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. 2024 Oct 16;230(4):821-831.
doi: 10.1093/infdis/jiae142.

Outpatient Visits and Antibiotic Use Due to Higher-Valency Pneumococcal Vaccine Serotypes

Laura M King  1 , Kristin L Andrejko  2 , Sarah Kabbani  3 , Sara Y Tartof  4 , Lauri A Hicks  3 , Adam L Cohen  2 , Miwako Kobayashi  2 , Joseph A Lewnard  1
Affiliations

Outpatient Visits and Antibiotic Use Due to Higher-Valency Pneumococcal Vaccine Serotypes

Laura M King et al. J Infect Dis. .

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 US 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 health care 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 (95% CI, 1.6-3.4) antibiotic prescriptions. PCV20-additional serotypes resulted in 15.0 (95% CI, 11.2-20.4) visits and 13.2 (95% CI, 9.9-18.0) antibiotic prescriptions annually per 1000 children. PCV15/20-additional serotypes account for 0.4% (95% CI, 0.2%-0.6%) and 2.1% (95% CI, 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; acute otitis media; antibiotic; outpatient; pediatric; pneumococcal conjugate vaccine; pneumonia; sinusitis.

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Conflict of interest statement

Potential conflicts of interest. L. M. K. reports consulting fees from Merck Sharpe & Dohme and Vaxcyte for unrelated work. J. A. L. reports research grants from Pfizer and Merck Sharpe & Dohme; and consulting fees from Pfizer, Merck, Sharpe & Dohme, and Vaxcyte for unrelated work. S. Y. T. reports research grants from Pfizer for unrelated work. All other authors report no potential conflicts. All authors have submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest. Conflicts that the editors consider relevant to the content of the manuscript have been disclosed.

Figures

Figure 1.
Figure 1.
Estimation framework. Framework to derive estimates of visits and antibiotic prescriptions attributable to PCV15- and PCV20-additional serotypes. All-cause incidence estimation methods are detailed in Supplementary Text 1. Primary attributable fraction analysis methods are detailed in Supplementary Text 2 (AOM) and Supplementary Text 3 (pneumonia, sinusitis), and supplemental methods in Supplementary Text 5. Abbreviations: AOM, acute otitis media; PCV, pneumococcal conjugate vaccine.
Figure 2.
Figure 2.
Pooled pneumococcal serotype distribution among children with acute respiratory infections from studies included in meta-analyses. Aggregated serotypes are denoted by *; PCV categorization is detailed in Supplementary Table 6. Only serotypes representing ≥ 1% of isolates are presented. Estimates are pooled directly from included studies (Supplementary Table 5); Supplementary Table 9 presents PCV category Markov-chain Monte Carlo estimates. Abbreviations: NT, nontypeable pneumococcal isolates; PCV, pneumococcal conjugate vaccine; excl., excluding.
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