Streptococcus pneumoniae infections have resulted in significant morbidity and mortality worldwide in children and adults. In Canada, Streptococcus pneumoniae remains one of the leading causes of infectious disease including pneumonia, meningitis, bacteremia and otitis media. Although the widespread use of pneumococcal conjugate vaccines (PCVs) in Canadian children has reduced the incidence of pneumococcal diseases associated with vaccine-serotypes, rapid increase of non-vaccine serotypes in carriage and pneumococcal infections is of great concern to clinicians. The main goal of this review is to provide an overall picture of invasive pneumococcal diseases (IPD) in Canada for the past few decades, including serotype changes and shifts in antibiotic resistance patterns. The effects of PCV vaccines on incidence, serotype distribution, antibiotic resistance of pneumococcal infections and nasopharyngeal (NP) carriage are discussed. We also examined historical outbreaks of Streptococcus pneumoniae and their public health impact. Recent developments in universal protein vaccines against pneumococcus show promise.