The Knowledge Hub

What is the Knowledge Hub?

Explore the VoICE Knowledge Hub—a searchable database featuring the latest peer-reviewed research on immunization benefits, especially in low- and middle-income countries. Browse the Knowledge Hub using a variety of different filters to find vaccine evidence based on country, region, topic, or disease. Click on a tag to find more evidence on a specific area, such as the return on investment of vaccines or impacts of infectious disease outbreaks.


Diseases & Vaccines


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Immunization Terms

Increasing influenza vaccination coverage by 10% leads to a 65% decrease in antibiotic use

A retrospective analysis of influenza vaccination coverage and antibiotic prescribing rates from 2010 to 2017 across states in the United States, controlling for differences in health infrastructure and yearly vaccine effectiveness, found that a 10-percentage point increase in influenza vaccination coverage was associated with a 6.5% decrease in antibiotic use across all age groups, equivalent to 14.2 fewer antibiotic prescriptions per 1000 individuals.

Klein EY, Schueller E, Tseng KK et al.. 2020. The Impact of Influenza Vaccination on Antibiotic Use in the United States, 2010–2017. Open Forum Infectious Diseases. 7(7).

Introduction of PCV10 reduced antimicrobial use for acute otitis media, saving healthcare costs and combating antimicrobial resistance

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 AA, Rinta-Kokko H, Nohynek H et al.. 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).

Immunization against influenza and pneumococcus can reduce healthcare visits and antibiotic use, improving overall health

This systematic review suggests that vaccination against influenza and pneumococcus can reduce overall healthcare visits and antimicrobial consumption. Of the 26 studies included in the review, 23 found significant reductions in antimicrobial use in vaccinated individuals or groups. This evidence indicates that improved coverage with existing vaccines may significantly reduce antimicrobial demand.

Doherty TM, Hausdorff WP, Kristinsson KG. 2020. Effect of vaccination on the use of antimicrobial agents: a systematic literature review. Annals of Medicine. 52(6).

Influenza vaccination reduces antibiotic prescriptions and helps fight against antibiotic resistance

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 ER, Fry AM, Hicks LA et al.. 2020. Reducing Antibiotic Use in Ambulatory Care Through Influenza Vaccination. Clinical Infectious Diseases. 71(11).

Immunization with pneumococcal and rotavirus vaccines can prevent millions of episodes of treatment with antibiotics

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 JA, Lo NC, Arinaminpathy N et al.. 2020. Childhood vaccines and antibiotic use in low- and middle-income countries. Nature. 581.

Immunization can prevent the rising costs and health effects of treating drug-resistant typhoid infections

The costs and health effects of treating typhoid might soon increase dramatically, since the bacteria that causes typhoid is becoming increasingly resistant to the most effective oral antimicrobial drugs, thus requiring treatment with more expensive intravenous antibiotics which may result in more frequent hospitalizations for suspected typhoid cases.

Andrews JR, Baker S, Marks F et al.. 2019. Typhoid conjugate vaccines: a new tool in the fight against antimicrobial resistance. Lancet Infectious Disease. 19(1).

Immunization with PCV7 and PCV13 in Madrid reduced pneumococcal disease and antibiotic resistance

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).

The PCV-13 vaccine may increase the susceptibility of antibiotic-resistant bacteria strains

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(1).

Influenza vaccines reduce antibiotic use by preventing secondary infections and unnecessary prescriptions for respiratory illnesses

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(1).

Switching to PCV13 for infants reduced drug-resistant IPD by 78-96% in children under five

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 Infectious Diseases. 15(3).