Regarding the Sept. 9 editorial "Upper hand on pneumonia": To protect people from community-acquired pneumonia (CAP), strategic use of pneumococcal vaccination is essential. The central and local governments need to enlighten the public on who is at increased risk of CAP and when they should be vaccinated.

It should be clarified that elderly people and those with chronic medical conditions are at increased risk of pneumonia. Chronic conditions such as cardiovascular disease, chronic obstructive pulmonary disease (COPD) and diabetes mellitus are associated with an increased incidence of CAP. Alcohol abuse and cigarette smoking are quite common in patients with severe forms of CAP.

Ideally, all high-risk people, including those older than 65, should be vaccinated. Vaccinations should be provided to immuno-competent patients if they live in certain environments including long-term care facilities, or if they have chronic illnesses such as cardiovascular disease including congestive heart failure, COPD, diabetes mellitus, alcoholism and chronic liver disease. Although vaccine efficacy may be reduced, immuno-compromised patients should also be vaccinated, including patients with HIV, malignant conditions, nephritic syndrome, chronic renal disease, leukemia or immuno-suppressive therapy including long-term corticosteroids.

It is important to repeat pneumococcal vaccination after five years for those who received their first before 65 and for immuno-compromised patients. Since October 2009, the health ministry has approved repeat vaccinations on condition that the benefit is deemed to outweigh any harm. In this rapidly aging society, we should keep in mind that "prevention is better than cure."

The opinions expressed in this letter to the editor are the writer's own and do not necessarily reflect the policies of The Japan Times.

hajime ichiseki