Globally Increasing Prevalence of Streptococcus pneumoniae in Pneumonia, Bloodstream Infection, Meningitis, Otitis Media and Sinusitis: Review and Rationale for PCV-13 in Egypt

Abstract

Objective: Streptococcus pneumoniae or pneumococcus is an opportunistic colonizer of the upper respiratory tract and can lead to so-called invasive pneumococcal disease (IPD), including meningitis, bacteremia, and pneumonia. Involving around 100 serotypes with limited cross-protection and variation with age and ambient conditions, vulnerable groups include children under 2, the elderly, and the immuno-compromised. While being a primary cause of pneumonia, it has gradually emerged as a leading cause of bacterial meningitis in Egypt and elsewhere. Integrating the pneumococcal conjugate vaccine (PCV-13) into the national immunization program of Egypt has become a necessity to prevent IPD. Methods: A focused review of English-language publications illustrating the epidemiology and increasing burden of IPD was conducted for the last 20 years. The review covered both global and local pneumonia, bloodstream infection and meningitis in children and adults. Results: Currently, 75% of countries (147/195) have implemented PCV into their immunization programs, while many non-implementing are from Africa that contains about 20% of the world’s population. Gaps in Africa's vaccine manufacturing capacity have been exposed during COVID-19 pandemic and warranted a presidential directive in Egypt to establish a vaccine manufacturing capacity for local and regional needs at the Vaccine and Biotechnology City (VBC). The pneumococcal conjugate vaccine (PCV-13) will be the first launch to mitigate the burden and risks of IPD. Conclusion: Serotype coverage of PCV-13 in Egyptian meningitis cases rose from 30% in 2003 to 90% in 2024. National implementation of the vaccine is essential to address this etiological shifting and reduce IPD incidence, mortality, antibiotic consumption, and associated healthcare costs. Serotype replacement; a crucial phenomenon seen after the introduction of the pneumococcal vaccine will be monitored.