumococcal Pneumonia: An Update," Annals of Internal Medicine 104 (1986): 79-86.
139. For a recent review of such proposals and attempts, see Mieczkowski and Wilson, "Adult Pneumococcal Vaccination," 1388-1389.