 - Appropriate documentation from medical records of prior receipt of pneumococcal vaccination with both the 13-valent conjugant vaccine PCV13 and 23-valent pneumococcal polysaccharide vaccine PPV23 within the last 5 years. If no documentation is available, then the PCV13 and PPV23 series PCV13 vaccine followed by PPV23 vaccine at least 8 weeks later must be completed more than 14 days prior to study entry. 