Pneumonia is the third cause of death in children under 5 years old in Indonesia, after prematurity and birth asphyxia (Indonesian Sample Registration System in 2014).

Pneumonia as the cause of death in children under 5 years old in South East Asia (Walker et al. in 2013) primarily due to Pneumococcus 33%, H. influenza 20,7%, and Influenza virus 11,1%. From 1.012 cases of community pneumonia in Bandung 2001 ? 2003, of 606 caused by Pneumococcus, 425 cases by H. influenza, and 79/332 cases by RSV.

In Indonesia, S. pneumonia (pneumococcus) colony  found in nasopharynx of 41 ? 52% healthy children under 5 years with no symptoms (Soewignyo, in Lombok 2001), 67,8% from 27,4% positive nasopharyngeal swab (CB Kartasasmita in Bandung 2005), 46% (Farida H et al. in Semarang 2010) and 46,2% healthy children under 5 years with no symptoms (Hadinegoro SR et al. in Lombok 2012). The infection can easily transmitted by nasopharyngeal secret  when coughing and sneezing. 

Pneumococcal bacteria in nasopharyngeal colony can invade into bloodstream and spread to other organ due to recurrent viral infection in nasopharynx, air pollution, and poor nutrition that cause the decreasing nasopharyngeal immunity. Pneumococcal invasion can cause septicemia, meningitis, and pneumonia that leads to severe illness, disability, and mortality in children under 5 years, especially 0 ? 2 years old.

Ruspanji et al. (in Cipto Mangunkusumo Hospital 1976 ? 1977) and Komang Kari (in Sanglah Hospital 2006) had proved that pneumococcus cause bacteremia, meningitis,  epilepsy, hydrocephalus, cerebral palsy, deafness with mortality rate 45%.

Realizing the fatal impact caused by pneumococcal infection, our baby, children, grandchildren, and niece or nephew should be protected from S. pneumonia infection with exclusive breastfeeding, sufficient and balance nutrition, avoid air pollution, clean and healthy life behavior, and also routine immunization and pneumococcal (PCV) immunization.

Routine PCV immunization for children under 5 years is recommended by WHO and SAGE in country with high mortality rate of children under 5 years due to pneumonia and it have done in many countries. WHO Position Paper in February 2019 concluded  that PCV 10 and PCV 13 have the same safety and effectiveness to prevent diseases caused by pneumococcus.

To choose PCV type that suitable for the local area needs, we have to consider the compatibility of serotypes in each countries, the presence of cross reaction between some of the serotypes,  the experience from every countries and  the budget of government and  family.