Vaccines impact
antibiotic-resistant
infections in two ways: through a direct reduction in the organisms and strains carrying resistant genes that are specifically targeted by the
vaccine and also via a secondary effect through a reduction in febrile illnesses that often lead to the use of
antibiotics. We review here the impact of pneumococcal
conjugate vaccines (PCVs) on the prevalence of
antibiotic-resistant disease and
antibiotic usage as an example of the direct effect of
vaccines on antibiotic resistance and the impact of
influenza vaccination on
antibiotic usage as an example of a secondary effect. A prelicensure study of a PCV in Africa demonstrated 67% fewer
penicillin-resistant invasive disease episodes in the PCV group compared with controls. Similar studies in the United States and Europe demonstrated reductions in
antibiotic use consistent with the
vaccines' impact on the risk of
otitis media infections in children. Postlicensure reductions in the circulation of
antibiotic-resistant strains targeted by the
vaccines have been dramatic, with virtual elimination of these strains in children following
vaccine introduction. In terms of a secondary effect, following
influenza vaccination reductions of 13-50% have been observed in the use of
antibiotics by individuals receiving
influenza vaccine compared with controls. With the demonstrated effectiveness of vaccination programs in impacting the risk of
antibiotic-resistant
infections and the increasing threat to public health that these
infections represent, more attention needs to be given to development and utilization of
vaccines to address antibiotic resistance.