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Impact of Widespread Introduction of Pneumococcal Conjugate Vaccines on Pneumococcal and Nonpneumococcal Otitis Media.
Clin Infect Dis. 2016 Sep 01; 63(5):611-8.CI

Abstract

BACKGROUND

Pneumococcal conjugated vaccines (PCVs) impact on complex otitis media (OM; including recurrent, nonresponsive, and chronic OM with effusion) was greater than that on simple, acute OM in previous studies. Since complex OM is often a polymicrobial disease, we speculated that reduction of complex OM by PCVs would be associated with reduction of non-pneumococcal OM.

METHODS

In a prospective, population-based, active surveillance, all OM episodes submitted for middle ear fluid culture in children <3 years from 2004 through 2015 were included. Three sub-periods were established: pre-PCV, PCV7, and PCV13. Incidence rate ratios (IRRs) comparing the 3 periods were calculated for pneumococcal, nontypable Haemophilus influenzae (NTHi), Moraxella catarrhalis, Streptococcus pyogenes, and culture-negative OM.

RESULTS

Overall, 7475 episodes were included. Of all-NTHi cases in the pre-PCV period, 34% were mixed with Streptococcus pneumoniae IRRs (95% confidence interval) comparing the pre-PCV to the PCV13 period were 0.02 (0.01-0.04), 0.12 (0.08-0.20), and 0.18 (0.15-0.21) for PCV7+6A serotypes, 5 additional PCV13 serotypes, and all-pneumococcal OM, respectively; non-PCV13 serotype episodes were not significantly reduced. IRRs for single NTHi, mixed NTHi + S. pneumoniae, and all-NTHi OM were 0.30 (0.25-0.35), 0.18 (0.13-0.24), and 0.25 (0.22-0.29), respectively. Moraxella catarrhalis, S. pyogenes, and culture-negative episodes were also significantly reduced.

CONCLUSIONS

Both pneumococcal and non-pneumococcal OM episodes, enriched with complex cases, declined substantially in children <3 years following sequential PCV7/PCV13 introduction. The reduction in non-pneumococcal episodes may be attributed to early OM episodes prevention, resulting in a lower rate of complex, often non-pneumococcal OM.

Authors+Show Affiliations

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

Pub Type(s)

Journal Article

Language

eng

PubMed ID

27225239

Citation

Ben-Shimol, Shalom, et al. "Impact of Widespread Introduction of Pneumococcal Conjugate Vaccines On Pneumococcal and Nonpneumococcal Otitis Media." Clinical Infectious Diseases : an Official Publication of the Infectious Diseases Society of America, vol. 63, no. 5, 2016, pp. 611-8.
Ben-Shimol S, Givon-Lavi N, Leibovitz E, et al. Impact of Widespread Introduction of Pneumococcal Conjugate Vaccines on Pneumococcal and Nonpneumococcal Otitis Media. Clin Infect Dis. 2016;63(5):611-8.
Ben-Shimol, S., Givon-Lavi, N., Leibovitz, E., Raiz, S., Greenberg, D., & Dagan, R. (2016). Impact of Widespread Introduction of Pneumococcal Conjugate Vaccines on Pneumococcal and Nonpneumococcal Otitis Media. Clinical Infectious Diseases : an Official Publication of the Infectious Diseases Society of America, 63(5), 611-8. https://doi.org/10.1093/cid/ciw347
Ben-Shimol S, et al. Impact of Widespread Introduction of Pneumococcal Conjugate Vaccines On Pneumococcal and Nonpneumococcal Otitis Media. Clin Infect Dis. 2016 Sep 1;63(5):611-8. PubMed PMID: 27225239.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Impact of Widespread Introduction of Pneumococcal Conjugate Vaccines on Pneumococcal and Nonpneumococcal Otitis Media. AU - Ben-Shimol,Shalom, AU - Givon-Lavi,Noga, AU - Leibovitz,Eugene, AU - Raiz,Simon, AU - Greenberg,David, AU - Dagan,Ron, Y1 - 2016/05/25/ PY - 2016/02/16/received PY - 2016/05/17/accepted PY - 2016/5/27/entrez PY - 2016/5/27/pubmed PY - 2017/12/21/medline KW - children KW - complicated otitis media KW - nontypable Haemophilus influenzae KW - pneumococcal conjugate vaccine KW - surveillance SP - 611 EP - 8 JF - Clinical infectious diseases : an official publication of the Infectious Diseases Society of America JO - Clin Infect Dis VL - 63 IS - 5 N2 - BACKGROUND: Pneumococcal conjugated vaccines (PCVs) impact on complex otitis media (OM; including recurrent, nonresponsive, and chronic OM with effusion) was greater than that on simple, acute OM in previous studies. Since complex OM is often a polymicrobial disease, we speculated that reduction of complex OM by PCVs would be associated with reduction of non-pneumococcal OM. METHODS: In a prospective, population-based, active surveillance, all OM episodes submitted for middle ear fluid culture in children <3 years from 2004 through 2015 were included. Three sub-periods were established: pre-PCV, PCV7, and PCV13. Incidence rate ratios (IRRs) comparing the 3 periods were calculated for pneumococcal, nontypable Haemophilus influenzae (NTHi), Moraxella catarrhalis, Streptococcus pyogenes, and culture-negative OM. RESULTS: Overall, 7475 episodes were included. Of all-NTHi cases in the pre-PCV period, 34% were mixed with Streptococcus pneumoniae IRRs (95% confidence interval) comparing the pre-PCV to the PCV13 period were 0.02 (0.01-0.04), 0.12 (0.08-0.20), and 0.18 (0.15-0.21) for PCV7+6A serotypes, 5 additional PCV13 serotypes, and all-pneumococcal OM, respectively; non-PCV13 serotype episodes were not significantly reduced. IRRs for single NTHi, mixed NTHi + S. pneumoniae, and all-NTHi OM were 0.30 (0.25-0.35), 0.18 (0.13-0.24), and 0.25 (0.22-0.29), respectively. Moraxella catarrhalis, S. pyogenes, and culture-negative episodes were also significantly reduced. CONCLUSIONS: Both pneumococcal and non-pneumococcal OM episodes, enriched with complex cases, declined substantially in children <3 years following sequential PCV7/PCV13 introduction. The reduction in non-pneumococcal episodes may be attributed to early OM episodes prevention, resulting in a lower rate of complex, often non-pneumococcal OM. SN - 1537-6591 UR - https://www.unboundmedicine.com/medline/citation/27225239/Impact_of_Widespread_Introduction_of_Pneumococcal_Conjugate_Vaccines_on_Pneumococcal_and_Nonpneumococcal_Otitis_Media_ L2 - https://academic.oup.com/cid/article-lookup/doi/10.1093/cid/ciw347 DB - PRIME DP - Unbound Medicine ER -