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Synflorix is a 10-valent pneumococcal conjugate vaccine (PHiD-CV) developed by GSK Vaccines to protect infants and young children against invasive pneumococcal disease, pneumonia, and acute otitis media. The vaccine contains capsular polysaccharides from 10 *Streptococcus pneumoniae* serotypes (1, 4, 5, 6B, 7F, 9V, 14, 18C, 19F, and 23F). A unique feature of this vaccine is the use of protein D, a highly conserved surface lipoprotein derived from non-typeable *Haemophilus influenzae* (NTHi), as the carrier protein for eight of the ten serotypes. The remaining two serotypes, 18C and 19F, are conjugated to tetanus toxoid and diphtheria toxoid, respectively. By incorporating the NTHi protein D antigen, the vaccine aims to provide additional protection against acute otitis media caused by non-typeable *Haemophilus influenzae*. It was first licensed in the European Union in 2009 and has been evaluated in numerous Phase III trials demonstrating non-inferiority to earlier pneumococcal conjugate vaccines.
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