Tuesday, May 13, 2025
5/13/2025
Quantifying the impact of vaccines on antibiotic use for respiratory infections in children - 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.
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