Pneumococcal Vaccination Strategies in the Real World of Chronically Ill Patients
Bibliographic record
Abstract
Throughout the world vaccination strategies are widely applied because they are cheap and cost-effective. The World Health Organization (WHO) provides recommendations for routine immunizations1. These recommendations are primarily based on vaccine studies performed in healthy children or elderly persons without significant comorbidity. For instance, the CAPITA study (Community-Acquired Pneumonia Immunization Trial in Adults) on about 85,000 adults aged 65 years and older is seen as a landmark study, demonstrating that a pneumococcal conjugate vaccine prevents a significant proportion of pneumococcal community-acquired pneumonia in adults2. The study is of considerable public health significance. However, in the real world the pneumococcal vaccine is not administered to the entire healthy elderly population. In contrast, this and other vaccines are given especially to protect chronically ill patients. In the above-mentioned CAPITA study, adults were excluded if they resided in nursing homes, had significant comorbidity that could result in an immune-suppressed state, or had medications that could affect the immune response. As a result, the decision to vaccinate these chronically ill patients is left to the discretion of the doctor. In the rheumatology field this has led to numerous investigator-initiated studies in adult and pediatric rheumatic diseases. Several reviews were published with immunization recommendations for adults and children with rheumatic conditions3,4,5. These immunization recommendations take into account the 2 main issues that play a role in patients with rheumatic diseases using immunosuppressive drugs: the safety and the efficacy of vaccines. Regarding safety, the product labels of most vaccines state that concomitant use of immunosuppressive drugs such as methotrexate (MTX) or biological disease-modifying antirheumatic drugs (DMARD) are a contraindication for … Address correspondence to Dr. N.M. Wulffraat. E-mail: n.wulffraat{at}umcutrecht.nl
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.002 | 0.009 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.000 | 0.001 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.003 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".