Division of Epidemiology, School of Public Health, University of California, Berkeley, Berkeley, CA, USA.
Division of Infectious Diseases and Vaccinology, School of Public Health, University of California, Berkeley, Berkeley, CA, USA.
Nature. 2020 May;581(7806):94-99. doi: 10.1038/s41586-020-2238-4. Epub 2020 Apr 29.
Vaccines may reduce the burden of antimicrobial resistance, in part by preventing infections for which treatment often includes the use of antibiotics. 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 greatest. 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 pathogens. 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 resistance.
疫苗可以减轻抗生素耐药性的负担，部分原因是可以预防需要使用抗生素治疗的感染。然而，疫苗接种对抗生素消耗的影响仍知之甚少——尤其是在抗生素耐药性负担最大的中低收入国家（LMICs）。在这里，我们表明，世界卫生组织扩大免疫规划最近实施的疫苗大大减少了 LMICs 五岁以下儿童的抗生素消耗。通过分析来自大规模家庭研究的数据，我们估计，肺炎球菌结合疫苗和减毒活轮状病毒疫苗分别为年龄组提供了 19.7%（95%置信区间，3.4-43.4%）和 11.4%（4.0-18.6%）的保护作用，以应对与疫苗针对的病原体相关的最大疾病负担。在目前的覆盖率水平下，肺炎球菌和轮状病毒疫苗每年分别预防 2380 万和 1360 万例五岁以下儿童因抗生素治疗的疾病。这些疫苗实现普遍覆盖目标所带来的直接保护作用可以预防另外 4000 万例抗生素治疗的疾病。这一证据支持在全球对抗抗生素耐药性的战略中优先考虑疫苗。
