Targeted pneumococcal conjugate vaccination strategies for high-risk children.

Streptococcus pneumoniae remains a leading cause of pneumonia mortality among children under five years of age, with the greatest burden in low- and middle-income countries (LMICs). Children with malnutrition and those following infection with measles or malaria experience immune dysfunction, with subsequent high risk of severe pneumonia and death. Targeted pneumococcal conjugate vaccine (PCV) strategies, timed to periods of greatest vulnerability among these high-risk groups, could reduce pneumonia burden and mortality in LMICs yet research in these populations remains limited, and specific PCV recommendations are lacking. This mini-review summarizes the disease burden and immune vulnerability associated with malnutrition, measles, and malaria, and highlights key research priorities to inform targeted PCV strategies among these high-risk children.