This suggests that PPSV23 vaccination is capable of generating T-cell-independent B-cell memory.23 In the present study, for serotypes 6B and 19F, the GMCs of serotype-specific IgG required for 50% killing were significantly lower after the third dose than before the first dose.14 Similar effects were acquired for serotypes 14 and 23F, even though decreases in IgG levels required for 50% killing were not significant. Although self-limited local and systemic reactions were more frequent after the second and third vaccinations than after the 1st Azaguanine-8 vaccination, no severe systemic reactions were seen after any vaccination. These data suggest that sustained practical serotype-specific IgG is definitely produced after the 1st, second, and third vaccinations and they confirm the security of the second and third vaccinations in elderly people with chronic lung disease. continues to be a major human being pathogen that causes infectious diseases in adults worldwide.1 Pneumonia is Azaguanine-8 still probably one of the most common causes of death in adults, and is the leading causative agent of pneumonia in Japan.2 As a result of introduction of 13-valent pneumococcal conjugate vaccine (PCV13) in the national immunization system among children in Japan, the current vaccination rate of the PCV13 is as high as 95% among children aged 5?years and younger.3 Consequently, the incidence of invasive pneumococcal disease (IPD) caused by the serotypes included in PCV13 is low in both children and adults, and there is a reducing tendency in the prevalence of penicillin-resistant pneumococcal strains.4 In some other countries, implementation of the seven-valent pneumococcal conjugate vaccine (PCV7) and PCV13 in children offers reportedly induced serotype alternative, leading to an elevated incidence of IPD caused by the non-vaccine serotype 12F.5,6 Recently, an increase in the incidence of IPD caused Gadd45a by serotype 12F among adults was reported in Japan.7 Because serotype 12F is included in the 23-valent pneumococcal polysaccharide vaccine (PPSV23), this vaccine is highly effective against serotype 12F IPD.8,9 The PPSV23 comprises a mixture of capsular polysaccharides from 23 serotypes of with these serotypes were prevalent as the causative agents of community-acquired pneumonia when the study patients received the first vaccination with PPSV23 between October 2001 and November 2002.22 Adverse reactions Participants were provided a diary to record their temp and any local or systemic reactions that occurred from the day of the third vaccination to day time 14 after this vaccination. They were instructed to assess the maximal diameter of any redness or swelling at the site of injection. This was classified as slight for diameters 1 cm and 5 cm, as moderate for diameters 5 cm and 10 cm, and as severe for diameters 10 cm. A systemic sign was considered slight when the participant experienced a certain sign but experienced no problems in daily life. A physical exam with an interview was carried out to record the participants condition on the day of the third vaccination and 14?days later. The going to physician assessed the presence of adverse reactions based on daily records submitted by the patient. Data for adverse reactions after Azaguanine-8 the third vaccination were compared with those after the 1st and second vaccinations.14,17 Statistical analysis Average antibody concentrations and increases are expressed as geometric means. Variations in the geometric mean concentrations (GMCs) of serotype-specific IgG, OIs, or IgG concentration required for 50% killing were assessed using the Wilcoxon matched-pairs signed-rank test. The human relationships between GMCs before the third vaccination and local adverse reactions after the third vaccination were compared using the MannCWhitney test. The frequencies of adverse reactions were compared between the 1st, second, and third vaccinations using College students test. Differences having a value .05 were considered to be significant. Results Patient characteristics The group of individuals comprised 7 males and 9 ladies whose imply age was 80?years; 10 participants were in their 70s and 6 were in their 80s. The mean interval between the second and third vaccinations was 5?years and 3?weeks. Their comorbid ailments included pulmonary tuberculosis sequelae (44%), bronchial asthma (19%), bronchiectasis (13%), and additional conditions (24%). Six individuals (38%) were on home oxygen therapy (Table 1). Azaguanine-8 Table 1. Baseline characteristics of 16 individuals with chronic pulmonary diseases. ?.01) and remained slightly higher than before the 1st vaccination, even at the time of the second vaccination. The GMCs of serotype-specific IgG for those serotypes increased significantly by the second vaccination, but the GMCs of serotype-specific IgG for serotypes 14 and 23F were lower 1?month after the second vaccination than 1?month after the first vaccination. Importantly,.