Lewnard JA, et al. - Among children, Streptococcus pneumoniae is identified to be a leading cause of pneumonia. However, because of diagnostic limitations, lacunae remains concerning the protection conferred by pneumococcal conjugate vaccines (PCVs) against pediatric pneumonia attributable to vaccine-serotype pneumococci. From population-based prospective surveillance studies in southern Israel between 2009-2018, they obtained data on vaccination and nasopharyngeal pneumococcal detection among children < 5 years old with community-acquired alveolar pneumonia (CAAP; “cases”) and those without respiratory symptoms (“controls”). PCV-conferred protection against carriage of vaccine-serotype pneumococci was determined via the relative risk of identifying these serotypes among vaccinated vs unvaccinated controls. Via the relative correlation of vaccine-serotype detection in the nasopharynx with CAAP case status, among vaccinated and unvaccinated children, determination of protection against progression of vaccine serotypes from carriage to CAAP was done. PCV-conferred protection against CAAP attributable to vaccine-serotype pneumococci was determined via the joint decrease in risks of carriage and disease progression. Analyses were performed including 1,032 CAAP cases and 7,743 controls. Among children, protection conferred by PCV against CAAP attributable to vaccine-targeted pneumococcal serotypes is identified resembling protection against vaccine-serotype invasive pneumococcal disease.