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Role of Vaccination in Reducing Antimicrobial Resistance

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Role of Vaccination in Reducing Antimicrobial Resistance Role of vaccination in reducing antimicrobial resistance Antimicrobial resistance is the reduced patient to enhance the natural tool needed to fight susceptibility of pathogenic bacteria to one or infections. First, some effective vaccines inhibit more of the antimicrobial agents administered in bacterial colonisation and, limit exposure of clinical medicine. Antimicrobial resistance is on bacteria to antimicrobials and thereby reduce the rise in most countries across the European transmission, reducing the spread of antimicrobial Union1. The result is that some serious bacterial resistant strains. Second, vaccination may prevent infections are becoming harder to treat and are a bacterial infection before the infections leads to therefore causing more disease, more prolonged disease or spreads to others. Several vaccines disease and more severe disease, which in turn may contribute to fewer occasions to prescribe leads to higher healthcare costs and reduced antibiotic treatments [1]. Therefore, by reducing the quality of life. In addition, antimicrobial-resistant prevalence of infection through vaccination the strains of some previously rare infections are number of patients visiting medical facilities are becoming also minimised, which in the majority of cases “Anti microbial more avoids the indiscriminate use of antibiotics. frequently resistance constitutes reported. As a Recent evidence suggests that antibiotic use can a serious danger to result, decrease in association with the initiation of antimicrobial immunisation programmes or increased uptake of public health” resistance available vaccines (e.g. pneumococcal and influenza immunisation programmes)4. This enable constitutes a not only to protect the vaccine from the pathogen serious danger to public health, which has been but this benefit is amplified by herd protection acknowledged by the European Commission2, the 3 effects. Vaccination, therefore, could limit the Council and the European Centre for Disease development of antimicrobial resistance by Prevention and Control (ECDC). decreasing the likelihood that bacteria targeted by certain vaccines would be exposed to antimicrobial Considering that acquired-resistance is mainly agents. Public authorities are increasingly driven by the exposure of bacteria to widely used acknowledging the role of vaccination in the fight antimicrobial agents, pragmatic responses to this against antimicrobial resistance and considering it problem are the promotion of judicious use of as a key intervention within their antimicrobial resistance programmes: antimicrobials and the prevention of the infections that would require antimicrobial treatment. “The trends observed in France confirm that Therefore any strategies which can reduce the use the fight against antimicrobial resistance is a of antibiotics should be considered as part of a long and demanding challenge and suggest long term strategy to combat this global health that the dissemination of recommendations for issue. Both viral and bacterial vaccines have the a rational use of antibiotics, infection control potential to reduce community reliance on and vaccination should be actively pursued.”[4] antibiotics. Contrary to antibiotics, vaccines have the benefit of working with the immune system of a The European Commission also acknowledged 1 that vaccination constituted an entire part of the ECDC (2010), Strategies for disease-specific programmes 2010- 2013. Available at: fight against antimicrobial resistance: http://ecdc.europa.eu/en/publications/Publications/100714_COR_Stra tegies_for_disease-specific_programmes_2010-2013.pdf 2 "EU-wide exchange of best practice of all Information about Commission initiatives available at http://ec.europa.eu/health/antimicrobial_resistance/policy/in relevant issues should be promoted. Examples dex_en.htm of good practice concerning antimicrobial 3 See for instance, Council Recommendation on patient safety, including the prevention and control of healthcare associated infections (9 June 2009). Available at: 4 Kyle J. Wilby, Denise Werry (2012), A review of the effect of http://eurlex.europa.eu/LexUriServ/LexUriServ.do?uri=OJ:C:2009:1 immunization programs on antimicrobial utilization, Vaccine 30 (2012) 51:0001:0006:EN:PDF 6509– 6514. resistance, vaccination campaigns and of whether the bacterium is sensitive to the hygiene/infection control should be discussed antimicrobials), and exchanged between Member States5." - Inhibit carriage (decrease acquisition and colonisation) of bacteria particularly targeted In 2010 several Member States were reported to by the vaccine, consequently decreasing the have “issued recommendations on vaccination likelihood that they might be exposed to against Streptococcus pneumoniae infections, antimicrobials and become antimicrobial addressing both children and the elderly in resistant; or, most cases”, as part of their action to prevent and - Prevent transmission of bacteria leading to control healthcare associated infections6. less likelihood of infection among unvaccinated On December 1st 2009, the Council had already members of the population (indirect herd) recognised that “a wide range of measures is protection). needed to ensure that currently available antibiotics remain effective for as long as For example, widespread vaccination with possible, such as effective vaccines to prevent pneumococcal conjugate vaccine has been infections7”. demonstrated to decrease the prevalence of antimicrobial resistance among colonising The purpose of this document is to provide a series pneumococcal isolates or disease causing clinical of examples where vaccination proves its role in isolates [1-4]. limiting antimicrobial resistance. Other theoretical examples could be typhoid fever 1. Existing evidence of the impact of or cholera, for which safe and effective vaccines vaccination on the reduction of are available. antimicrobial prescriptions and prevention of antimicrobial resistant Therefore, the preventive use of antibacterial diseases vaccines could potentially protect individuals and communities against infectious disease, including 1.1 Antibacterial vaccines impact on those caused by resistant bacterial strains. antimicrobial prescriptions and Vaccines could also potentially prevent bacterial prevention of antimicrobial resistant acquisition of resistance due to decreased diseases exposure to antimicrobial agents. Concept Table 1 A non-exhaustive list of existing vaccines targeting potentially antimicrobial resistant bacteria Vaccines targeting bacterial pathogens can have Diseases Pathogen Vaccine type(s) multiple beneficial effects because their induced Inactivated, recombinant Cholera V. cholerae immune response may prevent bacterial toxin subunit Diphtheria C. diphtheria Toxoid Invasive pneumococcal acquisition, colonisation and infection: S. pneumoniae Polysaccharide disease Meningitis N. meningitidis Polysaccharide, conjugate Meningitis, pneumonia, H. influenzae - Provide direct protection of individuals in the Conjugate epiglottis type B population from a bacterial disease (regardless Tetanus C. tetani Toxoid Meningitis, bacteremia/sepsis, S. pneumoniae Conjugate 5 (pneumonia), otitis media European Commission. Report from the Commission to the Council Polysaccharide, Live Typhoid fever S. typhi on the basis of member states’ reports on the implementation of the attenuated Council Recommendation (2002/77/EC) on the prudent use of Whooping cough B. pertussis Inactivated, sub-unit, toxoid antimicrobial agents in Human Medicine. 2005. Available at: http://ec.europa.eu/health/ph_threats/com/mic_res/com684_ en.pdf New and future vaccines targeting 6 European Commission (2010), Second Report from the EC to the antimicrobial-resistant bacteria Council on the basis of Member States’ reports on the implementation of the Council Recommendation (2002/77/EC) on the prudent use of antimicrobial agents in human medicine. Available at: The research, development and introduction of http://ec.europa.eu/health/antimicrobial_resistance/docs/amr_report2 _en.pdf new vaccines will play a critical role in the fight 7 Council Conclusions on innovative incentives for effective against the main antimicrobial-resistant bacteria. antibiotics, 2980th EPSCO Council meeting Brussels, 1 December 2009. Available at http://eurlex.europa.eu/LexUriServ/LexUriServ.do?uri=OJ:C:2009:3 Streptococcus pneumonia 02:0010:0011:EN:PDF The introduction of the first pneumococcal tuberculosis, which is now characterized by a conjugate vaccine, seven-valent, had a significant heavy level of antimicrobial resistance. impact in reducing antibiotic resistance, particularly in the background of programs in parallel intended 1.2 Antiviral vaccination’s impact on to limit antibiotic usage [1-4]8. Recent studies antimicrobial prescriptions demonstrated a shift in serotype distribution with a greater proportion of carriage (colonisation) by the In the case of viral vaccines, protection from a virus non-vaccine serotypes consequent to a decrease will reduce the number of viral infections which in in carriage in the vaccine-serotypes. In the setting some cases are mistakenly diagnosed as a of non-judicious antibiotic use, however, these non- bacterial infection and thus treated with antibiotics. vaccine serotypes may acquire antimicrobial An example of this situation is influenza, which is resistance. associated with excess rates of hospitalisation and mortality, in various groups including children. For “The introduction of the first instance, in Finland, 39.7%
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