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Near-elimination of otitis media caused by 13-valent pneumococcal conjugate vaccine (PCV) serotypes in southern Israel shortly after sequential introduction of 7-valent/13-valent PCV.

Abstract

BACKGROUND

Otitis media (OM) is common in early childhood. Streptococcus pneumoniae caused approximately 30%-60% of episodes before the pneumococcal conjugate vaccine (PCV) era. The 7-valent PCV (PCV7) was introduced to the Israeli National Immunization Plan in July 2009, and was gradually replaced by the 13-valent PCV (PCV13) starting in November 2010. We aimed at assessing the impact of PCV7/PCV13 sequential introduction on pneumococcal and overall OM necessitating middle ear fluid culture in children aged <2 years in southern Israel.

METHODS

This was a prospective, population-based, active surveillance. Our medical center is the only one in the region, enabling incidence calculation. All pneumococcal episodes submitted for culture between July 2004 and June 2013 were included. Three subperiods were defined: pre-PCV, PCV7, and PCV13.

RESULTS

Overall, 6122 OM episodes were recorded, and 1893 were pneumococcal. Compared with the pre-PCV period, OM caused by PCV7 plus serotype 6A and the 5 additional PCV13 serotypes (5VT : 1, 3, 5, 7F, 19A) decreased by 96% and 85%, respectively (incidence rate ratios [IRRs], 0.04 [95% confidence interval {CI}, .02-.08] and 0.15 [95% CI, .07-.30], respectively) in a 2-step pattern: In the PCV7 period, only OM caused by PCV7 + 6A serotypes was decreased; in the PCV13 period, 5VT OM rates decreased, along with an additional PCV7 + 6A OM reduction. A nonsignificant increase in non-PCV13 serotype OM was observed (IRR, 1.07 [95% CI, .72-1.58]). In total, 77% and 60% reductions of all-pneumococcal and all-cause OM incidences, respectively, were observed.

CONCLUSIONS

A substantial 2-step reduction of pneumococcal OM rates, with near-elimination of PCV13 disease, was observed shortly after PCV7/PCV13 introduction.

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  • Authors+Show Affiliations

    ,

    Pediatric Infectious Disease Unit The Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel.

    ,

    Pediatric Infectious Disease Unit The Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel.

    ,

    Pediatric Infectious Disease Unit The Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel.

    ,

    Department of Otolaryngology, Soroka University Medical Center The Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel.

    ,

    Pediatric Infectious Disease Unit The Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel.

    Pediatric Infectious Disease Unit The Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel.

    Source

    MeSH

    Humans
    Israel
    Otitis Media
    Pneumococcal Vaccines
    Prospective Studies
    Streptococcus pneumoniae
    Vaccines, Conjugate

    Pub Type(s)

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

    Language

    eng

    PubMed ID

    25159581

    Citation

    Ben-Shimol, Shalom, et al. "Near-elimination of Otitis Media Caused By 13-valent Pneumococcal Conjugate Vaccine (PCV) Serotypes in Southern Israel Shortly After Sequential Introduction of 7-valent/13-valent PCV." Clinical Infectious Diseases : an Official Publication of the Infectious Diseases Society of America, vol. 59, no. 12, 2014, pp. 1724-32.
    Ben-Shimol S, Givon-Lavi N, Leibovitz E, et al. Near-elimination of otitis media caused by 13-valent pneumococcal conjugate vaccine (PCV) serotypes in southern Israel shortly after sequential introduction of 7-valent/13-valent PCV. Clin Infect Dis. 2014;59(12):1724-32.
    Ben-Shimol, S., Givon-Lavi, N., Leibovitz, E., Raiz, S., Greenberg, D., & Dagan, R. (2014). Near-elimination of otitis media caused by 13-valent pneumococcal conjugate vaccine (PCV) serotypes in southern Israel shortly after sequential introduction of 7-valent/13-valent PCV. Clinical Infectious Diseases : an Official Publication of the Infectious Diseases Society of America, 59(12), pp. 1724-32. doi:10.1093/cid/ciu683.
    Ben-Shimol S, et al. Near-elimination of Otitis Media Caused By 13-valent Pneumococcal Conjugate Vaccine (PCV) Serotypes in Southern Israel Shortly After Sequential Introduction of 7-valent/13-valent PCV. Clin Infect Dis. 2014 Dec 15;59(12):1724-32. PubMed PMID: 25159581.
    * Article titles in AMA citation format should be in sentence-case
    TY - JOUR T1 - Near-elimination of otitis media caused by 13-valent pneumococcal conjugate vaccine (PCV) serotypes in southern Israel shortly after sequential introduction of 7-valent/13-valent PCV. AU - Ben-Shimol,Shalom, AU - Givon-Lavi,Noga, AU - Leibovitz,Eugene, AU - Raiz,Simon, AU - Greenberg,David, AU - Dagan,Ron, Y1 - 2014/08/25/ PY - 2014/8/28/entrez PY - 2014/8/28/pubmed PY - 2015/9/2/medline KW - Streptococcus pneumonia KW - children KW - otitis media KW - pneumococcal conjugate vaccine KW - surveillance SP - 1724 EP - 32 JF - Clinical infectious diseases : an official publication of the Infectious Diseases Society of America JO - Clin. Infect. Dis. VL - 59 IS - 12 N2 - BACKGROUND: Otitis media (OM) is common in early childhood. Streptococcus pneumoniae caused approximately 30%-60% of episodes before the pneumococcal conjugate vaccine (PCV) era. The 7-valent PCV (PCV7) was introduced to the Israeli National Immunization Plan in July 2009, and was gradually replaced by the 13-valent PCV (PCV13) starting in November 2010. We aimed at assessing the impact of PCV7/PCV13 sequential introduction on pneumococcal and overall OM necessitating middle ear fluid culture in children aged <2 years in southern Israel. METHODS: This was a prospective, population-based, active surveillance. Our medical center is the only one in the region, enabling incidence calculation. All pneumococcal episodes submitted for culture between July 2004 and June 2013 were included. Three subperiods were defined: pre-PCV, PCV7, and PCV13. RESULTS: Overall, 6122 OM episodes were recorded, and 1893 were pneumococcal. Compared with the pre-PCV period, OM caused by PCV7 plus serotype 6A and the 5 additional PCV13 serotypes (5VT : 1, 3, 5, 7F, 19A) decreased by 96% and 85%, respectively (incidence rate ratios [IRRs], 0.04 [95% confidence interval {CI}, .02-.08] and 0.15 [95% CI, .07-.30], respectively) in a 2-step pattern: In the PCV7 period, only OM caused by PCV7 + 6A serotypes was decreased; in the PCV13 period, 5VT OM rates decreased, along with an additional PCV7 + 6A OM reduction. A nonsignificant increase in non-PCV13 serotype OM was observed (IRR, 1.07 [95% CI, .72-1.58]). In total, 77% and 60% reductions of all-pneumococcal and all-cause OM incidences, respectively, were observed. CONCLUSIONS: A substantial 2-step reduction of pneumococcal OM rates, with near-elimination of PCV13 disease, was observed shortly after PCV7/PCV13 introduction. SN - 1537-6591 UR - https://www.unboundmedicine.com/medline/citation/25159581/full_citation L2 - https://academic.oup.com/cid/article-lookup/doi/10.1093/cid/ciu683 DB - PRIME DP - Unbound Medicine ER -