The clinical effectiveness of pneumococcal vaccination in preventing invasive pneumococcal disease has been demonstrated in several studies, but the small Denver study gave inconclusive results with a very large CI.

Austrian and colleagues found 79% clinical effectiveness against sputmculture positive pneumococcal pneumonia and/or bacterarmia combined among South Africa gold miners.

The clinical effectiveness of polyvalent pneumococcal vaccine against pneumococcal pneumonia in elderly persons and other high-risk groups has not yet been convincingly demonstrated.

Based on studies of clinical effectiveness and cost-effectiveness combined, it is worthwhile to give pneumococcal vaccine to all elderly persons to prevent invasive pneumococcal disease alone.

In this indirect cohort study, S. pneumoniae was isolated from CSF or blood, and effectiveness was estimated by comparing the proportion of pneumococcal infections in vaccinated and unvaccinated groups.

Vaccination effectiveness was not documented for immunocompromised patients but sample sizes were small for these groups.

The WHO recommendations were made by a Technical Advisory Group convened by WHO Regional Office for Europe.

Some countries now recommend routine pneumococcal vaccination for the heathly elderly population.

Most European countries recommend vaccination for chronically sick or immunocompromised patients.

Seven European countries recommend vaccination of elderly persons, and three also recommend vaccination of nursing home residents.

"Other" recommendations vary between countries, but conditions often mentioned include alcoholism, lover cirrhosis, CSF leaks and frequent hospitalisation.