Abstract

Vaccines may reduce the burden of antimicrobial resistance, in part by preventing infections for which treatment often includes the use of antibiotics1–4. However, the effects of vaccination on antibiotic consumption remain poorly understood—especially in low- and middle-income countries (LMICs), where the burden of antimicrobial resistance is greatest5. Here we show that vaccines that have recently been implemented in the World Health Organization’s Expanded Programme on Immunization reduce antibiotic consumption substantially among children under five years of age in LMICs. By analysing data from large-scale studies of households, we estimate that pneumococcal conjugate vaccines and live attenuated rotavirus vaccines confer 19.7% (95% confidence interval, 3.4–43.4%) and 11.4% (4.0–18.6%) protection against antibiotic-treated episodes of acute respiratory infection and diarrhoea, respectively, in age groups that experience the greatest disease burden attributable to the vaccine-targeted pathogens6,7. Under current coverage levels, pneumococcal and rotavirus vaccines prevent 23.8 million and 13.6 million episodes of antibiotic-treated illness, respectively, among children under five years of age in LMICs each year. Direct protection resulting from the achievement of universal coverage targets for these vaccines could prevent an additional 40.0 million episodes of antibiotic-treated illness. This evidence supports the prioritization of vaccines within the global strategy to combat antimicrobial resistance8.

Highlights

  • Acute respiratory infection (ARI) and diarrhoea are the leading causes of antibiotic use among children in LMICs15

  • We used these results to quantify the incidence of antibiotic consumption among children in low- and middle-income countries (LMICs) prevented by current uses of PCV10/13 and rotavirus vaccines, and the additional consumption that could be averted by achieving universal vaccine coverage targets[18]

  • We found that vaccines against S. pneumoniae and rotavirus reduce antibiotic consumption among children in LMICs

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Summary

Introduction

Acute respiratory infection (ARI) and diarrhoea are the leading causes of antibiotic use among children in LMICs15. We analysed data from demographic and health surveys to estimate: (i) the incidence of antibiotic treatment for ARI and diarrhoea among children in LMICs; (ii) the effectiveness of PCV10/13 and rotavirus vaccines in preventing antibiotic use associated with ARI and diarrhoea among children in these settings; and (iii) the proportion of antibiotic-treated ARI and diarrhoea cases attributable to vaccine-serotype S. pneumoniae and rotavirus, respectively. We developed a simple model using the vaccine effectiveness estimates described above to investigate the proportions of antibiotic-treated ARI and diarrhoea attributable to vaccine-serotype pneumococci and rotavirus, respectively (Methods) The model took these inputs together with pooled estimates of vaccine efficacy against disease caused by the targeted pathogens based on meta-analyses of previous studies (Supplementary Table 7). Because rotavirus vaccine efficacy beyond the second year of life is uncertain (and likely to be low)[19,20], and because we did not identify strong evidence of vaccine-conferred protection against antibiotic-treated diarrhoea in children aged [24,25,26,27,28,29,30,31,32,33,34,35,36,37,38,39,40,41,42,43,44,45,46,47,48,49,50,51,52,53,54,55,56,57,58,59] months, we limited our assessment of rotavirus-attributable antibiotic use to children aged 0–23 months

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