<prompt> The 23 valent pneumococci vaccine is recommended in all except -CSF leakChronic cardiac diseaseChidren less than 2 yearsNephrotic syndrome  <response>: Ans. is c i.e., Children less then 2 years Pneumacoccal vaccine . There are two types of pneumococcal vaccines available : ? 1 Polyvalent 23 type polysaccharide vaccine This polysaccharide vaccine represents the capsular antigen of 23 most prevalent serotypes. - It gives 80-90 protection which is long lasting 5 years. - It is not meant for general use, but only in persons at enhanced risk of pneumococcal infection such as those with absent or dysfunctional spleen; sickle cell disease, coeliac disease; Chronic liver or renal or lung or cardiac disease, DM, CSF leaks meningeal disruption: dural tear and; immunodeficiency including HIV infection. - It is not recommended in children under two years of age and those with lymphoreticular malignancies and immunosupprassive therapy. 2Conjugate vaccine - A different pneumococcal vaccine containing pneumococcal polysaccharide coupled conjugated to a carrier protein diphtheria toxoid has been developed. - The vaccine contains the capsular polysaccharide of seven most common pneumococcal serotypes. - It can be given to children under the age of 2 years but more than 6 weeks old. 