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Pneumococcal vaccine contains purified polysaccharide from 23 of the most common strains of S pneumoniae, which cause 90% of bacteremic episodes in the United States Antibody response following vaccination depends on the patient s immune status and the presence of concomitant disease Healthy adults have an excellent antibody response, as do

For example, if you create a NewLeft party, you might want the NewLeft voting choice to print a message and then fall through to Democrat (that is, to continue on with the statements in the Democrat case). You might (incorrectly) try writing the following:

ited information about use of this vaccine in adults suggests that those with poor antibody response to the 23-valent vaccine (such as renal transplant recipients) also have poor antibody response to the protein-conjugated vaccine despite its higher immunogenicity Mild reactions (erythema and tenderness) to pneumococcal vaccine occur in up to 50% of recipients, but systemic reactions are uncommon Similarly, revaccination at least 5 years after initial vaccination is associated with mild selflimited local but not systemic reactions Revaccination is not recommended for those who had a severe reaction (anaphylaxis or Arthus reaction) to the initial vaccination

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patients who are postsplenectomy and those with sickle cell disease Elderly individuals and those with chronic diseases (diabetes mellitus, alcoholic cirrhosis, chronic obstructive pulmonary disease, chronic renal insufficiency, lupus erythematosus, rheumatoid arthritis) have less vigorous response than young healthy adults Patients with Hodgkin s disease respond to vaccination if it is given before splenectomy, radiation, or chemotherapy, whereas patients with leukemia, lymphoma, and HIV infection respond sluggishly Although the efficacy of pneumococcal vaccine has been questioned, most authorities believe that vaccination is about 60 70% effective in preventing bacteremic disease in immunocompetent persons, but less effective at preventing pneumonia Fifty percent efficacy is observed in patients with underlying diseases (not severely immunocompromised), and less in immunocompromised patients (10%), largely because of inability to mount an antibody response in this population It is presently recommended for patients at increased risk for developing severe pneumococcal disease, especially asplenic patients and those with sickle cell disease It is also indicated for adults at increased risk for developing pneumococcal disease, including those with chronic illnesses (eg, cardiopulmonary disease, alcoholism, cirrhosis, chronic renal failure, nephrotic syndrome, cerebrospinal fluid leaks), those who are immunocompromised (eg, patients with Hodgkin s disease, lymphoma, chronic lymphocytic leukemia, multiple myeloma, congenital immunodeficiency, asymptomatic or symptomatic HIV infection, organ or bone marrow transplant recipients), those receiving immunosuppressive therapy (eg, long-term systemic corticosteroids, alkylating agents, and antimetabolites) and Alaskan Natives Because of the increased risk of developing pneumococcal meningitis following cochlear implants, patients receiving these implants should be given age-appropriate vaccination Although not currently recommended for smokers and black adults, some feel that these groups should be routinely immunized because of an increased risk of developing invasive disease In addition, it is recommended for all individuals over 65 years of age Whether 65 is the appropriate age to vaccinate healthy adults is unclear Antibody response declines with age, and some have suggested routine immunization at age 50 similar to the recommendation for tetanus (see above) A single dose of vaccine usually confers lifelong immunity One-time revaccination 5 years after initial vaccination is recommended for those at highest risk (see list above) In addition, a single revaccination is recommended for those 65 or more years of age who received the vaccine 5 years or more previously and were under age 65 at the time of primary vaccination Elderly individuals with unknown vaccination status should be immunized once Revaccination should also be considered for high-risk individuals previously immunized with the older 14-valent vaccine Since immunocompetent patients respond best to the vaccine, it should be given 2 weeks before splenectomy or before starting chemotherapy if that can be anticipated A protein-conjugated heptavalent pneumococcal vaccine used in children under 2 years of age is very effective at preventing meningitis and pneumonia but only modestly effective at preventing otitis media Unlike the adult polysaccharide vaccine, the pediatric conjugated vaccine decreases nasopharyngeal colonization, which results in less transmission to nonimmunized children and adults (herd immunity) Lim-.

case NewLeft: Console.WriteLine("The NewLeft members are voting Democratic."); case Democrat: Console.WriteLine("You voted Democratic.\n"); break;

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