VoICE Immunization Evidence: Antimicrobial Resistance
The conditions present in humanitarian emergency settings can lead to an increase in antimicrobial resistant infections.
A meta-analysis of antimicrobial resistance (AMR) in migrant populations in Europe found that 25% of migrants carried or were infected with antibiotic resistant organisms. When considering all migrant types, refugees and asylum seekers had a higher rate (33%) of carrying or being infected with AMR organisms than other migrant groups (7%).
The pneumococcal conjugate vaccine has been shown to significantly reduce the rate of antibiotic and multi-drug resistant strains of pneumococcal disease affecting children.
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.
2 of the 18 drug-resistant threats to US health security identified in a 2013 CDC report are potentially vaccine-preventable.
Antibiotic resistant strains of disease-causing bacteria are a serious problem among HIV positive people.
Among both HIV positive and HIV negative parents in a study in Kenya, 99% of pneumococcal strains found and tested were resistant to one or more antibiotics. HIV positive parents carried 16% more strains that were resistant to penicillin than those carried by HIV negative parents.
Use of vaccines decreases the need to use antibiotics to treat disease, thus reducing the opportunity for the development of antimicrobial resistance.
Reductions in the number of days that patients received antibiotic therapy have been documented among day-care attendees in Israel who received the 9-valent conjugate vaccine. Children who received vaccine had 10% fewer 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) as compared to children who did not receive PCV.
In a study of nearly 40,000 recipients of PCV7 and control subjects in northern California, there was a 5.4% reduction in the number of antibiotic prescriptions and a 12.6% reduction in the use of “second-line antibiotics” among children who received the pneumococcal conjugate vaccine. Between the time the first dose was administered and the age of 3.5 years, use of the vaccine prevented 35 antibiotic prescriptions per 100 fully vaccinated children.
The use of vaccines is a critical step in controlling the occurrence of antibiotic-resistant infections.
The US CDC identifies the use of vaccines as one of the 4 critical steps for controlling the spread of antibiotic resistance.
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.
Antimicrobial-resistant infections are expensive to treat and place an economic burden on families and health systems.
The US CDC estimates that antibiotic resistant pneumococcal infections in the US add $96 million to the costs of treatment each year.