Table 1 Randomised studies of pneumococcal vaccination

Austrian, 1976

15 valent/placebo 2 years

1: Putative pneumococcal pneumonia and/or bacteraemia2: Radiological pneumonia

1: Not given2: X-ray

Meningococcal vaccine and placebo combined.Methods not presented.

6 or 12 valent/placeboabout 2 years

1: Pneumonia 2: Bronchitis 3: Pneumococcal pneumonia

1: 3 or more symptoms ± X-ray confirmation for pneumonia 2: Bronchitis not specifically defined ± X-ray 3: Culture

No clinically important reactions

Pneumonia occurring more than 14 days after vaccination.

Riley et al, 1977

14 valent/placebo16 months

1: Pneumonia 2: LRTI 3: Respiratory death

1: Clinical ± X-ray 2: Sick, cough, pulmonary involvement 3: Questioning of relatives for symptoms of pneumonia

3% with swollen arm 24% sore arm 7% fever in 131 patients

12 valent/placebo3 years

1: Respiratory illness 2: Clinical pneumonia 3: Radiological pneumonia 4: Pneumococcal pneumonia

1: Clinically diagnosed 2: Clinically diagnosed 3: X-ray positive 4: X-ray positive seropositive pneumonia

Erythema 213/607 12/693 Induration 79/607 4/693

LRTI do not include pneumonia

12 valent/placebo30 months

1: Respiratory illness 2: Clinical pneumonia 3: Radiological pneumonia 4: Pneumococcal pneumonia

1: Clinically diagnosed 2: Clinically diagnosed 3: X-ray positive 4: X-ray positive seropositive pneumonia

Pneumococcal pneumonia here is more properly pneumococcal illness. LRTI includes pneumonia. Patients taken rather than number of ilnesses.

14 valent/untreated control2 years

1: Pneumonia 2: Pneumococcal pneumonia 3: Mortality

1: Definitions of pneumonia varied

Study undertaken in 50 hospitals and homes in one district

17 valent/placeboUp to one year

1: Pneumococcal infection 2: Pneumococcal bacteraemia 3: Pneumococcal death

1: Febrile episodes with pneumococci + X-ray 2: as 1 plus blood culture

No adverse reactions noticed

Most patients receiving therapy likely to impair immunological responses.

14 valent/placebo mean 2.9 years

1: Proved or probable pneumococcal pneumonia 2: Proved or probable pneumococcal bronchitis 3: Mortality

1: Pneumococcal infection is clinical infection and positive culture 2: Pneumococcal pneumonia is clinical infection, X-ray and positive culture 3: Bronchitis clinical plus negative chest X-ray plus positive culture

LRTI is bronchitis.

14 valent/placebo up to 2 years

1: Pneumonia 2: Deaths from pneumonia

1: Clinical, X-ray and positive culture

14 valent plus influenza vaccine/influenza vaccine plus placebo 2 years

1: LRTI 2: Pneumonia 3: Mortality

1: Fever, cough, sputum characteristics 2: LRTI plus positive X-ray

Information by illness episodes not by patients experiencing illness.

14 valent plus influenza vaccine/influenza vaccine alone

1: Pneumonia 2: Pneumococcal pneumonia 3: Pneumonia deaths

1: X-ray 2: Serological positive

23-valent/placebo 5 years

1: Pneumonia 2: Pneumococcal pneumonia 3: Pneumonia deaths

1: Clinical plus X-ray 2: Pneumonia plus culture or serology

No serious adverse events

French et al, 2000

23-valent/placebo 1 year

1: Invasive pneumococcal disease 2: Pneumococcal pneumonia 3: All pneumonia

1: All definite and probable invasive pneumococcal disease events