text: Probiotics as Adjuvants in Vaccine Strategy Is There More Room for Improvement It has been recognized that microbiota plays a key role in shaping immune system maturation and activity Since probiotic administration influences the microbiota composition and acts as a biological response modifier the efficacy of an adjuvant for boosting vaccine specific immunity is investigated A review of the literature was performed starting from the mechanisms to laboratory and clinical evidence The mechanisms and in vitro and animal models provide biological plausibility for microbiota use Probiotics have been investigated as adjuvants in farm conditions and as models to understand their potential in human vaccinations with promising results In human studies although probiotics were effective in ameliorating seroconversion to vaccines for influenza rotavirus and other micro organisms the results for clinical use are still controversial especially in particular settings such as during the last trimester of pregnancy Although this topic remains controversial the use of probiotics as adjuvant factors in vaccination represents a strategic key for different applications The available data are deeply influenced by heterogeneity among studies in terms of strains timing and duration of administration and patients Although these do not allow us to draw definitive conclusions probiotics as adjuvants in vaccination should be considered in future studies especially in the elderly and in children where vaccine effectiveness and duration of immunization really matter 