Pneumococcal disease in children in the Middle East and Northern Africa: A systematic literature review of clinical burden, serotype distribution, and vaccination programs.

Bacterial diseases caused by are an important public health problem in Middle Eastern and North African countries. The burden of is poorly documented in these regions, local surveillance programs are lacking. This systematic review was conducted in Medline and Embase to obtain a comprehensive overview of the clinical burden of pneumococcal disease and pneumococcal vaccination status in the pediatric population in Middle East and Northern Africa. Overall, 255 articles and gray literature sources were included in the study, with the majority representing Israel ( = 82), Türkiye ( = 40), Iran ( = 27), and Saudi Arabia ( = 13). The incidence of pneumococcal disease varied based on time frame and country. The dominant IPD serotypes varied, with serotypes 19F and 14 the most prevalent in the Middle East region and serotypes 19F, 14, and 6B the most prevalent in North Africa. The PCV introduction status was identified in most countries of interest except Egypt, Jordan, and Syria. This review sheds light on the significant impact of PCV on the burden of -related diseases. Serotypes 19F, 14, and 6B are still prevalent in the countries of MENA region despite inclusion in licensed PCVs. Genomic analysis could elucidate what the drivers of this persistence are, and future work could be developed around this. Continuous monitoring of serotype epidemiology is important for policy decisions on pediatric pneumococcal vaccination recommendations.