Reduction in antimicrobial resistance by the way of extensive vaccination

ABSTRACT

In recent years, antibiotic-resistant bacteria emerged as a great problem leading to treatment failures and an increase in the cost of healthcare. There is a growing belief in the use of vaccines to reduce the antimicrobial resistance (AMR). The vaccination could prevent the possibilities of infection that are known to induce AMR, which further reduces its treatment by antibiotics and the risk of its poor outcomes. It is possible to reduce the microbial population upon vaccination, which will theoretically reduce the chances for exchange of genetic elements responsible for resistance. The international collaborations among health workers and researchers are required to build surveillance and control strategy to combat antibiotic resistance. Priorities should be given towards the development of rapid diagnostics and characterization of resistant bacterial strains by basic and applied research.

Antibiotic-resistant bacteria emerged as a great problem leading to treatment failures and an increase in the cost of healthcare. There is a growing belief in the use of vaccines to reduce antimicrobial resistance (AMR). The vaccination could prevent the possibilities of infection that are known to induce AMR, which further reduces its treatment by antibiotics and the risk of its poor outcomes.¹ It is possible to reduce the microbial population upon vaccination, which will theoretically reduce the chances for exchange of genetic elements responsible for resistance.² Vaccines play a potential role in antibiotic stewardship by preventing bacterial infection and reducing the transmission of its resistant strains. Absence of antibiotics reduces the likelihood to select resistant variants of the targeted pathogen and other susceptible “bystander” species.³

Gram negative bacterial species are the major cause of pneumonia, meningitis, and urinary tract infections, which have a huge impact on the human health.^4,5 The inappropriate use of antibiotics and mutation in the genome could lead to the AMR.⁶ The routine vaccination against pathogens such as Haemophilus influenzae type b reduced the AMR in the locations where its vaccination has been deployed widely.⁷ However, countries like India, where the vaccination against Haemophilus influenzae type b was delayed showed increased incidence of AMR.⁸ The prevalence and threat of the multidrug resistant Mycobacterium tuberculosis has heightened not only in developing countries but globally.⁹ A qualitative data analysis from Nepal suggested the health care access, limited diagnostics and lack of health literacy are the contributing factors in developing the AMR among Salmonella typhimurium.¹⁰

Antibiotics are very effective in reducing the childhood pneumonia, a major cause of death in children worldwide. A study suggested 47% reduction in antibiotics for each day due to the implementation of pneumococcal conjugate vaccine in children younger than 5 years.¹¹ In the USA alone, introduction of pneumococcal conjugate vaccine reduced the penicillin resistant pneumococcal disease by 81% in children below the age of 2 years.¹² Lack of proper diagnosis in developing countries is a major barrier in the rational use of appropriate antibiotics against the causative pathogens. Consequently, the clinicians in the developing countries become compelled to treat the cases of respiratory problem with antibiotics which are not of bacterial origin. A study on 143 pneumococcal isolates from Malawi (2002–08) showed widespread resistance of Streptococcus pneumoniae due to extensive use of co-trimoxazole and sulfadoxine.¹³

On the other side, vaccines are of major importance, as clinician often prescribes the antibiotics for many virus specific symptoms. Major emphasis towards the appropriate use of the existing vaccines and development of the new vaccines concerning the major threat would require proper emphasis. The Government of Zambia has launched a mass vaccination program against Cholera from January 10, 2018 to vaccinate residents of Lusaka with support from the World Health Organization and its partners.¹⁴

Animals closely associated with humans also play an important role in determining the AMR strains of bacteria. Staphylococcus aureus is a leading cause of mastitis in cattle which is of major importance to the public health aspect. The subclinical form of mastitis mostly goes unnoticed leading to secretion of multiplying bacteria into the milk, which could potentially pass on to human through its consumption.¹⁵ In recent years, methicillin-resistant Staphylococcus aureus has emerged as a cause of bovine mastitis and threat to humans particularly in its subclinical form.¹⁶ Interestingly, a study conducted in pigs among 227 farms in Belgium, France, Germany and Sweden suggested reduction in antimicrobial usage upon extensive vaccination against common pig pathogens.¹⁷ There should be a holistic way to reduce the antimicrobial resistance considering both human and animal into consideration.

The international collaborations among health workers and researchers are required to build surveillance and control strategy to combat antibiotic resistance. Priorities should be given towards the development of rapid diagnostics and characterization of resistant bacterial strains by basic and applied research.

Funding Statement

The vaccine work in the laboratory is supported by the Department of Biotechnology [NER-BPMC], India, (BT/562/NE/U-Excel/2016).

Disclosure of potential conflicts of interest

No potential conflicts of interest were disclosed.