Reduction in All-Cause Acute Otitis Media in Children &lt;3 Years of Age in Primary Care Following Vaccination With 10-Valent Pneumococcal Haemophilus influenzae Protein-D Conjugate Vaccine: A Whole-Population Study

Sigurdsson, Samuel; Eyþórsson, Elías; Hrafnkelsson, Birgir; Erlendsdóttir, Helga; Kristinsson, Karl G.; Haraldsson, Ásgeir

doi:10.1093/cid/ciy233

Cited by 35 publications

(21 citation statements)

References 37 publications

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“…15,16 Many studies have shown that PCVs reduce AOM episodes, especially "severe" cases, and that this is mainly due to decreased incidence of pneumococcal AOM. 11,12,14,23 In a study conducted in Athens, Greece, Stamboulidis et al 15 found similar percentages of S. pyogenes (29%) in MEF cultures to us in children with AOM complicated by otorrhea after the introduction of PCV7. There are other analyses of MEF microbiology that also found remarkable prevalence of S. pyogenes and S. aureus in the postvaccine period.…”

Section: Discussionsupporting

confidence: 55%

“…Widespread adoption of the PCVs has led to a dramatic decrease in the incidence of invasive pneumococcal disease in children 7,8 and to a modest reduction in the incidence of AOM. [9][10][11][12] Both the introduction of PCVs and antibiotic selective pressure have resulted in changes in distribution of the bacterial causes of AOM over time. [13][14][15][16] For AOM, pneumococci and H. influenzae are the main targets of antibiotic prescription.…”

Section: Introductionmentioning

confidence: 99%

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Bacterial Spectrum of Acute Otitis Media in Bulgarian Children during the 10-Valent Pneumococcal Conjugate Vaccine Era

Setchanova

Stancheva²,

Попова³

et al. 2020

J Pediatr Infect Dis

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Objective The 10-valent pneumococcal conjugate vaccine (PCV10) was introduced in Bulgaria for universal childhood vaccination in 2010. The objective of this study was to describe bacterial pathogens responsible for acute otitis media (AOM) in children in the era of routine PCV10 immunization. Materials and Methods Middle ear fluid (MEF)/otorrhea or nasopharyngeal specimens were collected between May 2012 and April 2017 from 425 children aged < 12 years diagnosed with AOM; 71.5% of them were vaccinated. Capsular types of Streptococcus pneumoniae and Haemophilus influenzae and antimicrobial nonsusceptibility were determined. Results Among 240 children with “severe” AOM, the studied specimens were MEF/otorrhea, and a total of 132 (55.0%) children were culture-positive. The most frequently identified bacteria were S. pyоgenes (31.1%), followed by Staphylococcus aureus (21.2%), S. pneumoniae (20.4%), and nontypeable H. influenzae (12.1%). Among 185 nasopharyngeal specimens obtained from children at the onset of a “mild” AOM episode, 67.0% were culture-positive for otopathogens. The most common pathogens were S. pneumoniae (41.9%), followed by H. influenzae (25.8%), Moraxella catarrhalis (23.4%), and S. pyоgenes (14.5%), alone or in combinations. Among children with pneumococcal AOM (79), PCV10 serotypes (VTs) were 21.5%. A high prevalence (50%) of nonvaccine serotypes 3 (14), 19A (11), and 6C (7) was found among vaccinated children. Rates of nonsusceptibility of S. pneumoniae to penicillin, amoxicillin and erythromycin, and of multidrug resistance, were 51.2, 10.1, 51.2, and 51.2, respectively. The rate of ampicillin-non-susceptibility in H. influenzae was 25%. All M. catarrhalis isolates were β-lactamase producers, and 32.2% of S. pyogenes were erythromycin-resistant. Conclusion Following implementation of PCV10, S. pyogenes was the most prevalent pathogen in children with “severe” AOM. Numbers of S. pneumoniae recovered from MEF/otorrhea significantly decreased, as did the overall proportion of VTs among AOM patients. Streptococcus pneumoniae, H. influenzae, and M. catarrhalis were the most commonly found pathogens in the nasopharynx of children with less severe AOM episodes.

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Section: Discussionsupporting

confidence: 55%

Section: Introductionmentioning

confidence: 99%

Bacterial Spectrum of Acute Otitis Media in Bulgarian Children during the 10-Valent Pneumococcal Conjugate Vaccine Era

Setchanova

Stancheva²,

Попова³

et al. 2020

J Pediatr Infect Dis

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“…Children in the vaccine-eligible cohorts who underwent the procedure had visited a physician less often for the treatment of otitis media and had filled antimicrobial prescriptions than children in the VNEC, before undergoing the procedure. The largest increase in the incidence of TTP was observed in children 12-17 and 18-23 months of age, despite a considerable reduction in the incidence of acute otitis media in those age groups (10). These results are unexpected.…”

Section: Discussionmentioning

confidence: 84%

“…Even if it were the case, there is evidence to suggest that PCV decreases both recurrent acute otitis media and serous otitis media (8,29). This study group has previously shown that recurrent acute otitis media has decreased in Iceland following the introduction of PHiD-CV10 (10). There is an increasing trend in the incidence of TTP in the vaccine non-eligible cohorts among children 12-17 and 18-23 months of age, as seen in Figure 1.…”

Section: Discussionmentioning

confidence: 85%

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

et al. 2019

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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.

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Pneumococcal conjugate vaccines for preventing acute otitis media in children

Fortanier

Venekamp

Boonacker

et al. 2019

Cochrane Database of Systematic Reviews

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Background Prior to introducing pneumococcal conjugate vaccines (PCVs), Streptococcus pneumoniae was most commonly isolated from middle ear fluid of children with acute otitis media (AOM). Reducing nasopharyngeal colonisation of this bacterium by PCVs may lead to a decline in AOM. The effects of PCVs deserve ongoing monitoring since studies from the post-PCV era report a shift in causative otopathogens towards non-vaccine serotypes and other bacteria. This updated Cochrane Review was first published in 2002 and updated in 2004, 2009, and 2014. The review title was changed (to include the population, i.e. children) for this update. Objectives To assess the effect of PCVs in preventing AOM in children up to 12 years of age.

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Reduction in All-Cause Acute Otitis Media in Children <3 Years of Age in Primary Care Following Vaccination With 10-Valent Pneumococcal Haemophilus influenzae Protein-D Conjugate Vaccine: A Whole-Population Study

Abstract: The impact of PHiD-CV10 on all-cause AOM was considerable, mediated mainly by preventing the first two episodes of AOM. A decrease in the IR of AOM in children too young to receive direct vaccine protection was demonstrated, suggesting herd effect.

Cited by 35 publications

References 37 publications

Bacterial Spectrum of Acute Otitis Media in Bulgarian Children during the 10-Valent Pneumococcal Conjugate Vaccine Era

Bacterial Spectrum of Acute Otitis Media in Bulgarian Children during the 10-Valent Pneumococcal Conjugate Vaccine Era

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

Pneumococcal conjugate vaccines for preventing acute otitis media in children

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