Key Concept

Key Evidence: In this analysis of data from large-scale studies of households, two vaccines recently implemented in the WHO EPI, pneumococcal conjugate vaccines and live attenuated rotavirus vaccines, were estimated to confer 20% and 11% protection against antibiotic-treated episodes of acute respiratory infection and diarrhea, respectively, in the age groups with the greatest disease burden attributable to these pathogens. Under current coverage levels, pneumococcal and rotavirus vaccines are estimated to prevent 24 million and 14 million episodes, respectively, of antibiotic-treated illness each year among children in LMICs less than five years old. An additional 40 million episodes could be prevented through achievement of universal coverage targets.

Lewnard, J. A., Lo, N. C., Arinaminpathy, N., Frost, I., & Laxminarayan, R. 2020. Childhood vaccines and antibiotic use in low- and middle-income countries. Nature. 581.
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Key Evidence: Evaluation of the ability of pneumococcal conjugate vaccine to reduce the occurrence of respiratory infections and the resultant antibiotic drug use was conducted among day care attendees in Israel. It was observed that children who had received the 9-valent conjugate vaccine showed a 17% overall reduction in antibiotic usage. In particular, a 10% reduction in days of antibiotic usage for upper respiratory tract infections, 47% fewer days of antibiotic usage for lower respiratory tract infections, and 20% fewer days of antibiotic usage for otitis media (ear infections) when compared to children who did not receive PCV.

Dagan, R., Sikuler-Cohen, M., Zamir, O., et al 2001. Effect of a conjugate pneumococcal vaccine on the occurrence of respiratory infections and antibiotic use in day-care center attendees. Pediatric Infectious Disease Journal. 20(10).
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Key Evidence: Several studies have shown a 13-50% reduction in the use of antibiotics by children who have received influenza vaccine compared with unvaccinated controls. This is due to a decline in febrile illnesses causes by influenza — for which antibiotics are often prescribed inappropriately — as well as a decline in secondary bacterial infections requiring antibiotic treatment, such as pneumonia and middle ear infections, that are triggered by influenza.

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: In a study evaluating the impact of PCV7 on 40,000 recipients and control subjects in northern California revealed that the vaccine could significantly decrease the need for antibiotics to treat the disease. The children who had received the vaccine displayed a 5.4% reduction in the number of antibiotic prescriptions and a 12.6% reduction in the use of “second-line antibiotics” compared to the controls. Additionally, when looking at children in the time period between their first dose and attainment of the age of 3.5 years, receiving the vaccine had prevented 35 antibiotic prescriptions per 100 fully vaccinated children.

Fireman, B., Black, S.B., Shinefield, H.R., et al. 2003. Impact of pneumococcal conjugate vaccine on otitis media. Pediatric Infectious Disease Journal. 22(1).
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Key Evidence: In Iceland, a study of all children born over an 11-year period, before and after the introduction of pneumococcal conjugate vaccine (PCV) into the national immunization program, found a 6% decrease in all antibiotic prescriptions for children during their first four years of life and a 22% reduction in prescriptions for otitis media after the vaccine was introduced. Thus, in addition to reducing the burden of pneumococcal disease, PCV may also slow the spread of antibiotic resistance.

Eythorsson E, Sigurdsson S, Hrafnkelsson B 2018. Impact of the 10-valent pneumococcal conjugate vaccine on antimicrobial prescriptions in young children: a whole population study. BMC Infectious Disease. 18(505).
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Key Evidence: A study led by researchers from the U.S. Centers for Disease Control and Prevention found that across five winter influenza seasons (2013-2018), vaccination against influenza averted 1 in 25 antibiotic prescriptions among outpatients with acute respiratory illness (ARI). The study population included 37,487 ARI outpatients 6 months or older treated at over 50 healthcare facilities across the United States. The authors conclude that influenza vaccination may curb unnecessary antibiotic use and help reduce the global threat of antibiotic resistance.

Smith, E. R., Fry, A. M., Hicks, L. A., Fleming-Dutra, K. E., Flannery, B., Ferdinands, J., ... & Nowalk, M. P. 2020. Reducing Antibiotic Use in Ambulatory Care Through Influenza Vaccination. Clinical Infectious Diseases. ciaa464.
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Key Evidence: Vaccines against influenza reduce the use of antibiotics that drive drug resistance in bacteria in two ways. First, they prevent secondary bacterial infections caused by influenza, such as pneumonia and otitis media; in Ontario, Canada, the rate of prescribing for influenza-associated antibiotics declined around 64% after universal introduction of influenza vaccination compared to other Canadian provinces with more limited use of the vaccine. Second, they help prevent inappropriate antibiotic prescriptions for respiratory tract infections caused by influenza and other viruses, which account for half of all respiratory illnesses for which antibiotics are prescribed in the U.S.

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