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A legitimate indication for giving pneumovax is sickle cell anemia, because the destruction of the spleen causes increased susceptibility to encapsulated organisms including Strep, H. flu and Salmonella. One must administer the vaccine before the spleen is fibrosed, to give the individual ample opportunity to develop an effective immune response to these organisms. Sickle cell patients are more likely to suffer from salmonella osteomyelitis, which can result in avascular necrosis, esp of the femoral head.

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