Figure 3.

Changes in susceptibility to various drug classes, among all isolates (A–E) and by PCV inclusion (F–G) over a 10-year period after PCV implementation

Data are median (95% CI). Meta-regression estimates are adjusted for years passing since vaccine implementation, calendar time (to account for secular trends independent of vaccine implementation), invasive or non-invasive isolate source, and country wealth. Plotted estimates correspond to expected changes in susceptibility among non-invasive pneumococcal isolates sampled from children in a hypothetical country with per-capita gross domestic product equal to US$22 000. (A–E) Includes studies that distinguished intermediate and resistant phenotypes (297 studies and 719 322 isolates). (F–G) Susceptibility to penicillin and macrolides for serotypes included in or not included in vaccine product formulas. In the appendix, we summarise data availability and list coefficient estimates for each covariate included in regression models (pp 40–41). Data are restricted to the corpus of studies presenting data on both non-susceptible and resistant isolates (297 studies); analyses of data from all studies are presented in the appendix (pp 12, 42). PCV=pneumococcal conjugate vaccine.