Pneumococcal sepsis and meningitis in vaccinated subjects: a review of 55 reported cases.

Fifty-five cases of the occurrence of serious pneumococcal infections in both splenectomized and nonsplenectomized individuals who received pneumococcal vaccine were reviewed from the literature. Reasons for vaccine failure included the occurrence of non-vaccine-type pneumococcal infections (18 cases), possible poor antibody response to the vaccine, especially if it is given postsplenectomy and/or following intensive steroid or other immunosuppressive therapy, and decline in antibody titer over time. Although the total number of vaccinated individuals is unknown, the overwhelming majority of the many thousands of vaccinees have been successfully protected with pneumococcal vaccine. In spite of very rare vaccine failures, pneumococcal vaccination (and perhaps penicillin prophylaxis) is strongly recommended for patients at high risk of developing serious pneumococcal infections, including all individuals undergoing splenectomy for any reason, or for those who have had a splenectomy or have functional asplenia.