Studying PCV impact on clinical presentation of otitis media helps to understand its pathogenesis.
Age Factors
Child, Preschool
Heptavalent Pneumococcal Conjugate Vaccine
/ therapeutic use
Humans
Infant
Israel
/ epidemiology
Otitis Media
/ complications
Otitis Media with Effusion
/ etiology
Pneumococcal Infections
/ epidemiology
Pneumococcal Vaccines
/ therapeutic use
Population Surveillance
Prospective Studies
Serogroup
Streptococcus pneumoniae
/ isolation & purification
Tympanic Membrane
/ pathology
Tympanocentesis
Children
Complicated otitis media
Dynamics
PCV – pneumococcal conjugate vaccine
Spontaneous otorrhea
Surveillance
Tympanocentesis
Journal
Vaccine
ISSN: 1873-2518
Titre abrégé: Vaccine
Pays: Netherlands
ID NLM: 8406899
Informations de publication
Date de publication:
03 01 2019
03 01 2019
Historique:
received:
06
09
2018
revised:
18
11
2018
accepted:
19
11
2018
pubmed:
1
12
2018
medline:
7
6
2019
entrez:
1
12
2018
Statut:
ppublish
Résumé
Complex otitis media (OM) may present with intact tympanic membrane or spontaneous otorrhea. We compared dynamics of intact tympanic membrane and spontaneous otorrhea OM following 7- and 13-valent conjugated vaccines (PCV7, PCV13) implementation, since differences in dynamics may imply different underlying mechanisms. A prospective, population-based, active surveillance. Episodes with middle-ear fluid cultures in children < 3 years were included. Defined sub-periods were: pre-pneumococcal conjugated vaccines (PCV) (2004-2008); PCV7 (2009-2011); PCV13 (2014-2016). Of 7705 episodes, 57.2% had intact tympanic membrane, 16.8% spontaneous otorrhea, 26.0% unknown. In the pre-PCV period, the spontaneous otorrhea group was older and had higher proportions of factors associated with recurrence/chronicity. During the PCV7 period, spontaneous otorrhea and intact tympanic membrane episodes caused by PCV13 serotypes decreased significantly (43% and 51%, respectively) and those caused by non-PCV13 serotypes and culture-negative episodes increased significantly. However, rates increases were steeper in the spontaneous otorrhea group for both non-PCV13 serotypes (117% vs. 38%) and culture-negative (720% vs. 69%). In the spontaneous otorrhea group, nontypeable Haemophilus influenzae rates increased non-significantly by 10% and all-cause OM rates increased significantly by 56%, while in the intact tympanic membrane group the respective rates decreased significantly by 22% and 11%. These trends were especially pronounced in ages 24-35 months. Despite these differences, after PCV13 introduction, both spontaneous otorrhea and intact tympanic membrane rates declined for all outcomes. Spontaneous otorrhea was associated with older age, frequent history of complex OM and delayed PCV impact, suggesting a higher proportion of advanced-stage complex OM.
Sections du résumé
BACKGROUND
Complex otitis media (OM) may present with intact tympanic membrane or spontaneous otorrhea. We compared dynamics of intact tympanic membrane and spontaneous otorrhea OM following 7- and 13-valent conjugated vaccines (PCV7, PCV13) implementation, since differences in dynamics may imply different underlying mechanisms.
METHODS
A prospective, population-based, active surveillance. Episodes with middle-ear fluid cultures in children < 3 years were included. Defined sub-periods were: pre-pneumococcal conjugated vaccines (PCV) (2004-2008); PCV7 (2009-2011); PCV13 (2014-2016).
RESULTS
Of 7705 episodes, 57.2% had intact tympanic membrane, 16.8% spontaneous otorrhea, 26.0% unknown. In the pre-PCV period, the spontaneous otorrhea group was older and had higher proportions of factors associated with recurrence/chronicity. During the PCV7 period, spontaneous otorrhea and intact tympanic membrane episodes caused by PCV13 serotypes decreased significantly (43% and 51%, respectively) and those caused by non-PCV13 serotypes and culture-negative episodes increased significantly. However, rates increases were steeper in the spontaneous otorrhea group for both non-PCV13 serotypes (117% vs. 38%) and culture-negative (720% vs. 69%). In the spontaneous otorrhea group, nontypeable Haemophilus influenzae rates increased non-significantly by 10% and all-cause OM rates increased significantly by 56%, while in the intact tympanic membrane group the respective rates decreased significantly by 22% and 11%. These trends were especially pronounced in ages 24-35 months. Despite these differences, after PCV13 introduction, both spontaneous otorrhea and intact tympanic membrane rates declined for all outcomes.
CONCLUSIONS
Spontaneous otorrhea was associated with older age, frequent history of complex OM and delayed PCV impact, suggesting a higher proportion of advanced-stage complex OM.
Identifiants
pubmed: 30497832
pii: S0264-410X(18)31579-2
doi: 10.1016/j.vaccine.2018.11.054
pii:
doi:
Substances chimiques
13-valent pneumococcal vaccine
0
Heptavalent Pneumococcal Conjugate Vaccine
0
Pneumococcal Vaccines
0
Types de publication
Journal Article
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
1-6Informations de copyright
Copyright © 2018 Elsevier Ltd. All rights reserved.