PROJECT SUMMARY
Antibiotic resistance is a significant threat to human health. Human therapeutic antibiotic use, the majority of
which occurs in outpatient settings for non-severe infections, is a major, modifiable driver of resistance. Acute
respiratory infections (ARIs) account for large proportions of outpatient antibiotic use and vaccines have been
recognized as important mechanisms to combat antibiotic use and resistance, especially for ARIs. However,
uncertainties remain in understanding the contributions of common respiratory pathogens to outpatient antibiotic
use and quantifying the full potential of vaccines to reduce antibiotic use, impeding informed policymaking and
priority-setting for vaccine research and development. The proposed research addresses these gaps in the
context of both existing and pipeline vaccines for three common respiratory pathogens in children: Streptococcus
pneumonaie, influenza virus, and respiratory syncytial virus (RSV). The objective of this proposed work is to
estimate impacts of both existing and potential vaccine strategies on outpatient antibiotic prescriptions for ARIs
in children. More specifically, the research focuses on the following aims: 1) estimate the attributable fractions
of ARI-associated pediatric outpatient antibiotic use due to vaccine-preventable respiratory pathogens; 2)
evaluate the impact of pneumococcal vaccination strategies on outpatient antibiotic use for ARIs in children; and
3) evaluate the impact of viral (influenza, RSV) vaccination strategies on outpatient antibiotic use for ARIs in
children. This project focuses specifically on ARIs in children as they are both major drivers of outpatient antibiotic
use and targets of existing and pipeline vaccines. The work will leverage multiple, complementary, large-scale
data sources including both claims data (Optum Clinformatics, IBM MarketScan) and nationally-representative
outpatient medical surveys (National Ambulatory Medical Care Survey and National Hospital Ambulatory Medical
Care Survey), each with millions of pediatric ARI visits and outpatient antibiotic prescriptions per year, to address
these aims. The breadth of data and statistical and epidemiologic methods used in this proposed research will
enable a novel and comprehensive understanding of the potential for vaccines to reduce outpatient antibiotic
use for ARIs in children. This work will inform urgently-needed antibiotic resistance mitigation strategies and
priority setting and decision-making for vaccine research/development and policy. The proposed methods will
further provide a novel framework for evaluating current and future vaccines as outpatient infections and
antibiotic use are not commonly considered endpoints, despite their substantial burden. This research will be
enhanced by and complementary to my proposed training plan, which emphasizes development and experience
in epidemiologic and statistical methods, big data methods and applications, subject matter expertise, and
additional skills necessary for me to become an independent investigator. UC Berkeley, particularly the School
of Public Health, provides extensive resources and support to enable me to successfully complete the proposed
fellowship and fulfill my long-term goal of becoming a research-oriented infectious disease epidemiologist.