Dataset Information

Childhood vaccines and antibiotic use in low- and middle-income countries.

ABSTRACT: Vaccines may reduce the burden of antimicrobial resistance, in part by preventing infections for which treatment often includes the use of antibiotics^1-4. However, the effects of vaccination on antibiotic consumption remain poorly understood-especially in low- and middle-income countries (LMICs), where the burden of antimicrobial resistance is greatest⁵. Here we show that vaccines that have recently been implemented in the World Health Organization's Expanded Programme on Immunization reduce antibiotic consumption substantially among children under five years of age in LMICs. By analysing data from large-scale studies of households, we estimate that pneumococcal conjugate vaccines and live attenuated rotavirus vaccines confer 19.7% (95% confidence interval, 3.4-43.4%) and 11.4% (4.0-18.6%) protection against antibiotic-treated episodes of acute respiratory infection and diarrhoea, respectively, in age groups that experience the greatest disease burden attributable to the vaccine-targeted pathogens^6,7. Under current coverage levels, pneumococcal and rotavirus vaccines prevent 23.8 million and 13.6 million episodes of antibiotic-treated illness, respectively, among children under five years of age in LMICs each year. Direct protection resulting from the achievement of universal coverage targets for these vaccines could prevent an additional 40.0 million episodes of antibiotic-treated illness. This evidence supports the prioritization of vaccines within the global strategy to combat antimicrobial resistance⁸.

SUBMITTER: Lewnard JA

PROVIDER: S-EPMC7332418 | biostudies-literature | 2020 May

REPOSITORIES: biostudies-literature

ACCESS DATA

Publications

Childhood vaccines and antibiotic use in low- and middle-income countries.

Lewnard Joseph A JA Lo Nathan C NC Arinaminpathy Nimalan N Frost Isabel I Laxminarayan Ramanan R

Nature 20200429 7806

Vaccines may reduce the burden of antimicrobial resistance, in part by preventing infections for which treatment often includes the use of antibiotics<sup>1-4</sup>. However, the effects of vaccination on antibiotic consumption remain poorly understood-especially in low- and middle-income countries (LMICs), where the burden of antimicrobial resistance is greatest<sup>5</sup>. Here we show that vaccines that have recently been implemented in the World Health Organization's Expanded Programme on I ...[more]

PMID: 32376956

Similar Datasets

Project description:BackgroundAntimicrobial misuse is common in low-income and middle-income countries (LMICs), and this practice is a driver of antibiotic resistance. We compared community-based antibiotic access and use practices across communities in LMICs to identify contextually specific targets for interventions to improve antibiotic use practices.MethodsWe did quantitative and qualitative assessments of antibiotic access and use in six LMICs across Africa (Mozambique, Ghana, and South Africa) and Asia (Bangladesh, Vietnam, and Thailand) over a 2·5-year study period (July 1, 2016-Dec 31, 2018). We did quantitative assessments of community antibiotic access and use through supplier mapping, customer exit interviews, and household surveys. These quantitative assessments were triangulated with qualitative drug supplier and consumer interviews and discussions.FindingsVietnam and Bangladesh had the largest proportions of non-licensed antibiotic dispensing points. For mild illness, drug stores were the most common point of contact when seeking antibiotics in most countries, except South Africa and Mozambique, where public facilities were most common. Self-medication with antibiotics was found to be widespread in Vietnam (55·2% of antibiotics dispensed without prescription), Bangladesh (45·7%), and Ghana (36·1%), but less so in Mozambique (8·0%), South Africa (1·2%), and Thailand (3·9%). Self-medication was considered to be less time consuming, cheaper, and overall, more convenient than accessing them through health-care facilities. Factors determining where treatment was sought often involved relevant policies, trust in the supplier and the drug, disease severity, and whether the antibiotic was intended for a child. Confusion regarding how to identify oral antibiotics was revealed in both Africa and Asia.InterpretationContextual complexities and differences between countries with different incomes, policy frameworks, and cultural norms were revealed. These contextual differences render a single strategy inadequate and instead necessitate context-tailored, integrated intervention packages to improve antibiotic use in LMICs as part of global efforts to combat antibiotic resistance.FundingWellcome Trust and Volkswagen Foundation.

Project description:BackgroundDiarrhoea is the second most common cause of death among children under the age of five worldwide. The World Health Organization (WHO) recommends treating diarrhoea with oral rehydration therapy, intravenous fluids for severe dehydration, and zinc supplements. Antibiotics are only recommended to treat acute, invasive diarrhoea. Rising antibiotic resistance has led to a decrease in the effectiveness of treatments for diarrhoea.MethodsA systematic literature review in PubMed, Web of Science, and EMBASE was conducted to identify articles relevant to antibiotic-resistant childhood diarrhoea. Articles in English published between 1990 to 2020 that described antibiotic resistance patterns of common pathogens causing childhood diarrhoea in low- and middle-income countries were included. The studies were limited to papers that categorized children as 0-5 years or 0-10 years old. The proportion of isolates with resistance to major classes of antibiotics stratified by major WHO global regions and time was determined.ResultsQuantitative data were extracted from 44 articles that met screening criteria; most focused on children under five years. Escherichia coli isolates had relatively high resistance rates to ampicillin and tetracycline in the African (AFR), American (AMR), and Eastern Mediterranean Regions (EMR). There was moderate to high resistance to ampicillin and third generation cephalosporins among Salmonella spp in the AFR, EMR, and the Western Pacific Region (WPR). Resistance rates for ampicillin, co-trimoxazole, and chloramphenicol for Shigella in the AFR started at an alarmingly high rate ( ~ 90%) in 2006 and fluctuated over time. There were limited antibiotic resistance data for Aeromonas, Yersinia, and V. cholerae. The 161 isolates of Campylobacter analysed showed initially low rates of fluoroquinolone resistance with high rates of resistance in recent years, especially in the Southeast Asian Region.ConclusionsResistance to inexpensive antibiotics for treatment of invasive diarrhoea in children under ten years is widespread (although data on 6- to 10-year-old children are limited), and resistance rates to fluoroquinolones and later-generation cephalosporins are increasing. A strong regional surveillance system is needed to carefully monitor trends in antibiotic resistance, future studies should include school-aged children, and interventions are needed to reduce inappropriate use of antibiotics for the treatment of community-acquired, non-invasive diarrhoea.RegistrationThis systematic review was registered in Prospero (registration number CRD42020204004) in August 2020.

Project description:BACKGROUND:The aim of this study was to assess the relationship between early childhood caries (ECC) in 3-5-year-old children, seven indicators of poverty and the indicator of monetary poverty in low- and middle-income countries (LICs, MICs). METHODS:This ecologic study utilized 2007 to 2017 country-level data for LICs and MICs. Explanatory variables were seven indicators of poverty namely food, water, sanitation, health, shelter, access to information, education; and monetary poverty. The outcome variable was the percentage of 3-5-year-old children with ECC. A series of univariate general linear regression models were used to assess the relationship between the percentage of 3-5?year-old children with ECC and each of the seven indicators of poverty, and monetary poverty. This was followed by multivariable regression models to determined the combined effect of the seven indicators of poverty, as well as the combined effect of the seven indicators of poverty and monetary poverty. Adjusted R2 measured models' ability to explain the variation among LICs and MICs in the percentage of 3-5-year-old children with ECC. RESULTS:Significantly more people had food, sanitation, shelter, access to information, education and monetary poverty in LICs than in MICs. There was no difference in the prevalence of ECC in 3-5-year-old children between LICs and MICs. The combination of the seven indicators of poverty explained 15% of the variation in the percentage of 3-5-year-old children with ECC compared to 1% explained by monetary poverty. When the seven indicators of poverty and the indicator for monetary poverty were combined, the amount of variation explained by them was 10%. Only two of the poverty indicators had a direct relationship with the percentage of children with ECC; there was a higher percentage of ECC in countries with higher percentage of population living in slums (B?=?0.35) and in those countries with higher percentage of the population living below poverty lines (B?=?0.19). The other indicators had an inverse relationship. CONCLUSION:The use of multiple indicators to measures of poverty explained greater amount of variation in the percentage of 3-5-year-olds with ECC in LICs and MICs than using only the indicator for monetary poverty.

Dataset Information

Childhood vaccines and antibiotic use in low- and middle-income countries.

Publications

Childhood vaccines and antibiotic use in low- and middle-income countries.

Similar Datasets

OmicsDI is part of the ELIXIR infrastructure

Tweets