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Unfortunately, when laboratory methods rely solely on cultivation of pathogens and traditional phenotypic methods of pathogen characterization, physicians are forced to deduce the presence of BSI based on clinical symptoms, which are often nonspecific. Subsequently, antibiotic therapy is initiated based on clinical and epidemiologic profiles (28) rather than on laboratory evidence. Typically, within 1 to 3 days a microscopic Gram stain category (Gram-positive bacteria, Gram-negative bacteria, or fungi) provides physicians with a general direction for antibiotic therapy. Definitive results that eliminate the need for broad-spectrum therapy and enable de-escalation and the tailoring of treatment to the most effective antibiotic regimen often require more than 3 to 5 days. This gap has been implicated as one reason for high mortality and the emergence of drug-resistant microbes.

“It does not protect as promoted. It’s all a sales job: it’s all public relations.”

“I say, ‘Use this vaccine,’ ” he said. “The safety profile is actually quite good. But we have oversold it. Use it — but just know it’s not going to work nearly as well as everyone says.”

“Does it work as well as the measles vaccine? No, and it’s not likely to. But the vaccine works,” Dr. Joseph Bresee, chief of epidemiology and prevention in the C.D.C.’s influenza division, said. And research is advancing to improve the effectiveness of the vaccine.

The six least-vulnerable countries include all four Scandinavian countries, Germany, and Canada.