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Potential impact of influenza vaccine roll-out on antibiotic use in Africa
Gwenan M Knight1,2, Madeleine Clarkson2, Thushan I de Silva3,4,5
1Centre for Mathematical Modelling of Infectious Diseases, London School of Hygiene and Tropical Medicine, Keppel Street, London, UK.
Background:
Influenza infections result in both inappropriate and appropriate antibiotic prescribing. There is a huge burden of both influenza and infections caused by antimicrobial-resistant pathogens in Africa. Influenza vaccines have the potential to reduce appropriate antibiotic use, through reduction of secondary bacterial infections, as well as to reduce levels of influenza misdiagnosed and treated as a bacterial infection (inappropriate).
Objectives:
To estimate potential reductions in antibiotic use that are achievable by introducing an influenza vaccine into various African settings.
Methods:
Influenza incidence was combined with population size, vaccine and health system characteristics.
Results:
We estimated that the direct impact of vaccination could avert more than 390 prescriptions per 100 000 population per year if a 50% efficacious influenza vaccine at 30% coverage was introduced to adults >65 years old in South Africa or children 2-5 years old in Senegal. Across Africa, purely through reducing the number of severe acute respiratory infections, the same vaccine characteristics could avert at least 24 000 antibiotic prescriptions per year if given to children <5 years old.
Conclusions:
The introduction of an influenza vaccine into multiple African settings could have a dramatic indirect impact on antibiotic usage. Our values are limited underestimates, capturing only the direct impact of vaccination in a few settings and risk groups. This is owing to the huge lack of epidemiological information on antibiotic use and influenza in Africa. However, it is likely that influenza vaccination in Africa could substantially impact antibiotic usage in addition to influenza-related mortality and morbidity.
Insights
Introducing influenza vaccines in Africa can significantly reduce antibiotic prescriptions by preventing infections and misdiagnoses. This strategy offers a dual benefit in combating both influenza and antimicrobial resistance.
Area of Science:
- Public Health
- Infectious Diseases
- Vaccinology
Background:
- Influenza infections contribute to both appropriate and inappropriate antibiotic prescribing in Africa.
- Africa faces a substantial burden of influenza and antimicrobial-resistant infections.
- Influenza vaccination can decrease antibiotic use by reducing secondary bacterial infections and misdiagnoses of influenza as bacterial infections.
Purpose of the Study:
- To estimate the potential reduction in antibiotic use achievable through influenza vaccine introduction in diverse African settings.
- To quantify the impact of influenza vaccination on antibiotic prescribing patterns across the African continent.
Main Methods:
- Influenza incidence data were integrated with population demographics, vaccine efficacy, and health system characteristics.
- Modeling was used to estimate antibiotic prescription reductions based on vaccine coverage and efficacy in specific age groups and regions.
Main Results:
- Introducing a 50% efficacious influenza vaccine at 30% coverage in South African adults over 65 or Senegalese children aged 2-5 could avert over 390 antibiotic prescriptions per 100,000 population annually.
- Across Africa, the same vaccine could avert at least 24,000 antibiotic prescriptions yearly by reducing severe acute respiratory infections in children under 5.
Conclusions:
- Influenza vaccine introduction in Africa can yield significant indirect benefits by reducing overall antibiotic usage.
- Estimated reductions represent underestimates due to limited epidemiological data on influenza and antibiotic use in Africa.
- Influenza vaccination holds substantial potential to impact antibiotic usage, alongside reducing influenza-related mortality and morbidity.
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