| Abstract | Background: Antimicrobial resistance is a public-health threat and antimicrobial consumption is the main
contributor. The ten-valent pneumococcal conjugate vaccine (PHiD-CV10) was introduced into the Icelandic
vaccination program in 2011.
The aim was to estimate the vaccine impact of PHiD-CV10 on outpatient antimicrobial prescriptions in children.
Methods: Eleven Icelandic birth-cohorts (2005–2015) were followed from birth until three years of age or to the end of
the study period (December 31, 2016). Birth-cohorts were grouped as vaccine non-eligible (VNEC, 2005–2010)
or vaccine eligible (VEC, 2011–2015). Data on primary care visits for respiratory infections and antimicrobial
prescriptions were extracted from two national registers. Using national identification numbers, prescriptions
were linked to physician visits if filled within three days of the visit. Incidence rates and incidence rate ratios
between VNEC and VEC were calculated. An Andersen-Gill model was used to model the individual level data,
accounting for repeated events and censoring. Vaccine impact was calculated as (1 – Hazard Ratio) × 100%.
Results: Included were 53,510 children who contributed 151,992 person-years of follow-up and filled 231,660
antimicrobial prescriptions. The incidence rate was significantly lower in the VEC compared to the VNEC, 144.5
and 157.2 prescriptions per 100 person-years respectively (IRR 0.92, 95%CI 0.91–0.93). Children in VEC were
more likely to have filled zero (IRR 1.16 (95%CI 1.10–1.23) and 1–4 (IRR 1.08 95%CI 1.06–1.11) prescriptions
compared to children in VNEC. The vaccine impact of PHiD-CV10 against all-cause antimicrobial prescriptions
was 5.8% (95%CI 1.6–9.8%).When only considering acute otitis media-associated prescriptions, the vaccine
impact was 21.8% (95%CI 11.5–30.9%).
Conclusion: The introduction of PHiD-CV10 lead to reduced antimicrobial use in children, mainly by reducing
acute otitis media episodes. This intervention therefore reduces both disease burden and could slow the spread of
antimicrobial resistance.
Keywords: Pneumococcal vaccines, Antibiotic agents, Otitis media, Observational study, Survival analysis
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