Purpose of the review: Preventing pneumonia in the elderly and subjects with comorbidities is an unmet clinical need. Streptococcus pneumoniae is the commonest bacterial cause of pneumonia, and we summarise recent findings regarding current S. pneumoniae vaccines, and debate their efficacy and cost effectiveness in risk groups. We also discuss potential future vaccine strategies such as protein antigen vaccines. Recent findings: Current vaccination with PPV does not prevent S. pneumoniae

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... ia. Vaccination with PCV prevents nasopharyngeal colonisation, but although PCV13 has recently been shown to prevent S. pneumoniae pneumonia in adults its overall efficacy was relatively low. The results of cost-effectiveness studies of PCV vaccination in adults are variable with some showing this is a cost effective strategy, whereas others have not. The lack of cost-effectiveness is predominantly due to the current cost of the PCV vaccine and the existing herd immunity effect from childhood PCV vaccination on vaccine serotypes. Summary: S. pneumoniae pneumonia is a vaccine preventable disease but remains a common cause of morbidity and mortality. Advances in vaccination using approaches that induce serotypes-independent immunity and are immunogenic in high risk groups are required to reduce the burden of disease due to S. pneumoniae. Study 2013. Lancet (London, England) 2015, 385:117-71. 2. José RJ, Periselneris JN, Brown JS: Community-acquired pneumonia. Curr. Opin. Pulm. Med. 2015, 21:212-218. 3. Melegaro A, Edmunds WJ, Pebody R, Miller E, George R: The current burden of pneumococcal disease in England and Wales. J. Infect. 2006, 52:37-48. 4. Millett ERC, Quint JK, Smeeth L, Daniel RM, Thomas SL: Incidence of community-acquired lower respiratory tract infections and pneumonia among older adults in the United Kingdom: a population-based study. PLoS One 2013, 8:e75131. 5. Lim WS, Woodhead M: British Thoracic Society adult community acquired pneumonia audit 2009/10. Thorax 2011, 66:548-549. 6. Williams AE, José RJ, Brown JS, Chambers RC: Enhanced inflammation in aged mice following infection with Streptococcus pneumoniae is associated with decreased IL-10 and augmented chemokine production.