Pneumonia is a major cause of morbidity and mortality among older people residents of nursing homes1. Pneumococcus is the most important cause of pneumonia in this population, with an estimated 10-fold higher incidence of invasive (bloodstream) disease compared to community-dwelling seniors2. Despite the presence of an extant body of research and studies that strongly recommend prevention of this invasive disease, there are no clear-cut findings about the causal factors behind pneumonia. A systematic review which compared between two groups, those who had pneumococcal vaccination and those who did not (placebo), found a significant effect of vaccines of various valencies in reducing all-cause pneumonia (OR 0.71, 95% CI 0.52 to 0.97); however, findings did reveal significant heterogeneity3. The 23-pneumococcal polysaccharide vaccine …