In 2005, before most low- and middle-income countries started vaccinating children routinely for pneumococcal disease, it caused approximately 1.5 million deaths worldwide annually. About 700,000 to 1 million of these deaths were in children under five years. Pneumococcal disease occurs when Streptococcus pneumoniae invades a normally sterile area of the body, causing meningitis, pneumonia, septicaemia