Pediatric outpatient visits and antibiotic use attributable to higher valency pneumococcal conjugate vaccine serotypes
Authors: King Laura M , Andrejko Kristin L , Kabbani Sarah , Tartof Sara Y , Hicks Lauri A , Cohen Adam L , Kobayashi Miwako , Lewnard Joseph A 
Published: August 2023

AbstractImportanceStreptococcus pneumoniaeis a known etiology of acute respiratory infections (ARIs), which account for large proportions of outpatient visits and antibiotic use in children. In 2023, 15- and 20-valent pneumococcal conjugate vaccines (PCV15, PCV20) were recommended for routine use in infants. However, the burden of outpatient healthcare utilization among U.S. children attributable to the additional, non-PCV13 serotypes in PCV15/20 is unknown.ObjectiveTo estimate the incidence of outpatient visits and antibiotic prescriptions in U.S. children for acute otitis media, pneumonia, and sinusitis associated with PCV15- and PCV20-additional serotypes (non-PCV13 serotypes) to quantify potential impacts of PCV15/20 on outpatient visits and antibiotic prescriptions for these conditions.DesignMulti-component study including descriptive analyses of cross-sectional and cohort data on outpatient visits and antibiotic prescriptions from 2016–2019 and meta-analyses of pneumococcal serotype distribution in non-invasive respiratory infections.SettingOutpatient visits and antibiotic prescriptions among U.S. children.ParticipantsPediatric visits and antibiotic prescriptions among children captured in the National Ambulatory Medical Care Survey (NAMCS), the National Hospital Ambulatory Medicare Care Survey (NHAMCS), and Merative MarketScan, collectively representing healthcare delivery across all outpatient settings. Incidence denominators estimated using census (NAMCS/NHAMCS) and enrollment (MarketScan) data.Main outcome(s) and measure(s)Pediatric outpatient visit and antibiotic prescription incidence for acute otitis media, pneumonia, and sinusitis associated with PCV15/20-additional serotypes.ResultsWe estimated that per 1000 children annually, PCV15-additional serotypes accounted for 2.7 (95% confidence interval 1.8–3.9) visits and 2.4 (1.6–3.4) antibiotic prescriptions. PCV20-additional serotypes resulted in 15.0 (11.2–20.4) visits and 13.2 (9.9–18.0) antibiotic prescriptions annually per 1,000 children. Projected to national counts, PCV15/20-additional serotypes account for 173,000 (118,000–252,000) and 968,000 (722,000–1,318,000) antibiotic prescriptions among U.S. children each year, translating to 0.4% (0.2–0.6%) and 2.1% (1.5–3.0%) of all outpatient antibiotic use among children.Conclusions and relevancePCV15/20-additional serotypes account for a large burden of pediatric outpatient healthcare utilization. Compared with PCV15-additional serotypes, PCV20-additional serotypes account for >5 times the burden of visits and antibiotic prescriptions. These higher-valency PCVs, especially PCV20, may contribute to preventing ARIs and antibiotic use in children.Key pointsQuestion:What is the incidence of pediatric outpatient visits and antibiotic prescriptions for acute respiratory tract infections associated with the additional (non-13-valent pneumococcal conjugate vaccine) serotypes in 15- and 20-valent pneumococcal conjugate vaccines (PCV15, PCV20)?Findings:PCV15- and PCV20-additional serotypes account for an estimated 197,000 and 1,098,000 visits and 173,000 and 968,000 antibiotic prescriptions, respectively, for acute respiratory infections among U.S. children annually. Visit and antibiotic prescription burdens were concentrated among children aged <5 years.Meaning:Respiratory infections caused by serotypes in PCV15/20, especially PCV20, may be important contributors to outpatient visits and antibiotic use in children.