{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,13]],"date-time":"2026-07-13T12:11:13Z","timestamp":1783944673081,"version":"3.55.0"},"reference-count":47,"publisher":"BMJ","issue":"Suppl 1","license":[{"start":{"date-parts":[[2026,7,13]],"date-time":"2026-07-13T00:00:00Z","timestamp":1783900800000},"content-version":"unspecified","delay-in-days":193,"URL":"https:\/\/creativecommons.org\/licenses\/by\/3.0\/igo\/"}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["bmjph"],"accepted":{"date-parts":[[2026,6,8]]},"published-print":{"date-parts":[[2026,1]]},"abstract":"<jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>\n                      <jats:italic>Klebsiella pneumoniae<\/jats:italic>\n                      is a major cause of neonatal sepsis in Africa and a WHO priority pathogen for vaccine development. With growing antimicrobial resistance and limited treatment options, maternal vaccination offers a potential preventive strategy. This scoping review synthesises evidence on\n                      <jats:italic>K. pneumoniae<\/jats:italic>\n                      vaccine research in Africa and highlights gaps to guide future research and development priorities\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      A systematic PubMed search was conducted on 1 September 2025 to identify studies on\n                      <jats:italic>K. pneumoniae<\/jats:italic>\n                      vaccine research in Africa. Additional searches were conducted in ClinicalTrials.gov, the Pan-African Clinical Trials Registry and the WHO International Clinical Trials Registry Platform. Eligible studies were screened, and data were extracted and synthesised using a framework focused on disease burden, vaccine development and implementation considerations.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      A total of 14 studies published between 2008 and 2024 met the inclusion criteria, with most (11\/14) published in the last 5 years. Studies reported a high burden of\n                      <jats:italic>K. pneumoniae<\/jats:italic>\n                      infections across multiple African countries, particularly in neonatal sepsis and meningitis. While genomic and immunological studies provided insights into vaccine target selection, no\n                      <jats:italic>K. pneumoniae<\/jats:italic>\n                      vaccine trials were identified in Africa. Modelling studies suggest that maternal immunisation with a 70% effective vaccine could prevent approximately 400\u2009000 neonatal sepsis cases and 80\u2009000 deaths annually worldwide, including Africa. Key research gaps include limited epidemiological surveillance and absence of immune correlates of protection.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>\n                      Despite the high burden of\n                      <jats:italic>K. pneumoniae<\/jats:italic>\n                      neonatal infections in Africa, vaccine research remains in its early stages, with no ongoing clinical trials on the continent. Strengthening surveillance systems, advancing vaccine candidates and integrating\n                      <jats:italic>K. pneumoniae<\/jats:italic>\n                      vaccination into existing maternal immunisation programmes are critical next steps. Multisectoral collaboration among researchers, policymakers and continental and global health organisations will be essential to accelerate vaccine development and ensure equitable access in Africa.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjph-2025-004451","type":"journal-article","created":{"date-parts":[[2026,7,13]],"date-time":"2026-07-13T11:40:20Z","timestamp":1783942820000},"page":"e004451","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["<i>Klebsiella<\/i>\n                    vaccine research and development in Africa: a rapid scoping review of current evidence and future priorities"],"prefix":"10.1136","volume":"4","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0765-7497","authenticated-orcid":false,"given":"Chinwe","family":"Iwu-Jaja","sequence":"first","affiliation":[{"name":"World Health Organization Regional Office for Africa, Brazzaville, Congo"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4946-6736","authenticated-orcid":false,"given":"Akhona Victress","family":"Mazingisa","sequence":"additional","affiliation":[{"name":"Department of Community Health Studies, Durban University of Technology, Durban, South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anelisa","family":"Jaca","sequence":"additional","affiliation":[{"name":"South African Medical Research Council, Cape Town, South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chidozie D","family":"Iwu","sequence":"additional","affiliation":[{"name":"School of Health Systems and Public Health, University of Pretoria, Pretoria, South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Charles Shey","family":"Wiysonge","sequence":"additional","affiliation":[{"name":"Cochrane South Africa, South African Medical Research Council, Cape Town, South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2026,7,13]]},"reference":[{"key":"2026071304401209000_4.Suppl_1.e004451.1","doi-asserted-by":"publisher","DOI":"10.1128\/MMBR.00078-15"},{"key":"2026071304401209000_4.Suppl_1.e004451.2","doi-asserted-by":"crossref","DOI":"10.3389\/fmicb.2021.750662","article-title":"Clinical Epidemiology, Risk Factors, and Control Strategies of Klebsiella pneumoniae Infection","volume":"12","author":"Chang","year":"2021","journal-title":"Front Microbiol"},{"key":"2026071304401209000_4.Suppl_1.e004451.3","first-page":"2633851","article-title":"Hypervirulent Klebsiella pneumoniae","volume":"2","author":"Patel","year":"2017","journal-title":"OFID"},{"key":"2026071304401209000_4.Suppl_1.e004451.4","doi-asserted-by":"crossref","DOI":"10.3390\/vaccines12101177","article-title":"Klebsiella pneumoniae Lipopolysaccharide as a Vaccine Target and the Role of Antibodies in Protection from Disease","volume":"12","author":"Miller","year":"2024","journal-title":"Vaccines (Basel)"},{"key":"2026071304401209000_4.Suppl_1.e004451.5","article-title":"General Overview of Klebsiella pneumonia: Epidemiology and the Role of Siderophores in Its Pathogenicity","volume":"13","author":"Abbas","year":"2024","journal-title":"Biology (Basel)"},{"key":"2026071304401209000_4.Suppl_1.e004451.6","doi-asserted-by":"publisher","DOI":"10.1016\/S1473-3099(19)30414-1"},{"key":"2026071304401209000_4.Suppl_1.e004451.7","doi-asserted-by":"crossref","first-page":"e909","DOI":"10.1016\/S2214-109X(20)30205-9","article-title":"Initial findings from a novel population-based child mortality surveillance approach: a descriptive study","volume":"8","author":"Taylor","year":"2020","journal-title":"Lancet Glob Health"},{"key":"2026071304401209000_4.Suppl_1.e004451.8","doi-asserted-by":"crossref","first-page":"512","DOI":"10.1038\/s41564-021-00870-7","article-title":"Characterization of antimicrobial-resistant Gram-negative bacteria that cause neonatal sepsis in seven low- and middle-income countries","volume":"6","author":"Sands","year":"2021","journal-title":"Nat Microbiol"},{"key":"2026071304401209000_4.Suppl_1.e004451.9","doi-asserted-by":"crossref","first-page":"1677","DOI":"10.1016\/S1473-3099(21)00050-5","article-title":"Effects of antibiotic resistance, drug target attainment, bacterial pathogenicity and virulence, and antibiotic access and affordability on outcomes in neonatal sepsis: an international microbiology and drug evaluation prospective substudy (BARNARDS)","volume":"21","author":"Thomson","year":"2021","journal-title":"Lancet Infect Dis"},{"key":"2026071304401209000_4.Suppl_1.e004451.10","doi-asserted-by":"crossref","first-page":"e661","DOI":"10.1016\/S2214-109X(22)00043-2","article-title":"Neonatal sepsis and mortality in low-income and middle-income countries from a facility-based birth cohort: an international multisite prospective observational study","volume":"10","author":"Milton","year":"2022","journal-title":"Lancet Glob Health"},{"key":"2026071304401209000_4.Suppl_1.e004451.11","doi-asserted-by":"crossref","DOI":"10.1136\/bmjgh-2017-000347","article-title":"Economic burden of neonatal sepsis in sub-Saharan Africa","volume":"3","author":"Ranjeva","year":"2018","journal-title":"BMJ Glob Health"},{"key":"2026071304401209000_4.Suppl_1.e004451.12","doi-asserted-by":"publisher","DOI":"10.1128\/CMR.00047-19"},{"key":"2026071304401209000_4.Suppl_1.e004451.13","doi-asserted-by":"publisher","DOI":"10.1086\/655995"},{"key":"2026071304401209000_4.Suppl_1.e004451.14","doi-asserted-by":"crossref","first-page":"2221","DOI":"10.1016\/S0140-6736(22)02185-7","article-title":"Global mortality associated with 33 bacterial pathogens in 2019: a systematic analysis for the Global Burden of Disease Study 2019","volume":"400","author":"Ikuta","year":"2022","journal-title":"The Lancet"},{"key":"2026071304401209000_4.Suppl_1.e004451.15","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(21)02724-0\/ATTACHMENT\/4504FC2B-08AE-46D6-BD75-80811DF8B5E6\/MMC1.PDF"},{"key":"2026071304401209000_4.Suppl_1.e004451.16","doi-asserted-by":"crossref","unstructured":"Gahimbare L , Muvunyi CM , Aya N , et al . Antimicrobial resistance in the who african region: a systematic literature review 2016 \u2013 2020. 2024.","DOI":"10.3390\/antibiotics13070659"},{"key":"2026071304401209000_4.Suppl_1.e004451.17","doi-asserted-by":"crossref","first-page":"e131","DOI":"10.1016\/S2666-5247(23)00290-2","article-title":"Child deaths caused by Klebsiella pneumoniae in sub-Saharan Africa and south Asia: a secondary analysis of Child Health and Mortality Prevention Surveillance (CHAMPS) data","volume":"5","author":"Verani","year":"2024","journal-title":"Lancet Microbe"},{"key":"2026071304401209000_4.Suppl_1.e004451.18","doi-asserted-by":"crossref","first-page":"251","DOI":"10.1016\/j.ijid.2020.06.016","article-title":"Aetiology of bacterial meningitis in infants aged <90 days: Prospective surveillance in Luanda, Angola","volume":"97","author":"Pelkonen","year":"2020","journal-title":"Int J Infect Dis"},{"key":"2026071304401209000_4.Suppl_1.e004451.19","article-title":"Genomic and antigenic diversity of colonizing Klebsiella pneumoniae isolates mirrors that of invasive isolates in Blantyre, Malawi","volume":"8","author":"Lewis","year":"2022","journal-title":"Microb Genom"},{"key":"2026071304401209000_4.Suppl_1.e004451.20","doi-asserted-by":"crossref","DOI":"10.1016\/j.ebiom.2024.105424","article-title":"Identifying WHO global priority endemic pathogens for vaccine research and development (R&D) using multi-criteria decision analysis (MCDA): an objective of the Immunization Agenda 2030","volume":"110","author":"Hasso-Agopsowicz","year":"2024","journal-title":"EBioMedicine"},{"key":"2026071304401209000_4.Suppl_1.e004451.21","doi-asserted-by":"crossref","first-page":"S125","DOI":"10.1016\/j.vaccine.2024.02.072","article-title":"Vaccine value profile for Klebsiella pneumoniae","volume":"42","author":"Dangor","year":"2024","journal-title":"Vaccine"},{"key":"2026071304401209000_4.Suppl_1.e004451.22","doi-asserted-by":"publisher","DOI":"10.11124\/JBIES-20-00167"},{"key":"2026071304401209000_4.Suppl_1.e004451.23","doi-asserted-by":"publisher","DOI":"10.1097\/XEB.0000000000000050"},{"key":"2026071304401209000_4.Suppl_1.e004451.24","doi-asserted-by":"publisher","DOI":"10.7326\/M18-0850"},{"key":"2026071304401209000_4.Suppl_1.e004451.25","unstructured":"Pan african clincal trial registry. Available: https:\/\/pactr.samrc.ac.za\/ [Accessed 17 Jan 2025]."},{"key":"2026071304401209000_4.Suppl_1.e004451.26","unstructured":"World Health Organization . ICTRP search portal. Available: https:\/\/www.who.int\/clinical-trials-registry-platform\/the-ictrp-search-portal [Accessed 17 Jan 2025]."},{"key":"2026071304401209000_4.Suppl_1.e004451.27","unstructured":"Clinicaltrial.gov. Available: https:\/\/clinicaltrials.gov\/ [Accessed 17 Jan 2025]."},{"key":"2026071304401209000_4.Suppl_1.e004451.28","doi-asserted-by":"crossref","DOI":"10.1186\/s13643-016-0384-4","article-title":"Rayyan-a web and mobile app for systematic reviews","volume":"5","author":"Ouzzani","year":"2016","journal-title":"Syst Rev"},{"key":"2026071304401209000_4.Suppl_1.e004451.29","unstructured":"World Health Organization . Strategic framework for research on strategic framework for research on immunization in the who African region. 2018. Available: https:\/\/iris.who.int\/bitstream\/handle\/10665\/324962\/9789290234173-eng.pdf [Accessed 20 Apr 2024]."},{"key":"2026071304401209000_4.Suppl_1.e004451.30","doi-asserted-by":"crossref","DOI":"10.1186\/s13073-024-01342-3","article-title":"Longitudinal analysis within one hospital in sub-Saharan Africa over 20 years reveals repeated replacements of dominant clones of Klebsiella pneumoniae and stresses the importance to include temporal patterns for vaccine design considerations","volume":"16","author":"Heinz","year":"2024","journal-title":"Genome Med"},{"key":"2026071304401209000_4.Suppl_1.e004451.31","doi-asserted-by":"publisher","DOI":"10.1093\/cid\/ciab784"},{"key":"2026071304401209000_4.Suppl_1.e004451.32","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pmed.1004239","article-title":"Global, regional, and national estimates of the impact of a maternal Klebsiella pneumoniae vaccine: A Bayesian modeling analysis","volume":"20","author":"Kumar","year":"2023","journal-title":"PLoS Med"},{"key":"2026071304401209000_4.Suppl_1.e004451.33","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0205124","article-title":"Epidemiology of severe acute respiratory infections from hospital-based surveillance in Madagascar, November 2010 to July 2013","volume":"13","author":"Razanajatovo","year":"2010","journal-title":"PLoS ONE"},{"key":"2026071304401209000_4.Suppl_1.e004451.34","doi-asserted-by":"crossref","unstructured":"Zhang SL , McGann CM , Duranova T , et al . Maternal and neonatal igg against klebsiella pneumoniae are associated with broad protection from neonatal sepsis: a case-control study of hospitalized neonates in botswana. Infectious Diseases (except HIV\/AIDS) [Preprint] 2024. doi:10.1101\/2024.05.28.24308042","DOI":"10.1101\/2024.05.28.24308042"},{"key":"2026071304401209000_4.Suppl_1.e004451.35","doi-asserted-by":"crossref","DOI":"10.7189\/jogh.13.04106","article-title":"Invasive bacterial disease in young infants in rural Gambia: Population-based surveillance","volume":"13","author":"Olatunji","year":"2023","journal-title":"J Glob Health"},{"key":"2026071304401209000_4.Suppl_1.e004451.36","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0310528","article-title":"Demographic and pathogen characteristics of incident bacterial meningitis in infants in South Africa: A cohort study","volume":"19","author":"Kiakuvue","year":"2024","journal-title":"PLoS ONE"},{"key":"2026071304401209000_4.Suppl_1.e004451.37","doi-asserted-by":"crossref","first-page":"106341","DOI":"10.1016\/j.jinf.2024.106341","article-title":"Etiologies and comorbidities of meningitis deaths in children under 5 years in high-mortality settings: Insights from the CHAMPS Network in the post-pneumococcal vaccine era","volume":"89","author":"Mahtab","year":"2024","journal-title":"J Infect"},{"key":"2026071304401209000_4.Suppl_1.e004451.38","doi-asserted-by":"crossref","first-page":"429","DOI":"10.3855\/jidc.413","article-title":"Invasive bacteria isolates from children with severe infections in a Nigerian hospital","volume":"3","author":"Onipede","year":"2009","journal-title":"J Infect Dev Ctries"},{"key":"2026071304401209000_4.Suppl_1.e004451.39","first-page":"370","article-title":"Etiologic Agents and Outcome Determinants of Community-Acquired Pneumonia in Urban Children: A Hospital-Based Study","volume":"100","author":"Johnson","year":"2008","journal-title":"J Natl Med Assoc"},{"key":"2026071304401209000_4.Suppl_1.e004451.40","first-page":"154","article-title":"Aetiology of community-acquired neonatal sepsis in low and middle income countries","volume":"1","author":"Waters","year":"2011","journal-title":"J Glob Health"},{"key":"2026071304401209000_4.Suppl_1.e004451.41","doi-asserted-by":"crossref","first-page":"e342","DOI":"10.1093\/infdis\/jiaf600","article-title":"Safety and Immunogenicity of a Klebsiella pneumoniae Tetravalent Bioconjugate Vaccine (Kleb4V) Administered to Healthy Adults: A First-in-Human Phase I\/II Randomized and Controlled Study","volume":"233","author":"Alaimo","year":"2026","journal-title":"J Infect Dis"},{"key":"2026071304401209000_4.Suppl_1.e004451.42","doi-asserted-by":"publisher","DOI":"10.1080\/14760584.2019.1635460"},{"key":"2026071304401209000_4.Suppl_1.e004451.43","doi-asserted-by":"crossref","first-page":"2157","DOI":"10.1007\/s40121-021-00533-4","article-title":"Current Stage in the Development of Klebsiella pneumoniae Vaccines","volume":"10","author":"Assoni","year":"2021","journal-title":"Infect Dis Ther"},{"key":"2026071304401209000_4.Suppl_1.e004451.44","article-title":"The diversity of Klebsiella pneumoniae surface polysaccharides","volume":"2","author":"Follador","year":"2016","journal-title":"Microb Genom"},{"key":"2026071304401209000_4.Suppl_1.e004451.45","doi-asserted-by":"crossref","first-page":"4568","DOI":"10.1016\/j.vaccine.2019.06.020","article-title":"Maternal immunization in Malawi: A mixed methods study of community perceptions, programmatic considerations, and recommendations for future planning","volume":"37","author":"Fleming","year":"2019","journal-title":"Vaccine"},{"key":"2026071304401209000_4.Suppl_1.e004451.46","doi-asserted-by":"crossref","DOI":"10.1080\/21645515.2024.2314826","article-title":"\"Why has this new vaccine come and for what reasons?\" key antecedents and questions for acceptance of a future maternal GBS vaccine: Perspectives of pregnant women, lactating women, and community members in Kenya","volume":"20","author":"Limaye","year":"2024","journal-title":"Hum Vaccin Immunother"},{"key":"2026071304401209000_4.Suppl_1.e004451.47","doi-asserted-by":"crossref","DOI":"10.11604\/pamj.2022.43.168.32983","article-title":"The impact of faith-based organizations on maternal and child health care outcomes in Africa: taking stock of research evidence","volume":"43","author":"Nicol","year":"2022","journal-title":"Pan Afr Med J"}],"container-title":["BMJ Public Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bmjph-2025-004451","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,13]],"date-time":"2026-07-13T11:40:25Z","timestamp":1783942825000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmjpublichealth.bmj.com\/lookup\/doi\/10.1136\/bmjph-2025-004451"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,1]]},"references-count":47,"journal-issue":{"issue":"Suppl 1","published-online":{"date-parts":[[2026,7,13]]},"published-print":{"date-parts":[[2026,1]]}},"alternative-id":["10.1136\/bmjph-2025-004451"],"URL":"https:\/\/doi.org\/10.1136\/bmjph-2025-004451","relation":{},"ISSN":["2753-4294"],"issn-type":[{"value":"2753-4294","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,1]]}}}