VoICE Immunization Evidence: Antibiotic Resistance

Key Concept

Key Evidence: A community-based study in Vietnam found a high percent of children under five years of age were carrying pneumococcal bacteria in their noses and throats that were non-susceptible to commonly-used antibiotics. Of the strains tested, 18% were not susceptible to penicillin, 26% weren’t susceptible to cefotaxime, 76% were not susceptible to meropenem and 14% were not susceptible to all three nor to any of the “macrolide” drugs (e.g., erthromycin and azithromycin). However, 90% of the multi-drug resistant strains are serotypes that are in the 13-strain pneumococcal conjugate vaccine (PCV-13) and thus the introduction of a vaccine is expected to increase the susceptibility of circulating strains of the bacteria.

Nguyen HAT, Fujii H, Vu HTT et al. 2019. An alarmingly high nasal carriage rate of Streptococcus pneumoniae serotype 19F non-susceptible to multiple beta-lactam antimicrobials among Vietnamese children. BMC Infectious Diseases. 19(241).

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Key Evidence: The US CDC identifies the use of vaccines as one of the 4 critical steps for controlling the spread of antibiotic resistance.

Centers for Disease Control and Prevention 2013. Antibiotic resistance threats in the United States, 2013 (Report).

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Key Evidence: According to a study in a hypothetical endemic population, vaccination using typhoid conjugate vaccine will reverse the current increase in the percent of chronic carriers of the disease who are antibiotic resistant, if at least 50% of the target population is vaccinated. This would deplete an important “reservoir” of antibiotic resistant typhoid.

Kaufhold S, Yaesoubi R, Pitzer VE 2019. Predicting the impact of typhoid conjugate vaccines on antimicrobial resistance. Clinical Infectious Diseases. 68 (Suppl 2).

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Key Evidence: A systematic review of studies from India found that prior to widespread use of the pneumococcal conjugate vaccine, antibiotic resistance in serious pneumoccocal infections among Indian children has been common. Penicillin resistance was found in 10% of invasive pneumococcal disease (IPD) cases, while trimethoprim/sulfamethoxazole resistance was found in more than 80% of these cases.

Singh, J., Sundaresan, S., Manoharan, A. and Shet, A. 2017. Serotype distribution and antimicrobial susceptibility pattern in children≤ 5 years with invasive pneumococcal disease in India–A systematic review. Vaccine. 35(35), pp.4501-4509.

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Key Evidence: Shortly after its introduction of Hib vaccine in the United Kingdom, a decrease in resistant (ᵝ-lactamase-positive) strains were documented. In the U.S., following introduction of pneumococcal conjugate vaccines, including PCV13, there was a decrease in both antibiotic use and in the prevalence of pneumococcal strains not susceptible to antibiotics.

Jansen KU, Knirsch C, Anderson AS 2018. The role of vaccines in preventing bacterial antimicrobial resistance. Nature Medicine. 24.

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