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Otitis media in children vaccinated during consecutive 7-valent or 10-valent pneumococcal conjugate vaccination schedules.
BMC Pediatr. 2014 Aug 11; 14:200.BPed

Abstract

BACKGROUND

In 2001 when 7-valent pneumococcal conjugate vaccine (PCV7) was introduced, almost all (90%) young Australian Indigenous children living in remote communities had some form of otitis media (OM), including 24% with tympanic membrane perforation (TMP). In late 2009, the Northern Territory childhood vaccination schedule replaced PCV7 with 10-valent pneumococcal Haemophilus influenzae protein D conjugate vaccine (PHiD-CV10).

METHODS

We conducted regular surveillance of all forms of OM in children in remote Indigenous communities between September 2008 and December 2012. This analysis compares children less than 36 months of age who received a primary course of at least two doses of PCV7 or PHiD-CV10, and not more than one dose of another pneumococcal vaccine.

RESULTS

Mean ages of 444 PCV7- and 451 PHiD-CV10-vaccinated children were 20 and 18 months, respectively. Bilaterally normal middle ears were detected in 7% and 9% respectively. OM with effusion was diagnosed in 41% and 51% (Risk Difference 10% [95% Confidence Interval 3 to 17] p = 0.002), any suppurative OM (acute OM or any TMP) in 51% versus 39% (RD -12% [95% CI -19 to -5] p = 0.0004], and TMP in 17% versus 14% (RD -3% [95% CI -8 to 2] p = 0.2), respectively. Multivariate analyses described a similar independent negative association between suppurative OM and PHiD-CV10 compared to PCV7 (Odds Ratio = 0.6 [95% CI 0.4 to 0.8] p = 0.001). Additional children in the household were a risk factor for OM (OR = 2.4 [95% CI 2 to 4] p = 0.001 for the third additional child), and older age and male gender were associated with less disease. Other measured risk factors were non-significant. Similar clinical results were found for children who had received non-mixed PCV schedules.

CONCLUSIONS

Otitis media remains a significant health and social issue for Australian Indigenous children despite PCV vaccination. Around 90% of young children have some form of OM. Children vaccinated in with PHiD-CV10 had less suppurative OM than children vaccinated with PCV7. Ongoing surveillance during the PCV13 era, and trials of early intervention including earlier and mixed vaccine schedules are warranted.

Authors+Show Affiliations

Menzies School of Health Research, Charles Darwin University, Darwin, NT, Australia. Amanda.leach@menzies.edu.au.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Evaluation Study
Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

25109288

Citation

Leach, Amanda Jane, et al. "Otitis Media in Children Vaccinated During Consecutive 7-valent or 10-valent Pneumococcal Conjugate Vaccination Schedules." BMC Pediatrics, vol. 14, 2014, p. 200.
Leach AJ, Wigger C, Andrews R, et al. Otitis media in children vaccinated during consecutive 7-valent or 10-valent pneumococcal conjugate vaccination schedules. BMC Pediatr. 2014;14:200.
Leach, A. J., Wigger, C., Andrews, R., Chatfield, M., Smith-Vaughan, H., & Morris, P. S. (2014). Otitis media in children vaccinated during consecutive 7-valent or 10-valent pneumococcal conjugate vaccination schedules. BMC Pediatrics, 14, 200. https://doi.org/10.1186/1471-2431-14-200
Leach AJ, et al. Otitis Media in Children Vaccinated During Consecutive 7-valent or 10-valent Pneumococcal Conjugate Vaccination Schedules. BMC Pediatr. 2014 Aug 11;14:200. PubMed PMID: 25109288.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Otitis media in children vaccinated during consecutive 7-valent or 10-valent pneumococcal conjugate vaccination schedules. AU - Leach,Amanda Jane, AU - Wigger,Christine, AU - Andrews,Ross, AU - Chatfield,Mark, AU - Smith-Vaughan,Heidi, AU - Morris,Peter Stanley, Y1 - 2014/08/11/ PY - 2014/03/03/received PY - 2014/07/29/accepted PY - 2014/8/12/entrez PY - 2014/8/12/pubmed PY - 2015/4/18/medline SP - 200 EP - 200 JF - BMC pediatrics JO - BMC Pediatr VL - 14 N2 - BACKGROUND: In 2001 when 7-valent pneumococcal conjugate vaccine (PCV7) was introduced, almost all (90%) young Australian Indigenous children living in remote communities had some form of otitis media (OM), including 24% with tympanic membrane perforation (TMP). In late 2009, the Northern Territory childhood vaccination schedule replaced PCV7 with 10-valent pneumococcal Haemophilus influenzae protein D conjugate vaccine (PHiD-CV10). METHODS: We conducted regular surveillance of all forms of OM in children in remote Indigenous communities between September 2008 and December 2012. This analysis compares children less than 36 months of age who received a primary course of at least two doses of PCV7 or PHiD-CV10, and not more than one dose of another pneumococcal vaccine. RESULTS: Mean ages of 444 PCV7- and 451 PHiD-CV10-vaccinated children were 20 and 18 months, respectively. Bilaterally normal middle ears were detected in 7% and 9% respectively. OM with effusion was diagnosed in 41% and 51% (Risk Difference 10% [95% Confidence Interval 3 to 17] p = 0.002), any suppurative OM (acute OM or any TMP) in 51% versus 39% (RD -12% [95% CI -19 to -5] p = 0.0004], and TMP in 17% versus 14% (RD -3% [95% CI -8 to 2] p = 0.2), respectively. Multivariate analyses described a similar independent negative association between suppurative OM and PHiD-CV10 compared to PCV7 (Odds Ratio = 0.6 [95% CI 0.4 to 0.8] p = 0.001). Additional children in the household were a risk factor for OM (OR = 2.4 [95% CI 2 to 4] p = 0.001 for the third additional child), and older age and male gender were associated with less disease. Other measured risk factors were non-significant. Similar clinical results were found for children who had received non-mixed PCV schedules. CONCLUSIONS: Otitis media remains a significant health and social issue for Australian Indigenous children despite PCV vaccination. Around 90% of young children have some form of OM. Children vaccinated in with PHiD-CV10 had less suppurative OM than children vaccinated with PCV7. Ongoing surveillance during the PCV13 era, and trials of early intervention including earlier and mixed vaccine schedules are warranted. SN - 1471-2431 UR - https://www.unboundmedicine.com/medline/citation/25109288/Otitis_media_in_children_vaccinated_during_consecutive_7_valent_or_10_valent_pneumococcal_conjugate_vaccination_schedules_ L2 - https://bmcpediatr.biomedcentral.com/articles/10.1186/1471-2431-14-200 DB - PRIME DP - Unbound Medicine ER -