Disease due to Streptococcus pneumoniae, the pneumococcus, remains a major source of illness in older persons. Globally, it remains the most important pathogen in respiratory infection deaths.

Conjugated pneumococcal vaccines are used extensively in national pediatric programs, whereas a polysaccharide vaccine is used in all age groups, but mainly in the elderly and for high-risk groups.

Recent data from the Netherlands led to the licensing in many countries of conjugated pneumococcal vaccines for older persons. There are substantial differences in recommendations from various national immunization technical advisory groups, which owe at least as much to differing assessments of available studies as to differences in local epidemiology.

This review examines those differences and proposes a way forward.