Journal of Vaccine Research 2024, Vol.14, No.2, 54-64 http://medscipublisher.com/index.php/jvr 59 Figure 2 Changes in susceptibility to various drug classes, among all isolates (A-E) and by PCV inclusion (F-G) over a 10-year period after PCV implementation (Adopted from Andrejkod et al., 2021) Image caption: The figure shows the changes in non-susceptibility and resistance of pneumococcal isolates to various antibiotics (penicillin, macrolides, sulfamethoxazole-trimethoprim, third-generation cephalosporins, and tetracycline (A-E)) in different regions 10 years after the implementation of PCVs. The data indicate significant reductions in resistance to penicillin, sulfamethoxazole-trimethoprim, and third-generation cephalosporins, especially among the serotypes included in the vaccine (F-G). Changes in resistance to macrolides and tetracycline are less pronounced, but the overall trend is still downward. These results demonstrate the effectiveness of PCVs in reducing resistance to multiple antibiotics, thereby alleviating the pressure on antibiotic treatments (Adapted from Andrejkod et al., 2021) 5.2 Role of Hib vaccines in combating AMR The influenza vaccine plays a crucial role in reducing antibiotic use and addressing antibiotic resistance (AMR). Studies have shown that influenza vaccination can significantly reduce the risk of bacterial co-infections, which often complicate influenza illness and necessitate antibiotic prescriptions (Villegas et al., 2021). For instance, the Hib (Haemophilus influenzae type B) vaccine achieves this goal by effectively reducing the need for antibiotics. Widespread Hib vaccination has significantly lowered the incidence of Hib-related diseases, directly leading to a reduction in antibiotic use, thereby limiting the emergence and spread of resistant bacterial strains. In areas with high vaccine coverage, the incidence of Hib-related diseases has significantly decreased, resulting in a marked reduction in antibiotic prescriptions. This not only reduces the need for individual antibiotic treatments but also lowers the risk of spreading resistant strains within the community through herd immunity effects. For example, studies by Esposito and Principi (2018) indicate that following the implementation of Hib vaccination programs, the incidence of Hib-related diseases such as otitis media and meningitis in children significantly decreased, reducing reliance on antibiotics. It has been found that the widespread use of the Hib vaccine is effective not only in developed countries but also shows significant benefits in developing countries. These regions, where sanitary conditions are relatively poor and infection risks are higher, have seen substantial improvements in public health and reductions in the burden of Hib-related diseases and excessive antibiotic use with the introduction of the vaccine (Jit and Cooper, 2020). Jansen et al. (2021) further emphasize the global
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