小柯机器人

美国加州大学伯克利分校Joseph A. Lewnard小组的最新成果揭示了中低收入国家儿童的疫苗和抗生素使用情况。相关论文于2020年4月29日在线发表在《自然》杂志上。

研究人员发现世界卫生组织最近实施的“扩大免疫计划”降低了疫苗在中低收入国家5岁以下儿童的抗生素消费量。通过大规模的家庭数据分析，研究人员估计在急性呼吸道感染和腹泻发生最严重的年龄组中，肺炎球菌结合疫苗和减毒轮状病毒活疫苗可提供19.7％（95％置信区间，3.4-43.4％）和11.4％（4.0-18.6％）的抗生素治疗保护。

在目前的覆盖水平下，肺炎球菌和轮状病毒疫苗每年分别在低收入和中等收入国家的5岁以下儿童中预防了2380万例和1360万例抗生素治疗疾病。通过实现这些疫苗的全民覆盖而获得的直接保护可以预防额外4,000万例抗生素治疗疾病。这些证据支持在抗击抗生素耐药性的全球战略中，疫苗的重要作用。

据了解，疫苗可以减轻抗菌素耐药性，这部分是通过预防感染实现的；而感染通常又会使用抗生素进行治疗。但是，疫苗接种对抗生素消耗的影响知之甚少，特别是在中低收入国家其产生抗生素耐药性的可能性最大。

附：英文原文

Title: Childhood vaccines and antibiotic use in low- and middle-income countries

Author: Joseph A. Lewnard, Nathan C. Lo, Nimalan Arinaminpathy, Isabel Frost, Ramanan Laxminarayan

Issue&Volume: 2020-04-29

Abstract: Vaccines may reduce the burden of antimicrobial resistance, in part by preventing infections for which treatment often includes the use of antibiotics1,2,3,4. 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 pathogens6,7. 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.

DOI: 10.1038/s41586-020-2238-4

Source: https://www.nature.com/articles/s41586-020-2238-4

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