Sir.—A recent article in the Journal (1981;135:155-158) reviewed six cases of pneumococcal disease with vaccine serotypes. In the discussion of the authors' cases, one of us (M.K.H.) was quoted in reference to a case of nonvaccine pneumococcal meningitis occurring in a splenectomized, vaccinated child receiving penicillin prophylaxis. We now present the details of this child's illness and laboratory investigations, which include corroboration of compliance with oral antibiotic prophylaxis, quantitation of antigenemia, and measurement of premorbid, acute, and follow-up antibody titers to vaccine and infecting organisms.
Report of a Case.—A 10-year-old girl underwent surgical splenectomy at the age of 2 years for hypersplenism complicating β thalassemia. Immediately after her operation, oral antibiotic prophylaxis with penicillin V potassium, 250 mg twice a day, was begun. In February 1978 she also received 14-valent pneumococcal vaccine (Pneumovax); daily penicillin prophylaxis was continued.
On Dec 13, 1978, after initial improvement from a three-day