Childhood vaccines and antibiotic use in low- and middle-income countries
Joseph A Lewnard1,2,3, Nathan C Lo4, Nimalan Arinaminpathy5
1Division of Epidemiology, School of Public Health, University of California, Berkeley, Berkeley, CA, USA. jlewnard@berkeley.edu.
Insights
Vaccines significantly reduce antibiotic use in young children in low-income countries by preventing infections. Pneumococcal and rotavirus vaccines are key to combating antimicrobial resistance and reducing illness episodes.
Area of Science:
- Global Health
- Infectious Diseases
- Vaccinology
Background:
- Antimicrobial resistance (AMR) is a major global health threat, particularly in low- and middle-income countries (LMICs).
- Antibiotic consumption for infections contributes to AMR, but the impact of vaccines on this consumption is not well understood in LMICs.
Purpose of the Study:
- To quantify the effect of recently implemented vaccines on antibiotic consumption in children under five in LMICs.
- To assess the role of vaccines in reducing antibiotic-treated infections and supporting the global strategy against antimicrobial resistance.
Main Methods:
- Analysis of large-scale household studies in LMICs.
- Estimation of vaccine effectiveness against antibiotic-treated acute respiratory infections and diarrhea.
- Calculation of prevented antibiotic-treated illness episodes under current and universal vaccine coverage.
Main Results:
- Pneumococcal conjugate vaccines (PCV) and live attenuated rotavirus vaccines (RV) substantially reduce antibiotic consumption.
- PCV and RV provide 19.7% and 11.4% protection against antibiotic-treated acute respiratory infection and diarrhea, respectively.
- Current vaccine coverage prevents millions of antibiotic-treated episodes annually, with potential for greater impact at universal coverage.
Conclusions:
- Vaccines implemented through the WHO Expanded Programme on Immunization significantly reduce antibiotic use in young children in LMICs.
- Prioritizing vaccines is crucial for the global strategy to combat antimicrobial resistance.
- Increased vaccine coverage offers substantial potential to decrease antibiotic-treated illnesses.
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.
Related Concept Videos
01:26Pharmacokinetics in Pediatric Patients: Drug Excretion
01:29Microorganisms in Medicine and Therapeutics
00:57Antibiotic Selection
01:51Vaccinations
01:23Pharmacokinetics in Pediatric Patients: Overview and Drug Absorption
01:30Development of Antibiotic Resistance