Pneumococcal disease is a major cause of illness and death in the young, the elderly, and those with certain medical conditions. Pneumococcal conjugate vaccines are changing both the epidemiology of pneumococcal disease and disease burden. Conjugate vaccines were first licensed in 2000 for use in young children; second generation conjugates covering more serotypes became available in 2009 and are now part of the routine infant immunization programs of most countries around the world. When part of a routine program, conjugate vaccines not only prevent disease in the targeted age group but also in unvaccinated children and adults because of reduced pneumococcal transmission. Measurement of these direct and indirect benefits of immunization programs has illustrated how young children serve as the primary reservoir of pneumococci in the community. Clinical trials of pneumococcal conjugate vaccines have proven to be an effective method for eliciting the proportion of disease syndromes like pneumonia that is caused by pneumococci or pneumococcal and viral co-infections. While these highly successful vaccines are introduced into more places, surveillance programs are monitoring for signs of any increase in disease caused by serotypes the vaccines are not designed to prevent.