Despite advances in our knowledge of the pathogenesis and host immune response and efforts at prevention and treatment, S. pneumoniae continues to cause considerable disease and mortality. The currently available polysaccharide vaccines confer moderate protection in most adults and older children, but they are underutilized. There are an estimated 40,000 deaths per year among U.S. adults due to pneumococcus, of which nearly half might be prevented if the current recommendations for vaccination were followed. Future advances must include augmented efforts at coverage of older children and adults via improvements in education, delivery mechanisms and financing. The major advance in the field is the development of conjugate vaccines which appear safe, immunogenic and efficacious against invasive pneumoccocal disease in infants. The first conjugate vaccine is anticipated to be available for use in the U.S. in the year 2000.
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