Effect of Pediatric Influenza Vaccination on Antibiotic Resistance, England and Wales

Chungman Chae; Nicholas G. Davies; Mark Jit; Katherine E. Atkins

Emerging Infectious Diseases. 2020;26(1):138-142.

Abstract and Introduction

Abstract

Vaccines against viral infections have been proposed to reduce prescribing of antibiotics and thereby help control resistant bacterial infections. However, by combining published data sources, we predict that pediatric live attenuated influenza vaccination in England and Wales will not substantially reduce antibiotic consumption or adverse health outcomes associated with antibiotic resistance.

Introduction

Antibiotic use drives the spread of antibiotic resistance. A considerable proportion of antibiotic prescriptions are prescribed unnecessarily for conditions that are either self-limiting or nonbacterial in etiology.^[1] Because influenza is often treated inappropriately with antibiotics, expanding access to influenza vaccines has been proposed as a means of reducing unnecessary prescribing and preventing resistant infections.^[2]

In 2013, England and Wales began rolling out the live attenuated influenza vaccine (LAIV) for 2–16-year-old children.^[3] Here, we estimate the potential effect on antibiotic prescribing and antibiotic resistance.

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Next Section

Abstract and Introduction
The Study
Conclusions
References

Table 1. Projected effect of pediatric LAIV on antibiotic prescription rates, England and Wales*
Age group	Influenza-attributed consultation rate†	Prescriptions per consultation	Direct prescribing rate reduction, unmatched‡	Direct prescribing rate reduction, matched‡	Overall LAIV effectiveness§	Overall prescribing rate reduction¶
0–6 mo	29.7 (23.7–35.9)	0.597 (0.474–0.719)	–	–	0.574 (0.501–0.651)	10.2 (7.03–13.5)
6 m–4 y	29.7 (23.7–35.9)	0.597 (0.474–0.719)	7.46 (5.31–9.64)	12.4 (8.85–16.1)	0.663 (0.618–0.714)	11.8 (8.31–15.4)
5–14 y	22.1 (17.6–26.7)	0.588 (0.466–0.708)	5.46 (3.89–7.06)	9.11 (6.48–11.8)	0.754 (0.709–0.794)	9.81 (6.97–12.8)
15–44 y	12.8 (10.2–15.4)	0.676 (0.536–0.814)	3.64 (2.59–4.70)	6.06 (4.31–7.83)	0.446 (0.394–0.502)	3.86 (2.66–5.09)
45–64 y	12.4 (9.84–14.9)	0.805 (0.639–0.970)	–	–	0.423 (0.374–0.484)	4.22 (2.90–5.58)
≥65 y	12.2 (9.67–14.7)	0.857 (0.680–1.03)	–	–	0.477 (0.397–0.561)	4.97 (3.34–6.68)
Overall	14.7 (11.7–17.7)	0.726 (0.576–0.875)	5.80 (4.13–7.49)	9.86 (7.01–12.9)	0.494 (0.446–0.549)	5.32 (3.74–7.00)

*All estimates reported as mean (95% highest density interval). LAIV, live attenuated influenza vaccine; –, age group not subject to pediatric LAIV.
†Per 1,000 person-years in England and Wales.
‡Reduction in antibiotic prescriptions among vaccinees per 1,000 vaccine recipients, not accounting for herd immunity, presented separately for unmatched and matched seasons.
§Reduction in influenza cases assuming a 50% uptake among children 2–16 years of age, accounting for herd immunity.
¶Per 1,000 person-years in England and Wales, accounting for herd immunity.