Based on the current knowledge of the efficacy of the polysaccharide pneumococcal vaccine we recommend:

• To vaccinate patients with a very high risk of developing invasive pneumococcal infection despite the limited evidence of efficacy of the vaccine in this patient group (level of evidence 3).
  Patients considered at very high risk are those with functional or anatomic asplenia. Patients undergoing elective splenectomy should be vaccinated 2 weeks prior to the intervention.  In case of non elective (traumatic) splenectomy, the vaccine should be given 2 weeks after the intervention.
• To discuss the possibility of vaccination in immunocompetent adult persons who have an increased risk of invasive pneumococcal infections. Considered “increased risk” are patients older then 50 years and suffering from chronic cardiovascular diseases, chronic pulmonary diseases (not astma), alcoholism. Patients older than 65 years also have an increased risk. Topics that should be discussed: increased incidence of invasive pneumococcal infections, efficacy of the vaccine against IPD, lack of proof of efficacy for pneumococcal pneumonia, safety, cost, side-effects and revaccination. The yearly flu vaccination can be an opportunity to raise and discuss this issue with the patient (level of evidence 1).
• Upon patients’ request, GP’s should provide appropriate information about the vaccine.