Pediatric ASP Toolkit

Effective Vaccinations can lead to Decrease in Antibiotic Use by:

• Reducing incidence of bacterial infections
• Reducing concerns of serious complications from infections
• Reducing the incidence of viral infection, in particular influenza, that is frequently mistreated with antibiotics

Antibiotic Use has Decreased Since Introduction of Pneumococcal Vaccination

• In the United States, rates of antibiotic prescribing to children have declined since the 1990s; since that time period, PCV7 was introduced in 2000 and replaced by PCV13 in 2010, and several national treatment guidelines for common pediatric infections were published during that time period as well.
• A Danish study on national antibiotic prescribing found the proportion of infants prescribed at least one antibiotic prescription decreased from 40.7% among infants born in 2004 to 34.6% among infants born in 2012; during this time, 2 pneumococcal conjugate vaccines (PCVs) (PCV7 in 2007 and PCV13 in 2010) were introduced along with national antibiotic prescribing guidelines in 2007. (Kinlaw A, Sturmer T, Lund J, et al. Trends in antibiotic use by birth season and birth year. Pediatrics. 2017; 140(3):e20170441)
• Additionally, national outpatient prescribing rates have declined by 6% from 2011 to 2017, with reductions primarily driven by children. Antibiotic prescriptions per 1000 population has declined 16% among children ages 0 to 19 years. (Source: CDC’s office of Antibiotic Stewardship and IQVIA Xponent; data provided by Dr. Laurie Hicks, personal communication)

Antibiotic Resistance has Decreased Since Introduction of Pneumococcal Vaccinations

Vaccines may impact antimicrobial resistance in two ways: 

• Reducing or eliminating the risk of infection caused by antibiotic-resistant strains.
• Reducing rates of febrile illnesses and the likelihood of secondary infections following the prevented episode. 

https://www.pnas.org/content/115/51/12896 (Impact of vaccines on antibiotic resistance PNAS)

PCV7

• Kyaw MH1, Lynfield R, Schaffner W, et al. Effect of introduction of the pneumococcal conjugate vaccine on drug-resistant Streptococcus pneumoniae. N Engl J Med. 2006 Apr 6;354(14):1455-63.
• Hampton LM, Farley MM, Schaffner W, et al. Prevention of antibiotic-nonsusceptible Streptococcus pneumoniae with conjugate vaccines. J Infect Dis. 2012 Feb 1;205(3):401-11.

PCV13

• Antibiotic-nonsusceptible isolates causing invasive pneumococcal disease in children < 5 years decreased from 6.5 to 0.5 per 100,000 from 2009 to 2013. (Tomczyk S, Lynfield R, Schaffner W, et al. Prevention of antibiotic-nonsusceptible invasive pneumococcal disease with the 13-valent pneumococcal conjugate vaccine. Clin Infect Dis. 2016;62(9):1119–1125pmid:26908787))

Influenza Vaccine

• A retrospective observational study in 50 U.S. states and the District of Columbia reported that a 10-percentage point increase in influenza vaccination rate was associated with a 6.5% decrease in antibiotic use. Increased vaccination coverage reduced prescribing rates the most in the pediatric population.

https://academic.oup.com/ofid/article/7/7/ofaa223/5854124 (The impact of influenza vaccine in antibiotic prescription OFID)

Vaccinations Decrease the Incidence of Serious Bacterial Infections

• Greenhow TL, Hung YY, Herz A. Bacteremia in children 3 to 36 months old after introduction of conjugated pneumococcal vaccines. Pediatrics. 2017;139(4):e20162098
• Fear of serious infectious complications such as meningitis, which have declined significantly with introduction of vaccines, is one driver for inappropriate antibiotic prescribing in the outpatient setting (Sanchez GV, Roberts RM, Albert AP, et al. Effects of knowledge, attitudes, and practices of primary care providers on antibiotic selection, United States. Emerg Infect Dis. 2014 Dec;20(12):2041)

Global Impact

• The Center for Disease Dynamics, Economics & Policy estimates that universal coverage of children under 5 years with a pneumococcal conjugate vaccine in the 75 countries in their analysis could avert up to 11.4 million days of antibiotics per year. (Laxminarayan, R et al. Access to effective Antibiotics: a worldwide challenge. The Lancet, Volume 387, Issue 10014, 168 – 175)
• Vaccines reduce the use of antibiotics in middle- and low-income countries. 

https://www.nature.com/articles/s41586-020-2238-4 (Vaccines and antibiotic use in low and middle income countries) 

• The World Health Organization (WHO) published an action framework to promote leveraging vaccines to reduce antibiotic use and prevent antimicrobial resistance. The document provides guidance on prioritizing sustainable activities that increase equitable vaccination coverages along with development of new vaccines. 

https://academic.oup.com/cid/advance-article/doi/10.1093/cid/ciab062/6119610 (Leveraging vaccines to decrease antibiotic use CID)

Cocooning Protects Vulnerable Populations, Specifically Our Neonates

• Infants less than 6 months of age are too young to have received all doses of vaccine necessary for protection from pertussis, influenza, and others. Unvaccinated adults and family members can be a vector for spreading these diseases to the infant.

• Infants less than 6 months of age are too young to have received all doses of vaccine necessary for protection from pertussis, influenza, and others. Unvaccinated adults and family members can be a vector for spreading these diseases to the infant.
• Administering Tdap during pregnancy, preferably during the third trimester, can reduce annual infant pertussis incidence by more than 13% over postpartum. Also, additional doses to fathers and grandparents can additionally reduce by an additional 16% resulting in lower infant deaths due to pertussis. Pregnancy dose Tdap and postpartum cocooning to prevent infant pertussis: a decision analysis.
• Other vaccines important in cocooning infants include influenza and measles vaccine.