Key Concept

Key Evidence: A large U.S. study of surveillance data examining the impact of switching from PCV7 to PCV13 for infants demonstrated how important vaccination is in combating antimicrobial resistance. While the incidence of antibiotic-resistant invasive pneumococcal disease (IPD) was increasing before the introduction of PCV13, drug resistant IPD declined 78-96% in children under five after the vaccine introduction.

Moore MR, Link-Gelles R, Schaffner W et al. 2015. Effect of use of 13-valent PCV in children on invasive pneumococcal disease in children and adults in the USA: analysis of multisite, population-based surveillance. Lancet. 15.
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Key Evidence: This study from South Africa demonstrates significant declines in invasive pneumococcal disease cases caused by bacteria that are resistant to one or more antibiotics. In fact, the rate of infections resistant to two different antibiotics declined nearly twice as much as infections that could be treated with antibiotics.

Von Gottberg, A., de Gouveia, L., Tempia, S., et al. 2014. Effects of pneumococcal vaccine in invasive pneumococcal disease in South Africa. New England Journal of Medicine. 371(20).
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Key Evidence: Following the introduction of PCV7 and later PCV13 in Madrid, Spain, there was a 70% reduction in the incidence of invasive pneumococcal disease in children less than 15 years of age. There was also a pronounced decline in the percentages of penicillin- and cefotaxime-resistant strains of the pneumococcus bacteria. After PCV13 was introduced in 2010, cefotaxime resistance among meningitis patients completely disappeared and both cefotaxime and penicillin resistance among non-meningitis cases declined to very low levels (<3%).

Picazo JJ, Ruiz-Contreras J, Casado-Flores J et al. 2019. Impact of 13-valent pneumococcal conjugate vaccine on invasive pneumococcal disease in children under 15 years old in Madrid, Spain, 2007 to 2016: the HERACLES clinical surveillance study. Vaccine. 37(16).
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Key Evidence: Studies in several countries have shown that, following the introduction of pneumococcal conjugate vaccine, there was a reduction in the number and percent of drug-resistant cases of pneumococcal diseases in children, and in some countries in adults, due to herd effects. In Japan there was a 10-fold decline in the proportion of penicillin-resistance among cases of invasive pneumococcal disease (from 56% to 5%), and in the U.S. there were reductions of 81% and 49% in the proportion of penicillin-resistant cases in children less than two years and in adults more than 65 years old, respectively.

Klugman KP, Black S 2018. Impact of existing vaccines in reducing antibiotic resistance: primary and secondary effects. Proceedings of the National Academy of Sciences. 115(51).
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Key Evidence: A retrospective observational register-based study found that the 2010 introduction of PCV10 for infants in Finland led to an estimated 15% reduction among unvaccinated children in purchases of antimicrobials recommended for acute otitis media (AOM), the most common reason for antimicrobial use in many countries. The indirect effects of PCV10 introduction contribute to health care savings and may also help to combat antimicrobial resistance.

Palmu, A. A., Rinta-Kokko, H., Nohynek, H., & Nuorti, J. P. 2020. Indirect Impact of Ten-valent Pneumococcal Conjugate Vaccine Program on Reducing Antimicrobial Use and Tympanostomy Tube Placements in Finland. The Pediatric Infectious Disease Journal. 39(9).
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