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.
Global Issues
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.
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.
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.
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.
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.
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.
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.
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.
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.