Vaccination as a solution of the issue of resistance S. pneumoniae
Authors: Ruban H. P. , Struch S. V. 
Published: May 2021

Relevance Antimicrobial resistance (AMR) is a growing acute global health issue. Uncontrolled combined use of antibiotics determines changes in the microbial agents' properties, leading to a decrease of susceptibility to antimicrobial substances and increasing the probability of severe invasive bacterial infections with limited possibilities to treat them. Vaccination against pneumococcal infection as well as improvement of the health care providers awareness can be considered as part of AMR management strategies. A number of epidemiological observations have been published indicating a change in antimicrobial resistance to Streptococcus pneumoniae following the implementation of the national infant immunization program against pneumococcal infection. Aim. To analyze the literature data on the pneumococcal vaccination contribution to the reduction of the number of pneumococcal diseases and the need for antibacterial therapy and to assess the burden of invasive pneumococcal diseases globally and in the Republic of Belarus (RB) and to identify gaps in the awareness of practicing physicians on pneumococcal infection immunoprophylaxis, its' effectiveness and impact on AMR. Conclusions. WHO considers and promote vaccination as an AMR containment measure. There are a lot of publications with the examples of countries with pneumococcal infection pediatric national immunization programs (NIP) and epidemiological data on changes in the S.pneumoniae sensitivity to antibacterial drugs after the start of the NIP. During the period of the mass PCV immunization and the subsequent drift of strains the sensitivity to antimicrobials may return. In Israel 88% and 93% reduction of otitis media cases caused by resistant to penicillin and macrolides vaccine types of S.pneumoniae after the phased introduction of PCV7 and PCV13 to the infant NIP, comparing to the period before vaccination introduction. A decrease in the frequency of bacteremia in combination with a sharp decrease in the proportion of penicillin-resistant pneumococcal isolates (from 50.9% to 5.3%) is also described. In France the proportion of S.pneumoniae strains with reduced susceptibility or resistance to penicillin declined from 47.1% to 39% after the start of PCV13 NIP; researchers also noted a decrease in antibiotic-resistant isolates of S.pneumoniae in children with otitis media: by 26, 31, 55, 29 and 57%, respectively, to penicillin, amoxicillin, cefotaxime, erythromycin and co-trimoxazole to in 2011. A study in Germany revealed a decrease in macrolide-resistant IPD strains after the start of PCV13 use of (in children 8.2%; in adults 8.8%) compared with the period after the introduction of PCV7 (17.3% and 13.0%) and especially in the cohort of children compared with the period before the use of PCV7 (24.8% and 13.3%). In Scotland, there was a decrease in the number of penicillin-resistant strains isolated from the blood of patients with IPD after the introduction of PCV13 into the NIP. The publication of the results of three parallel studies in Finland evaluated the effectiveness of PCV10 in reducing the number of IPD caused by vaccine-specific serotypes of PCV10 by 93%, 98% and 100%, respectively. At the same time, the effectiveness against «related» PCV10 serotypes was equal to 46%, 51% and 78%, respectively, and the estimated effectiveness against unrelated PCV10 serotypes was negative. Composition and resistance profile of the lower respiratory tract microflora isolated from sputum pneumococcal strains in children in 2016–2018, demonstrated up to 72.4% resistance to macrolides, 31.3% resistance to cefotaxime and 8.3% – to ceftriaxone. Spn serotypes structure in under 5 years of age children with meningitis was characterized by relatively high uniformity. Majority (92%) of multiresistant meningeal strains are covered by current PCVs. An anonymous questionnaire showed pediatricians' insufficient awareness about current approaches to pneumococcal infection prevention, underestimation of IPD risks and complications, and the impact of vaccination on reducing AMR. Additional education is required to increase the level of knowledge and understanding of the PCVs role in AMR reduction. PCV NIP introduction will provide additional opportunities to reduce AMR in the Republic of Belarus.