Peer-reviewed article
Pre and post introduction of pneumococcal conjugate vaccines in children in Eastern Mediterranean Region and effect on antimicrobial resistance, a narrative review.
Basma M Saleh, Osama Mere, Seham Elmrayed ·
Summary
Written by AI, not yet AICS's view · claude-haiku-4-5-20251001This review examines how pneumococcal conjugate vaccines (PCVs) have affected antibiotic resistance and disease patterns in children across the Eastern Mediterranean Region. While PCV introduction in some countries like Saudi Arabia and Lebanon has improved antibiotic susceptibility and reduced vaccine-preventable disease, significant challenges remain including low vaccination coverage in Yemen and Egypt, the emergence of non-vaccine resistant strains, and high rates of multidrug-resistant bacteria. The review emphasizes that vaccines alone are insufficient without stronger surveillance, higher vaccine coverage, and better antibiotic stewardship.
Key points
- Post-PCV13 introduction in Saudi Arabia improved penicillin susceptibility from 37% to 100% in invasive pneumococcal isolates
- Lebanon reported significant reductions in vaccine-type antimicrobial resistance following PCV introduction
- Vaccination coverage is inconsistent across the region, with Yemen at 76% and Egypt having no PCV programme
- Non-vaccine serotypes now represent 73.5% of isolates in Omani children, with multidrug resistance rates reaching 85.7% in Yemen
- Comprehensive strategies including higher-valency vaccines, improved surveillance, and antibiotic stewardship are needed to address ongoing antimicrobial resistance
Limitations
This is a narrative review that synthesizes existing literature rather than presenting new primary data, so it cannot establish causation or provide precise estimates of vaccine impact across all settings. The review does not include detailed methodological assessment of the studies it examines, and the heterogeneity of data sources and surveillance systems across countries limits the ability to make direct regional comparisons.
Abstract
BACKGROUND: Antimicrobial resistance (AMR) is a pressing public health challenge in the Eastern Mediterranean Region (EMR), with Streptococcus pneumoniae being a major contributor due to its role in invasive pneumococcal disease (IPD). Pneumococcal conjugate vaccines (PCVs) have shown promise in reducing vaccine-type IPD and AMR, yet significant barriers persist. OBJECTIVE: This review examines the impact of PCVs on AMR, serotype distribution, and vaccine coverage in pediatric populations within the EMR, emphasizing the interplay between vaccination strategies and AMR trends. CONTENT: The introduction of PCVs, particularly PCV13, has led to reductions in vaccine-type IPD and AMR in several EMR countries. For example, post-PCV13 penicillin susceptibility in Saudi Arabia improved from 37 to 100% in invasive isolates, and Lebanon reported significant reductions in vaccine-type AMR. However, challenges such as inconsistent vaccination coverage (e.g., 76% in Yemen, absent in Egypt), socio-political instability, and the emergence of non-vaccine serotypes (NVTs) as per shown in the 73.5% of isolates in Omani children and the high multidrug resistance (MDR) rates (e.g., 85.7% in Yemen) undermine these benefits. Serotype replacement phenomena, driven by ecological shifts, are increasingly contributing to disease burden and AMR. While PCVs reduce the need for antibiotics and limit selective pressures driving resistance, high rates of MDR and inadequate antibiotic stewardship remain concerns. Strengthened vaccination programs, high-valency vaccines, and robust surveillance systems are critical to addressing these challenges. CONCLUSION: PCVs play a pivotal role in mitigating AMR and reducing pneumococcal disease burden in the EMR. However, suboptimal vaccine coverage, NVT emergence, and persistent AMR highlight the need for comprehensive strategies, including enhanced coverage of higher valency vaccines, robust surveillance, targeted public health interventions, strengthened antibiotic stewardship, and improved regional collaboration. Addressing these issues can significantly reduce the AMR burden and improve health outcomes across the region.