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    Is there an authentic increased risk of pneumococcal pneumonia among young mothers whose children were fully vaccinated with PCV7? The role of methodological shortcomings

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    We read with interest the manuscript of Hak et al., who car-ried out a nested case-control study in the U.K. to assess the riskof pneumococcal pneumonia in young mothers, whose children were vaccinated with 3 doses of 7-valent pneumococcal-conjugate-vaccine (PCV7) by 24 months of age. The Authors hypothesizedthat the increased risk of pneumonia is a consequence of a serotypereplacement following pneumococcal vaccination. However, publichealth advantages related to prevention of pneumococcal diseasedue to vaccination were not adequately pointed out; consequently,the low impact of the maternal risk (i.e., only 6 cases/45,000 person-year in the group aged 20–24 years were registered) deserves tobe more emphasized, rather than focusing only on the strengthof the association. Furthermore, the incidence rate detected inthe age-group 20–24 years largely contributed to the changeof the overall incidence (from 61 to 81 cases per 100,000 in 2006 and 2010, respectively), but it was not possible to understand if the temporal trend of the incidence rates was statistically significant
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