Hospital-based influenza and pneumococcal vaccination: Sutton's Law applied to prevention.

TLDR: This commentary will address the following six issues: the epidemiological rationale for hospitalbased influenza and pneumococcal vaccination; the translation of these epidemiological findings into clinical and public policy; changes in the scientific understanding of the benefits of influenza and pneumoniae vaccination; experience in implementing hospitalbased programs for vaccination; practical issues for hospital-based vaccination; and an enhanced role for infection control practitioners in ensuring that Sutton’s Law for influenza and lung cancer vaccination is followed.

Abstract: Pneumonia and influenza continue to be two of the major causes of hospitalization and death throughout the world. It is fitting that this issue of the Journal is devoted to addressing these important topics. Many of these cases are caused by influenza virus and Streptococcus pneumoniae and could be prevented if the delivery of influenza and pneumococcal vaccines were more effectively targeted to those individuals who are otherwise destined to be hospitalized or to die due to one of these diseases. That persons with vaccine-preventable influenza and pneumococcal infections are still admitted to our hospitals is a sobering reminder that there still is important work to do. Early in their education, virtually all medical students are taught the importance of following Sutton’s Law in formulating a differential diagnosis. Sutton’s Law is based on the remark made by the notorious bank robber, Willie Sutton. When asked why he robbed banks, he replied, “That’s where the money is.” In formulating a differential diagnosis, the student is advised to think first of common problems, not rare diseases. More often than not, diagnosing a common problem is “where the money is.” Sutton’s Law also can be applied to the prevention of influenza and pneumococcal infections. In this instance, the question asked is, “What is the best vaccination strategy for reaching people who, if not vaccinated, will have the greatest likelihood of being hospitalized or dying of these two diseases?” The answer is patients who are being discharged from the hospital. Hospital-based influenza and pneumococcal vaccination is “where the money is.” In this commentary, we will address the following six issues: (1) the epidemiological rationale for hospitalbased influenza and pneumococcal vaccination; (2) the translation of these epidemiological findings into clinical and public policy; (3) changes in the scientific understanding of the benefits of influenza and pneumococcal vaccination; (4) experience in implementing hospitalbased programs for vaccination; (5) practical issues for hospital-based vaccination; and (6) an enhanced role for infection control practitioners in ensuring that Sutton’s Law for influenza and pneumococcal vaccination is followed.