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Discontinuation of primary Mycobacterium avium complex (MAC) prophylaxis during HAART (Brooks et al., pp. 549–53). From 1996 through 2002, nearly 1000 patients receiving HAART became eligible to discontinue primary MAC prophylaxis after immune reconstitution, according to published guidelines. The proportion of those patients who discontinued prophylaxis increased from 17% to 85% during the 7-year time period. The risk of MAC infection after discontinuation of prophylaxis was not substantially increased among patients who maintained a CD4 cell count >100 cells/µL. Cessation of primary MAC prophylaxis after immune reconstitution decreases the cost of care, the risk of adverse drug reaction, and the risk of antimicrobial resistance and may improve compliance with antiretroviral therapy.

Pediatric pneumococcal serotypes in elderly adults (Feikin et al., pp. 481–7). Nearly 3000 adult pneumococcal isolates collected before introduction of the 7-valent pneumococcal conjugate vaccine were analyzed to determine serotype. The risk of infection with pediatric serotypes was significantly higher among people aged ⩾65 years than among those aged 35–49 years. Among people aged ⩾85 years, more than one-half of all cases of invasive pneumococcal disease were caused by the 5 pediatric serotypes. Vaccination of elderly persons against pediatric pneumococcal serotypes may be needed.

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