Despite the Healthy People 2010 goal of a pneumococcal polysaccharide vaccine (PPV) vaccination rate of 90% by year 2010, rates remain low and racial disparities exist. This paper systematically reviewed medical literature published between 1981 and 2000 regarding physician and patient knowledge, attitudes, and practices related to pneumococcal vaccination. Among physicians the vaccine is generally believed to be efficacious and safe but difficulty in determining the vaccination status and lack of knowledge regarding re-vaccination were reported as barriers to vaccination. Among patients, there is a lack of awareness among patients of the existence of PPV. Furthermore, a large percentage of patients do not recall being informed about or recommended to receive the vaccine by their physician.