and trivalent vaccines. MMR vaccination was included in one of the large health maintenance organization case-control studies of possible serious bacterial infection after immunization (Black et al., 1991); although there was a trend toward fewer infections in vaccinees than in controls, none of the differences was significant.

At present, the data are insufficient to answer with certainty whether immunosuppression in the form of laboratory and skin test abnormalities after the receipt of a vaccine does, in fact, indicate a decrease in the capacity to resist infection. Therefore, as new vaccines are developed and as the old ones are used at different dosages or in different combinations or are administered at different ages, this question should continue to be a concern. To date, studies of current vaccines suggest that if immunization leads to an infection, it must do so infrequently.

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