IN LATE 1977, the Food and Drug-Administration (FDA) licensed a pneumococcal vaccine containing antigens from 14 of the 83 known serotypes of Streptococcus pneumoniae, and in 1983 the manufacturers expanded the preparation to 23 antigens. Eversince the vaccine's release, many groups, including the Immunization Practice Advisory Committee sponsored by the US Public Health Service, have endorsed a nationwide vaccination program for people with increased susceptibility to pneumococcal disease. The most recent statement of the Immunization Practices Advisory Committee,1 issued in 1989, recommends immunizing (1) everyone aged 65 years or older; (2) all individuals 2 years of age or older with chronic illnesses (such as diabetes mellitus, alcoholism, cirrhosis, cerebrospinal fluid leaks, unspecified cardiovascular and pulmonary diseases), immunocompromising disorders (such as anatomic or functional asplenia, nephrotic syndrome, chronic renal failure, lymphoma, multiple myeloma, organ transplantation), or human immunodeficiency virus infection; and (3) persons living in special environments or social settings
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