VoICE Immunization Evidence: Vaccines Alleviate Health System Pressure
Vaccines alleviate health systems pressure
Key Evidence: Among 33,000 preschool children in the UK (who received at least one prescription of amoxicillin) there were ~15% fewer amoxicillin prescriptions given during the influenza season to children who had received the live attenuated influenza vaccine than among children who were not vaccinated. This suggests that flu vaccination may lead to a reduction in excess, inappropriate prescribing of antibiotics for influenza in children.
Key Evidence: Over a four-year period following the introduction of PCV-10 in Finland, purchases of antimicrobials that are recommended for the treatment of acute otitis media (middle-ear infection) for children born during these years fell by nearly 18%, compared to pre-vaccine years, and the rate of surgeries to place ear tubes for severe cases fell 15%. Although it is considered a mild disease, acute otitis media caused by pneumococcus is 1,000 times more common in young children than invasive pneumococcal disease, such as pneumonia or meningitis, and thus the public health impact of the vaccine in reducing otitis media cases and in saving health care costs is considerable.
Key Evidence: 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.
Immunization can decrease hospital admissions, thus alleviating pressure on overburdened health systems.
Key Evidence: Prior to the introduction of rotavirus vaccines in the U.S., there were an estimated 205,000 – 272,000 emergency department visits and 55,000 – 70,000 hospitalizations due to rotavirus in children each year. A series of studies found that hospitalizations in children under five due to rotavirus declined, on average by 80% from the pre-vaccine to the post-vaccine era, while both outpatient visits and emergency department visits due to rotavirus declined 57%.
Key Evidence: Two years after rotavirus vaccine introduction in Rwanda, the country saw nearly 400 fewer hospital admissions for diarrhea among young children at 24 district hospitals.
Key Evidence: A study based on population- and lab-based surveillance of bacterial infections in the U.S. estimated that, of the estimated 400,000 cases and 30,000 deaths from invasive pneumococcal disease (IPD) that were likely prevented from 2001 to 2012 with the introduction of PCV7 (in 2000) and PCV13 (in 2010) in the infant immunization schedule, more than half of cases prevented and nearly 90% of prevented deaths were among people older than 5 years of age.
Key Evidence: A study in Australia estimated that adding dTpa vaccination for pregnant women to the current pertussis immunization program for children would prevent an additional 8,800 symptomatic pertussis cases (mostly unreported) and 146 hospitalizations each year in all ages, including infants and their mothers, as well as one death every 22 months. The study found maternal pertussis vaccination to be cost-effective.
From the VoICE Editors: Note: The formulation used in this study is abbreviated dTpa.
Key Evidence: A review of evaluations of rotavirus vaccine impact on hospitalizations and all-cause acute gastroenteritis (AGE) across multiple countries showed that during the first decade since vaccine licensure, a 32% median reduction in hospitalizations due to AGE were observed in children under a year of age. In children younger than 5 years of age a 38% median reduction was noted. Additionally, laboratory confirmed cases of rotavirus-related hospitalization dropped by 80% and 67% in children under 1 year and 5 years of age respectively. The vaccine introduction also lead to a 46% decrease of AGE in children under 5 years of age in a high mortality setting.
From the VoICE Editors: These observations were evaluated using standardized, evidence- based PRISMA guideline.
Following introduction of PCV in New Zealand, hospitalizations of children under 6 years of age due to invasive pneumococcal disease decreased by 73%, for all-cause pneumonia decreased by 8% and for otitis media decreased by 25%.
Key Evidence: In a Bangladeshi study, pneumonia and acute diarrhea were the first and third most common reasons for childhood hospital admission with over half (54%) of the acute diarrhea admissions caused by rotavirus. One in four children taken to this large pediatric hospital were refused admission because all beds were occupied. Vaccination could have prevented children with rotavirus from requiring essential hospital resources when one in four children refused admission had symptoms of pneumonia.