Evaluating the impact of RSV immunisation strategies on antibiotic use in England

With a sizable fraction of primary care antibiotics prescribing attributable to RSV, the promising suite of prophylactic pharmaceuticals against could reduce the need for antibiotics in addition to controlling respiratory disease. To assess the potential impact of RSV vaccines on the reduction in primary care antibiotic prescribing in England, we integrate results from a dynamic transmission model of RSV and a statistical attribution framework. Under base case assumptions, targeting children aged 5-14 years reduces antibiotic prescribing by 10.9 (8.0-14.2) antibiotic courses per 10,000 person years. This reduction in antibiotic use would gain 128 DALYs and avert 51,000 GBP associated with infections caused by drug resistant bacteria. Seasonally administering monoclonal antibodies (mAbs) to high risk infants under 6 months is the most efficient strategy (reducing per person year antibiotic prescribing by 2.6 (1.9-3.3) antibiotic courses per 1,000 mAb courses). ### Competing Interest Statement The authors have declared no competing interest. ### Funding Statement N.G.D. and M.J. were funded by the National Institute for Health Research Health Protection Research Unit (NIHR HPRU) in Immunisation (HPRU-2019-NIHR200929) at the London School of Hygiene and Tropical Medicine and M.J. was funded by the NIHR HPRU in Modelling & Health Economics (HPRU-2019-NIHR200908) at Imperial College and the London School of Hygiene and Tropical Medicine, both in partnership with the UK Health Security Agency. The views expressed are those of the authors and not necessarily those of the NHS, National Institute for Health Research, Department of Health or the UK Health Security Agency. ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines and uploaded the relevant EQUATOR Network research reporting checklist(s) and other pertinent material as supplementary files, if applicable. Yes All data produced are available online at github.com/katiito/rsvvaccines_amr