Pneumococcal pneumonia is the leading infectious cause of childhood mortality with an estimated 257 000 deaths globally among children aged 1–59 months in 2015 [1, 2]. Streptococcus pneumoniae is the most common cause of bacterial pneumonia in children [3]. HIV-infected children are at increased risk of pneumococcal pneumonia morbidity and mortality, with an estimated incidence of severe pneumococcal lower respiratory tract infection 42 times higher among HIV-infected children aged 2–24 months compared with HIV-uninfected children [4, 5]. Pneumococcal conjugate vaccines (PCVs) prevent pneumococcal disease by reducing pneumococci carriage in the nasopharynx [6]. Before PCV introduction, Mozambique’s invasive pneumococcal disease incidence was 245 episodes per 100 000 child-years at risk for children less than 5 years of age, and severe pneumonia caused 16% of hospital admissions among children less than 2 years of age in 2009, with a case-fatality ratio of 11% [7, 8]. In April 2013, Mozambique introduced 10-valent PCV (PCV10) into its routine immunization program using a 2, 3, and 4 months of age schedule (3 + 0) without a booster or catch-up campaign. We describe the impact of PCV10 introduction in Mozambique on vaccine-type (VT) and non-VT pneumococcal carriage among children less than 5 years by HIV status, and the remaining carriage burden 3 years after the implementation of the infant PCV10 program. Additionally, given concern for increasing antimicrobial resistance of S. pneumoniae, we evaluated PCV10 impact on antimicrobial non-susceptible pneumococcal carriage.