Kumar Chirag K, Gleason Alec C, Parameswaran Giridara Gopal, Summan Amit, Klein Eili, Laxminarayan Ramanan, Nandi Arindam
Princeton University, Princeton, NJ, USA.
One Health Trust, Bengaluru, India.
Lancet Reg Health Southeast Asia. 2024 Oct 16;31:100498. doi: 10.1016/j.lansea.2024.100498. eCollection 2024 Dec.
Childhood vaccinations can reduce disease burden and associated antibiotic use, in turn reducing the risk of antimicrobial resistance (AMR). We retrospectively estimated the population-level reductions in antibiotic use in India following the introduction of vaccines against and type B in the national immunization program for children in the mid-2010s and projected future gains to 2028 if vaccination coverage were to be increased.
Using IndiaSim, a dynamic agent-based microsimulation model (ABM) for India, we simulated the spread of and type B (Hib) among children to estimate reductions in antibiotic use under the scenarios of: (i) pneumococcal and Hib vaccine coverage levels equivalent to the national coverage of pentavalent diphtheria-pertussis-tetanus third dose (DPT3) compared to a baseline of no vaccination, and (ii) near-universal (90%) coverage of the vaccines compared to pre-COVID national DPT3-level coverage. Model parameters, including national DPT3 coverage rates, were based on data from the National Family Household Survey 2015-2016 and other published sources. We quantified reductions in antibiotic consumption nationally and by state and wealth quintiles.
We estimate that coverage of and Hib vaccines at the same level as DPT3 in India would translate to a 61.4% [95% UI: 43.8-69.5] reduction in attributable antibiotic use compared to a baseline of zero vaccination coverage. Increases in childhood vaccination coverage between 2004 and 2016 have likely reduced attributable antibiotic demand by as much as 93.4% among the poorest quintile. Increasing vaccination coverage by an additional 11 percentage points from 2016 levels results in mortality and antibiotic use across wealth quintiles becoming increasingly similar (p < 0.05), reducing in health inquities. We project that near-universal vaccine coverage would further reduce inequities in antibiotic demand and may eliminate of outbreak-associated antibiotic use from and Hib.
Though vaccination has a complex relationship with antibiotic use because both are modulated by socioeconomic factors, increasing vaccinations for and Hib may have a significant impact on reducing antibiotic use and improving health outcomes among the poorest individuals.
The Bill & Melinda Gates Foundation (grant numbers OPP1158136 and OPP1190803).
儿童疫苗接种可减轻疾病负担并减少相关抗生素使用，进而降低抗菌药物耐药性（AMR）风险。我们回顾性估计了2010年代中期印度国家儿童免疫规划引入针对[具体疾病1]和B型[具体疾病2]的疫苗后，全国抗生素使用量在人群层面的减少情况，并预测如果提高疫苗接种覆盖率，到2028年的未来收益。
我们使用IndiaSim，一个针对印度的基于主体的动态微观模拟模型（ABM），模拟[具体疾病1]和B型[具体疾病2]（Hib）在儿童中的传播，以估计在以下情景下抗生素使用的减少情况：（i）肺炎球菌和Hib疫苗接种覆盖率与五价白喉-百日咳-破伤风第三剂（DPT3）的全国覆盖率相当，与无疫苗接种的基线相比；（ii）与新冠疫情前的全国DPT3水平覆盖率相比，疫苗覆盖率接近普遍（90%）。模型参数，包括全国DPT3覆盖率，基于2015 - 2016年全国家庭住户调查和其他已发表来源的数据。我们量化了全国以及按邦和财富五分位数划分的抗生素消费量的减少情况。
我们估计，印度肺炎球菌和Hib疫苗覆盖率与DPT3相当时，与零疫苗接种覆盖率的基线相比，可归因的抗生素使用量将减少61.4%[95%置信区间：43.8 - 69.5]。2004年至2016年儿童疫苗接种覆盖率的提高可能使最贫困五分位数人群中可归因的抗生素需求减少多达93.4%。从2016年的水平再提高11个百分点的疫苗接种覆盖率，会使各财富五分位数的死亡率和抗生素使用情况变得越来越相似（p < 0.05），从而减少健康不平等。我们预测，接近普遍的疫苗接种覆盖率将进一步减少抗生素需求方面的不平等，并可能消除与[具体疾病1]和Hib疫情相关的抗生素使用。
尽管疫苗接种与抗生素使用存在复杂关系，因为两者都受社会经济因素调节，但增加[具体疾病1]和Hib疫苗接种可能对减少最贫困人群的抗生素使用和改善健康结果产生重大影响。
比尔及梅琳达·盖茨基金会（资助编号OPP1158136和OPP1190803）。
