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.

Reactive vaccination campaigns prevented a large measles outbreak, saving thousands of cases in a refugee camp

A large measles outbreak of 1,700 cases occurred in the Rohingya refugee population in Cox’s Bazar, Bangladesh in 2017. In response, two reactive vaccination campaigns delivered the measles and rubella (MR) vaccine to children aged 6 months to 15 years old. This modeling study found that these reactive vaccination campaigns rapidly curbed outbreak transmission, averting an estimated 77,000 measles cases in the refugee camp. This demonstrates that reactive vaccination campaigns can be highly effective in preventing large measles outbreaks in the context of refugee camps, even when prior vaccination rates are low.

Chin T, Buckee CO, Mahmud AS. 2020. Quantifying the success of measles vaccination campaigns in the Rohingya refugee camps. Epidemics. 30.

Mobile health teams in Afghanistan improved immunization coverage in remote and conflict-affected areas, benefiting mothers and children

In Afghanistan, delivering health services through sustained, scheduled mobile health teams in remote and conflict-affected villages improved coverage of maternal and child health interventions, including immunization. The proportion of children under 1 year receiving their first dose of measles vaccine was higher in districts that had received mobile health team services for at least the previous 3 years (73.8%) compared to control districts in the same province (57.3%). The researchers concluded that incorporating mobile clinics into health system infrastructure in a systematic way can effectively improve health for hard to reach mothers and children in remote and conflict-affected areas.

Edmond K, Yousufi K, Naziri M et al.. 2020. Mobile outreach health services for mothers and children in conflict-affected and remote areas: A population-based study from Afghanistan. Archives of Disease in Childhood. 105(1).

Immunization can prevent severe respiratory infections in children, reducing hospital admissions and deaths worldwide

A systematic review of the global burden of acute lower respiratory infections associated with seasonal influenza in children under 5 years found that just in 2018 these infections led to an estimated 870,000 hospital admissions and 15,300 in-hospital deaths. About 23% of these hospital admissions and 36% of the in-hospital deaths were in infants under 6 months and about 82% of the in-hospital deaths occurred in low-income and lower-middle-income countries.

Wang X, Li Y, O'Brien KL et al.. 2020. Global burden of respiratory infections associated with seasonal influenza in children under 5 years in 2018: a systematic review and modelling study. Lancet Global Health. 8(4).

Conflict events can disrupt immunization programs and lead to attacks on health workers

This modeling study examined the impact of conflict events on disease control efforts during an Ebola outbreak in the Democratic Republic of the Congo. The model used a timeline of conflict events and an ethnographic appraisal of attacks on health care workers and treatment centers to estimate their impact on the epidemic trajectory of Ebola. Overall, the population-level effectiveness of vaccination was reduced by 43% due to disruptive conflict events. The researchers also found that declining incidence of Ebola was repeatedly reversed by conflict events. This framework can be extended to other diseases and regions experiencing conflict.

Wells CR, Pandey A, Ndeffo Mbah ML et al.. 2019. The exacerbation of Ebola outbreaks by conflict in the Democratic Republic of the Congo. Proceedings of the National Academy of Sciences. 116(48).

A study in Jordan found that a proactive vaccination campaign has maintained high immunity rates, even with an influx of refugees

The results of a 2016 cross-sectional polio serosurvey found that the Jordan Ministry of Health’s proactive campaign to locate and vaccinate high-risk populations has been successful in maintaining high population immunity — even with a recent influx of refugees from Syria. The study included a community sample of 479 children under 5 years living in areas of Jordan identified as high risk due to being hard-to-reach, having high numbers of refugees, and lower vaccine coverage (under 90%). Polio immunity was found to be over 96% for polio types 1, 2, and 3 even for children living in refugee camps.

Farag NH, Wannemuehler K, Weldon W et al.. 2020. Estimating population immunity to poliovirus in Jordan’s high-risk areas. Human Vaccines & Immunotherapeutics. 16(3).