The first vaccines to prevent pneumococcal infections, crude preparations of killed bacteria, were developed by Sir Almroth Wright in 1911 to try to alleviate the high mortality and morbidity among gold miners in South Africa.1 Discovery that antibodies against purified polysaccharides of the capsular surface of pneumococci were protective led to development of polysaccharide vaccines that were marketed in the 1940s. These vaccines were commercial failures because the advent of antimicrobials led to a perception that pneumococcal infections were no longer a major threat.2 Subsequent evidence of the persistence of significant morbidity from pneumococcal infections, as well as mortality rates of 25% to 30% in patients with invasive (including bacteremic) pneumococcal infections despite early treatment with antimicrobials, led to redevelopment of a polysaccharide vaccine, approved in the United States in 1977, that contained 14 of the more than 90 serotypes of pneumococci (responsible for about 80% of invasive pneumococcal infections in the United States). In 1983 the current expanded formulation of the vaccine that contains polysaccharides of 23 pneumococcal serotypes (PPSV23) was introduced.
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