Objectives: To understand factors associated with pneumococcal vaccination in the elderly during visits to acute care providers. Methods: We included all elderly 65 years of age and older enrolled in a health insurance registry in a large Canadian city. Pneumococcal vaccination status was determined using a vaccination administrative database. Unvaccinated elderly were linked to ambulatory and inpatient care databases to determine acute care visits. Logistic regression was used to determine odds ratios for vaccination during a first visit to an acute care provider in 2009. Results: Of 53,249 unvaccinated elderly, 23,574 presented to at least one acute care provider in 2009. Acute care visits were significantly associated with receipt of PPV (11.0% vs. 7.8%, risk adjusted odds ratio [OR]=1.53; 95% confidence interval [CI]=1.44,1.62), particularly ambulatory care visits during influenza season (OR=4.36; 95% CI=2.86,6.66) and inpatient visits with lengths of stay >14 days (OR=7.71, 95% CI=4.41,13.47). Conclusions: Acute care visits hold potential to increase PPV coverage in the elderly and were associated with greater pneumococcal vaccine uptake during the annual influenza season and long hospital stays.