Outpatient visits and antibiotic use due to higher valency pneumococcal vaccine serotypes

Laura M King; Kristin L Andrejko; Sarah Kabbani; Sara Y Tartof; Lauri A Hicks; Adam L Cohen; Miwako Kobayashi; Joseph A Lewnard

doi:10.1093/infdis/jiae142

Outpatient visits and antibiotic use due to higher valency pneumococcal vaccine serotypes

J Infect Dis. 2024 Mar 18:jiae142. doi: 10.1093/infdis/jiae142. Online ahead of print.

Authors

Laura M King¹, Kristin L Andrejko², Sarah Kabbani³, Sara Y Tartof⁴, Lauri A Hicks³, Adam L Cohen², Miwako Kobayashi², Joseph A Lewnard¹

Affiliations

¹ School of Public Health, University of California, Berkeley, Berkeley, CA, United States of America.
² Division of Bacterial Diseases, Centers for Disease Control and Prevention, Atlanta, GA, United States of America.
³ Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, GA, United States of America.
⁴ Kaiser Permanente Department of Research & Evaluation Southern California, Pasadena, CA, United States of America.

PMID: 38498565
DOI: 10.1093/infdis/jiae142

Abstract

Background: In 2022-2023, 15- and 20-valent pneumococcal conjugate vaccines (PCV15/PCV20) were recommended for infants. We aimed to estimate the incidence of outpatient visits and antibiotic prescriptions in U.S. children (≤17 years) from 2016-2019 for acute otitis media, pneumonia, and sinusitis associated with PCV15- and PCV20-additional (non-PCV13) serotypes to quantify PCV15/20 potential impacts.

Methods: We estimated the incidence of PCV15/20-additional serotype-attributable visits and antibiotic prescriptions as the product of all-cause incidence rates, derived from national healthcare surveys and MarketScan databases, and PCV15/20-additional serotype-attributable fractions. We estimated serotype-specific attributable fractions using modified vaccine-probe approaches incorporating incidence changes post-PCV13 and ratios of PCV13 versus PCV15/20 serotype frequencies, estimated through meta-analyses.

Results: Per 1000 children annually, PCV15-additional serotypes accounted for an estimated 2.7 (95% confidence interval 1.8-3.9) visits and 2.4 (1.6-3.4) antibiotic prescriptions. PCV20-additional serotypes resulted in 15.0 (11.2-20.4) visits and 13.2 (9.9-18.0) antibiotic prescriptions annually per 1,000 children. PCV15/20-additional serotypes account for 0.4% (0.2-0.6%) and 2.1% (1.5-3.0%) of pediatric outpatient antibiotic use.

Conclusions: Compared with PCV15-additional serotypes, PCV20-additional serotypes account for >5 times the burden of visits and antibiotic prescriptions. Higher-valency PCVs, especially PCV20, may contribute to preventing pediatric pneumococcal respiratory infections and antibiotic use.

Keywords: Streptococcus pneumoniae; antibiotic; pediatric; pneumococcal conjugate vaccine.

Published by Oxford University Press on behalf of Infectious Diseases Society of America 2024.