Modelling the global impact of the 13-valent pneumococcal vaccine on antibiotic use for otitis media. (30th September 2020)

• Record Type: Journal Article
• Authors: Moffatt, M; Wasserman, M
• Is Part Of: European journal of public health. Volume 30:Number 5(2020)
• Publication Date: 2020-09-30
• Subjects: Epidemiology -- Europe -- Periodicals; Public health -- Europe -- Periodicals; 362.109405
• DOI: 10.1093/eurpub/ckaa166.1423
• Languages: English
• ISSNs: 1101-1262

Abstract

Abstract: Background: Antimicrobial resistance (AMR) is a critical issue in global health causing approximately 1 million annual deaths. Vaccines are essential in addressing AMR as they reduce resistant strains and prevent development of resistance by preventing spread of disease and resulting antimicrobial use. This analysis evaluates the impact the 13-valent pneumococcal conjugate vaccine (PCV13) has had on dispensed antibiotic prescriptions (DAP) due to otitis media (OM), one of the largest drivers of DAP globally. Methods: An Excel-based model was developed to estimate number of infants vaccinated with PCV13, and the associated reduction in OM cases in children <5 since 2010. OM cases averted were based on a global meta-analysis and estimated cases averted were applied to infants vaccinated by country. DAP avoided were estimated assuming 90% of OM cases were prescribed an antibiotic. We then compared our modelled estimates to metrics measuring number needed to vaccinate to prevent DAP from any outcome. Results: Over the past 10 years, we estimated 286, 54m infants were vaccinated with PCV13, with 158, 33m OM cases and as many as 142, 49m DAP avoided globally. By WHO region, reductions in OM rates and DAP respectively are estimated to have been; Africa and Eastern Mediterranean (103, 05m; 92, 74m), South-East Asia and Western Pacific (8, 82m; 7, 94m), Europe (20, 70m; 18, 63m) and Americas (25, 76m; 23, 18m). Using rates from the literature of 0, 20 to 1, 79 total DAP avoided per child vaccinated, results ranged from to 71, 63m to 511, 68m. Conclusions: PCV13 use has resulted in substantial reductions in OM and DAP. As we focus on OM in children <5, results underestimate the full impact of PCV13 on DAP as vaccine impact on other pneumococcal diseases and adults through herd effect are not included. Recognition of the role of vaccination in addressing AMR burden is an opportunity to encourage patients, providers and healthcare systems to continually prioritize vaccination in public health efforts. Key messages: Over the past 10 years, PCV13 has led to considerable reductions in dispensed antibiotic prescriptions globally, highlighting the importance of prioritizing vaccination in global healthcare systems. Our findings illustrate how vaccines can play an essential role in reducing the global burden of antimicrobial resistance through reduction of antibiotic use.