Vaccines for Urinary Tract Infections in Children: A Systematic Review

Background Recurrent urinary tract infections (rUTIs) are a significant problem in children, potentially leading to permanent renal scarring. The increasing prevalence of antimicrobial resistance necessitates alternative prevention strategies to prophylactic antibiotics. Vaccines that stimulate immunity against uropathogens represent a promising approach. Objectives We aim to update a previous review from 2024 on UTI vaccines in adults, which will provide contextual contrast for the paediatric focus of this paper. We then will systematically review the evidence for vaccines in preventing rUTIs in the paediatric population, evaluate current and emerging vaccine options, and identify gaps in research. Methods This systematic review followed PRISMA guidelines. Eligible studies included randomised controlled trials (RCTs) and observational studies of children (<18) comparing vaccines against prophylactic antibiotics, a placebo, or an alternative therapy, with UTI frequency as a primary outcome. We searched PubMed/MEDLINE, Scopus, and Embase from inception to July 13, 2025; the adult update used a separate PubMed search from January 2024. Risk of bias was assessed using the Cochrane RoB 2.0 and ROBINS-I tools. A narrative synthesis was performed due to study heterogeneity. The study protocol was not prospectively registered. Results Five primary studies comprising a total of 233 children were included. The evidence for UTI vaccines in children is sparse and derived from small, often dated studies. Intramuscular Solco-Urovac and oral UroVaxom (OM-89) show some promise in reducing UTI recurrence in small cohorts. Uromune (MV140), a sublingual vaccine with growing evidence in adults, has no published paediatric trials. Discussion A key limitation of the evidence is that studies excluded high-risk children with urological abnormalities. There is an evidence chasm for paediatric UTI vaccines; routine use cannot be recommended from current data. Large-scale methodologically robust RCTs are urgently needed.