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Persons using assistive technology might not be able to fully access information in this file. For assistance, please send e-mail to: mmwrq@cdc.gov. Type 508 Accommodation and the title of the report in the subject line of e-mail. Recommendations Regarding Penicillin-Resistant Pneumococcal Disease -- SpainBecause infections caused by drug-resistant strains of Streptococcus pneumoniae are common in Spain (1,2), CDC has received numerous inquiries about vaccination of travelers to the 1992 Summer Olympics in Barcelona and the 1992 World's Fair in Seville. Pneumococcal vaccination is recommended for all persons with risk factors for serious pneumococcal infection (3). However, CDC does not recommend vaccination of all travelers to Spain because the incidence of invasive pneumococcal disease among persons without risk factors is low (4,5). Vaccination does not appear to prevent nasopharyngeal carriage of vaccine-type strains (6,7), and there is no evidence that drug-resistant strains are more virulent than susceptible strains. In recent years, most pneumococcal infections occurring in Spain have been caused by strains resistant to at least one commonly used antimicrobial agent including penicillin, chloramphenicol, trimethoprim/sulfamethoxazole, or erythromycin. Rates of high-level penicillin resistance (i.e., minimal inhibitory concentration greater than or equal to 2 ug/mL) increased from 0% of strains isolated in 1979 to 13%-15% of strains isolated in 1989-90 (1,2). The level of resistance to other beta-lactam agents generally parallels the level of resistance to penicillin (8). In contrast, only one ( less than 0.02%) of more than 5000 pneumococcal isolates submitted to CDC from the United States during 1979-1987 had a high level of penicillin resistance (9). Pneumococcal polysaccharide vaccine should be administered to travelers with risk factors for serious pneumococcal infection, including those who have undergone splenectomy, those with chronic medical conditions (e.g., cardiovascular disease, pulmonary disease, diabetes mellitus, and chronic renal failure) or on immunosuppressive therapy, persons infected with human immunodeficiency virus, and all persons aged greater than or equal to 65 years (3). Physicians should be aware of the possibility of infections with drug-resistant strains of S. pneumoniae in travelers returning from Spain. References
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