The potential impact of influenza vaccine rollout on antibiotic use in Africa

Background: Influenza infections result in both inappropriate and appropriate antibiotic prescribing. There is a huge burden of both influenza and infections with antimicrobial resistant (AMR) pathogens in Africa. Influenza vaccines have the potential to reduce both appropriate antibiotic use, through the reduction in secondary bacterial infections, as well as to reduce levels of i nfluenza misdiagnosed and treated as a bacterial infection (inappropriate). Objectives: To estimate potential reductions in antibiotic use achievable by introducing an influenza vaccine to various African settings. Methods: I nfluenza incidence was combine d with population size , vaccine and health system characteristics. Results : We estimated that the direct impact of vaccination could avert more than 390 prescriptions per 100,000 population per year if a 50% efficacious influenza vaccine at 30% coverage w ere introduced to adults >65 y ears old (yo) in South Africa or children 2 - 5 yo in Senegal. Across Africa, purely through reducing the number of severe acute respiratory infections, the same vaccine characteristics could avert at least 2 4 ,000 antibiotic prescriptions per year if given to children < 5 years . Conclusions: The introduction of an influenza vaccine into multiple African settings could have a dramatic indirect impact on antibiotic usage. Our values are limited underestimates, captur ing only the direct impact of vaccination in a few settings and risk groups. This is due to the huge lack of epidemiological information on antibiotic use and influenza in Africa . However, it is likely that influenza vaccination in Africa could substantially impact antibiotic usage in addition to influenza - related mortality and morbidity