This review describes major contributions to our understanding of pneumococcal diseases among children in hinterland of China. The data demonstrated that Streptococcus pneumoniae (S. pneumoniae) is an important pathogen of pyogenic meningitis, pneumonia, and other infectious diseases in children. The distribution of serotypes of S. pneumoniae showed great diversity in several studies in various cities during different years. The penicillin nonsusceptibility rates, although variable, demonstrated an increase over time in China. The prevalence of resistance to erythromycin, trimethoprim-sulfamethoxazole or tetracycline was reported to be over 80% and exceeded those reported from other developed countries. A national survey on serotype prevalence, antimicrobial resistance and molecular epidemiology of S. pneumoniae, especially in invasive pneumococcal diseases, and studies to determine pneumococcal disease burden should be undertaken in the future to provide evidence and guidance to the use of vaccine and antibiotics in S. pneumoniae infections. Crown Copyright (C) 2008 Published by Elsevier Ltd. All rights reserved.