A 10-year survey was undertaken to determine whether patients who developed pneumococcal bacteraemia had previously been given pneumococcal vaccine, and whether they had previously had the opportunity of being vaccinated. Fifty-two per cent of the patients were candidates for vaccine. Of these, only 14% had been vaccinated. In the preceding five years, 97% of non-vaccinated patients had the opportunity of being assessed for, and administered, vaccine. Guidelines for the use of pneumococcal vaccine are not being followed, despite opportunities to do so.