Increase in tympanostomy tube placements despite pneumococcal vaccination, a population‐based study

Abstract

Aim The aim was to estimate the impact of the 10‐valent pneumococcal vaccine (PHiD‐CV) on tympanostomy tube placements (TTP) in children under five years of age in Iceland. Methods This population‐based observational cohort study followed 11 consecutive birth‐cohorts 2005–2015 from birth until their fifth birthday. Population registries were merged using national identification numbers. The risk of TTP was compared between birth‐cohorts adjusted for the number of previous otitis media diagnoses and antimicrobial prescriptions. A Cox regression model was applied and the hazard ratio (HR) of TTP was estimated between each birth‐cohort and the last vaccine non‐eligible birth‐cohort. The vaccine impact of PHiD‐CV10 on TTP was estimated as 1‐HR ×100%. Results In total, 51 247 children were followed for 210 724 person‐years, of which 14 351 underwent 20 373 procedures. The estimated vaccine impact on TTP was −6% (95% CI −16% to 2.7%). Children in the vaccine‐eligible cohorts had fewer previous otitis media diagnoses and had been prescribed fewer antimicrobials prior to the procedure than children in the vaccine non‐eligible cohorts. Conclusion Despite high uptake of PHiD‐CV10, tympanostomy procedures increased in Iceland during the study period. Vaccine‐eligible children had milder disease prior to the procedure. The reason underlying these findings are speculative.

Efficacy of Pneumococcal Vaccine on Otitis Media: A Systematic Review and Meta‐Analysis

“…One hundred and seventy‐eight abstracts were selected, and 165 full‐text articles were reviewed. After meticulous reading and discussion, 27 studies 3,4,7,10‐33 were included in the qualitative analysis.…”

“…One study 11 reported a greater reduction in the number of tympanostomy tube insertions in the PCV13 group than in the PCV7 group (HR, 0.76; 95% CI, 0.72‐0.80). One study 10 reported no significant decrease in the rate of tympanostomy tube insertion between the pre‐PCV10 and post‐PCV10 periods (Table 1).…”

“…The remaining 5 studies 10,11,13,16,21 were included in the qualitative analysis. In 3 studies, 13,16,21 the rate of tympanostomy tube insertion was significantly decreased in the post-PCV7 period compared with the pre-PCV vaccine period.…”

Panel 4: Recent advances in understanding the natural history of the otitis media microbiome and its response to environmental pressures

“…In OM, studies using large data resources (e.g. hospital and government datasets) are emerging, including linkage of medical presentation and management data, such as emergency room and primary health care presentations for OM [140], records of grommet insertions after vaccination program implementation [141], and records of grommet insertions in health insurance databases [142]. In these settings, comprehensive conclusions can only be drawn where quality data exist and are managed by a centralised tool.…”

Highlights in this issue

“…Eythorsson et al. report that the incidence of ear tube insertions increased in Iceland after the introduction of the pneumococcal vaccine into the paediatric vaccination programme in 2011 . The reasons for these findings are speculative.…”