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In the 11 years from 1982 to 1992, microbiology laboratories in England and Wales reported 22,567 episodes of serious illness in which Streptococcus pneumoniae was isolated from blood and 3500 in which it was isolated from cerebrospinal fluid. Half of the reported cases of bacteraemia occurred in people of over 65 years (11,299 cases). A predisposing cause was seldom reported. Annual totals of reports of pneumococcal bacteraemia and meningitis have risen in parallel with other serious infections. The rates of pneumococcal infections reported in very young and elderly people have risen much more rapidly and, although this observation may be artefactual, it may be associated with an observed increase in reports of antibiotic resistance. The proportion of pneumococcal isolates resistant to penicillin rose from 0.3% in 1989 to 1.9% in 1992 (p < 0.05). We suggest that the role of pneumococcal vaccination should be re-evaluated.
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