Acute Mastoiditis in the Pneumococcal Conjugate Vaccine Era

Abstract

bFollowing the introduction of the 7-and 13-valent pneumococcal conjugate vaccines, we observed an inverse relationship between the increasing rate of immunized children and the proportion of middle ear fluid cultures collected during acute mastoiditis episodes that tested positive for Streptococcus pneumoniae among a subset of children 0 to 6 years old who had initially presented with severe acute otitis media and had bacterial cultures collected during tympanocentesis or from spontaneous otorrhea.A cute mastoiditis (AM) is a suppurative complication of acute otitis media (AOM), which often requires hospitalization and intravenous antibiotics and sometimes requires surgery. The most common otopathogen in AM is Streptococcus pneumoniae (1). In an attempt to control the impact of pneumococcal diseases, pneumococcal conjugate vaccines (PCVs) were gradually implemented in many countries during the past decade. In Israel, PCV7 was formally introduced into the national immunization program in July 2009 and was replaced by PCV13 in November 2010 (2). Both vaccines were or are, respectively, given at 2, 4, and 12 months of age. This change in the vaccination regimen allowed us to study the dynamics of AM incidence and bacteriology in a subset of children with AOM throughout a short time frame, from the pre-PCV7 era to the post-PCV13 era.This study was approved by the Edith Wolfson Medical Center's ethics review board. We retrospectively identified children 0 to 6 years of age who presented to the pediatric emergency room from 1 January 2008 through 31 December 2013 with severe AOM, defined as an AOM episode which either required tympanocentesis, due to a lack of clinical improvement after Ն48 h of antibiotic therapy, or presented with spontaneous otorrhea. In these children, we identified AM episodes (International Classification of Diseases code 383.0X). The AM diagnosis was based on clinical findings (postauricular tenderness, erythema or swelling, protruding auricle, palpable/fluctuating mass) and systemic signs (fever, lethargy, irritability, poor feeding, diarrhea). Children with previous ear surgery, immune deficiencies, and congenital malformations of the ear, nasopharynx, or palate were excluded from the study. In all eligible children, middle ear fluid (MEF) cultures were collected either during tympanocentesis with the use of a sterile flocked swab or from spontaneous otorrhea, from which pus was collected by swabbing the external ear meatus. Samples were processed for conventional cultures at the Edith Wolfson Medical Center's microbiology laboratory. MEF cultures that tested positive for external ear canal saprophytes were excluded.The PCV status for each AM episode was obtained from records at the Mother and Child Health Clinics, where all childhood vaccines are given in Israel. Each child was categorized according to his or her vaccination status at his or her AM presentation as either "unimmunized" if no dose of PCV immunization had been given or "any PCV7/PCV13 immunized" if Ն1 dose of PCV7/ PCV13 had b...

Continuous Effectiveness of Pneumococcal 13-Valent Conjugate Vaccine on Pediatric Pneumococcal Otomastoiditis: Results of 15 Years of Active/Prospective Surveillance in a Mexican Hospital on the Mexico-US Border

“…Nevertheless, publications particularly searching for the effect of either PCV7 and/or PCV13 on OM are scarce [15][16][17][18].…”

“…However, its effectiveness in decreasing otomastoiditis (OM), a local/suppurative complication of AOM, has barely been reviewed [15][16][17][18]. We have performed several studies related to IPD, particularly by looking at the effectiveness of PCV13 on overall IPD and meningitis and pleural empyema [19][20][21].…”

Severity of pneumococcal versus non‐pneumococcal acute otitis media in children

“…The study design has been previously described in detail . In brief, children <6 years of age who had MEF cultures obtained during ‘severe’ AOM episodes during 2008–2013 were retrospectively identified.…”

Acute Otologic Infections in Pediatric Patients

“…There is some recent evidence that suggests that the PCV13 may decrease the incidence of mastoiditis caused by S. pneumoniae. 39 Other less commonly isolated organisms include coagulase negative Staphylococcus, Pseudomonas aeruginosa, and H. influenzae. 40 P. aeruginosa can be a causative organism but is frequently a contaminant when cultures are obtained from the outer ear.…”