Policy & Economic Research (PER) Department, International Vaccine Institute, Seoul, Korea (the Republic of)
Infectious Diseases, The Novo Nordisk Foundation, Copenhagen, Denmark.
BMJ Glob Health. 2023 Jul;8(7). doi: 10.1136/bmjgh-2022-011341.
Antimicrobial resistance (AMR) is a global health threat with 1.27 million and 4.95 million deaths attributable to and associated with bacterial AMR, respectively, in 2019. Our aim is to estimate the vaccine avertable bacterial AMR burden based on existing and future vaccines at the regional and global levels by pathogen and infectious syndromes.
We developed a static proportional impact model to estimate the vaccination impact on 15 bacterial pathogens in terms of reduction in age-specific AMR burden estimates for 2019 from the Global Research on Antimicrobial Resistance project in direct proportion to efficacy, coverage, target population for protection, and duration of protection of existing and future vaccines.
The AMR burden avertable by vaccination in 2019 was highest for the WHO Africa and South-East Asia regions, for lower respiratory infections, tuberculosis, and bloodstream infections by infectious syndromes, and for and by pathogen. In the baseline scenario for vaccination of primary age groups against 15 pathogens, we estimated vaccine-avertable AMR burden of 0.51 (95% UI 0.49-0.54) million deaths and 28 (27-29) million disability-adjusted life-years (DALYs) associated with bacterial AMR, and 0.15 (0.14-0.17) million deaths and 7.6 (7.1-8.0) million DALYs attributable to AMR globally in 2019. In the high-potential scenario for vaccination of additional age groups against seven pathogens, we estimated vaccine-avertable AMR burden of an additional 1.2 (1.18-1.23) million deaths and 37 (36-39) million DALYs associated with AMR, and 0.33 (0.32-0.34) million deaths and 10 (9.8-11) million DALYs attributable to AMR globally in 2019.
Increased coverage of existing vaccines and development of new vaccines are effective means to reduce AMR, and this evidence should inform the full value of vaccine assessments.
抗生素耐药性（AMR）是一个全球性的健康威胁，据估计，2019 年分别有 127 万人和 495 万人的死亡可归因于细菌 AMR 和与细菌 AMR 相关。我们的目的是根据现有的和未来的疫苗，按病原体和传染病综合征，在区域和全球范围内估计基于疫苗的可避免的细菌 AMR 负担。
我们开发了一个静态比例影响模型，根据全球抗生素耐药性研究项目中 2019 年的年龄特异性 AMR 负担估计值，按疫苗的疗效、覆盖率、保护目标人群以及现有和未来疫苗的保护持续时间的比例，来估计 15 种细菌病原体的疫苗接种对 AMR 的影响。
按病原体划分，2019 年可通过疫苗接种避免的 AMR 负担最高的是世界卫生组织非洲和东南亚区域，按传染病综合征划分，是下呼吸道感染、结核病和血流感染，按病原体划分，是 和 。在针对 15 种病原体对主要年龄组进行疫苗接种的基线情况下，我们估计 2019 年与细菌 AMR 相关的可通过疫苗接种避免的 AMR 负担为 0.51（95%置信区间 0.49-0.54）百万例死亡和 28（27-29）百万残疾调整生命年（DALY），全球与 AMR 相关的 0.15（0.14-0.17）百万例死亡和 7.6（7.1-8.0）百万 DALY。在针对七种病原体对额外年龄组进行疫苗接种的高潜力情况下，我们估计额外的 1.2（1.18-1.23）百万例死亡和 37（36-39）百万 DALY 与 AMR 相关，全球与 AMR 相关的 0.33（0.32-0.34）百万例死亡和 10（9.8-11）百万 DALY。
增加现有疫苗的覆盖率和开发新疫苗是减少 AMR 的有效手段，这一证据应告知充分评估疫苗的全部价值。
