International Vaccine Institute, Seoul, Republic of Korea.
Division of Clinical Pharmacology, Department of Laboratory Medicine, Karolinska Institutet, Karolinska University Hospital Huddinge, Stockholm, Sweden.
Clin Infect Dis. 2023 Dec 20;77(Suppl 7):S597-S607. doi: 10.1093/cid/ciad562.
Antimicrobial resistance (AMR) poses an immediate danger to global health. If unaddressed, the current upsurge in AMR threatens to reverse the achievements in reducing the infectious disease-associated mortality and morbidity associated with antimicrobial treatment. Consequently, there is an urgent need for strategies to prevent or slow the progress of AMR. Vaccines potentially contribute both directly and indirectly to combating AMR. Modeling studies have indicated significant gains from vaccination in reducing AMR burdens for specific pathogens, reducing mortality/morbidity, and economic loss. However, quantifying the real impact of vaccines in these reductions is challenging because many of the study designs used to evaluate the contribution of vaccination programs are affected by significant background confounding, and potential selection and information bias. Here, we discuss challenges in assessing vaccine impact to reduce AMR burdens and suggest potential approaches for vaccine impact evaluation nested in vaccine trials.
抗菌药物耐药性（AMR）对全球健康构成直接威胁。如果不加以解决，当前 AMR 的激增有可能使在减少与抗菌药物治疗相关的传染病死亡率和发病率方面取得的成果付诸东流。因此，迫切需要制定策略来预防或减缓 AMR 的进展。疫苗可能直接和间接地对抗 AMR 做出贡献。建模研究表明，疫苗接种在减少特定病原体的 AMR 负担、降低死亡率/发病率和经济损失方面具有显著收益。然而，量化疫苗在这些减少中的实际影响具有挑战性，因为许多用于评估疫苗接种计划贡献的研究设计受到重大背景混杂以及潜在选择和信息偏倚的影响。在这里，我们讨论了评估疫苗接种减少 AMR 负担的影响所面临的挑战，并提出了在疫苗试验中嵌套的疫苗影响评估的潜在方法。
