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Comparative Study
. 2009 Feb 19:9:14.
doi: 10.1186/1471-2431-9-14.

Pneumococcal vaccination and otitis media in Australian Aboriginal infants: comparison of two birth cohorts before and after introduction of vaccination

Grant Austin Mackenzie  1 , Jonathan Rhys Carapetis, Amanda Jane Leach, Peter Stanley Morris
Affiliations
Comparative Study

Pneumococcal vaccination and otitis media in Australian Aboriginal infants: comparison of two birth cohorts before and after introduction of vaccination

Grant Austin Mackenzie et al. BMC Pediatr. .

Abstract

Background: Aboriginal children in remote Australia have high rates of complicated middle ear disease associated with Streptococcus pneumoniae and other pathogens. We assessed the effectiveness of pneumococcal vaccination for prevention of otitis media in this setting.

Methods: We compared two birth cohorts, one enrolled before (1996-2001), and the second enrolled after introduction of 7-valent pneumococcal conjugate and booster 23-valent polysaccharide vaccine (2001-2004). Source populations were the same for both cohorts. Detailed examinations including tympanometry, video-recorded pneumatic otoscopy and collection of discharge from tympanic membrane perforations, were performed as soon as possible after birth and then at regular intervals until 24 months of life. Analyses (survival, point prevalence and incidence) were adjusted for confounding factors and repeated measures with sensitivity analyses of differential follow-up.

Results: Ninety-seven vaccinees and 51 comparison participants were enrolled. By age 6 months, 96% (81/84) of vaccinees and 100% (41/41) of comparison subjects experienced otitis media with effusion (OME), and by 12 months 89% and 88% experienced acute otitis media (AOM), 34% and 35% experienced tympanic membrane perforation (TMP) and 14% and 23% experienced chronic suppurative otitis media (CSOM). Age at the first episode of OME, AOM, TMP and CSOM was not significantly different between the two groups. Adjusted incidence of AOM (incidence rate ratio: 0.88 [95% confidence interval (CI): 0.69-1.13]) and TMP (incidence rate ratio: 0.63 [0.36-1.11]) was not significantly reduced in vaccinees. Vaccinees experienced less recurrent TMP, 9% (8/95) versus 22% (11/51), (odds ratio: 0.33 [0.11-1.00]).

Conclusion: Results of this study should be interpreted with caution due to potential bias and confounding. It appears that introduction of pneumococcal vaccination among Aboriginal infants was not associated with significant changes in prevalence or age of onset of different OM outcomes or the incidence of AOM or TMP. Vaccinees appeared to experience reduced recurrence of TMP. Ongoing high rates of complicated OM necessitate additional strategies to prevent ear disease in this population.

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Figures

Figure 1
Figure 1
Enrolment and follow-up profile. Demonstrating numbers of participants entering and leaving follow-up at different ages.
Figure 2
Figure 2
Kaplan-Meier curves for time to first event. Time to first: OME (A), AOM (B), TMP (C) and CSOM (D).
Figure 3
Figure 3
Cumulative hazard curves for events of AOM (A) and new TMP (B).
See this image and copyright information in PMC

Comment in

References

    1. Morris PS, Leach AJ, Silberberg P, Mellon G, Wilson C, Hamilton E, Beissbarth J. Otitis media in young Aboriginal children from remote communities in Northern and Central Australia: a cross sectional survey. BMC Pediatrics. 2005;5:27. doi: 10.1186/1471-2431-5-27. - DOI - PMC - PubMed
    1. Rothstein J, Heazlewood R, Fraser M. Health of Aboriginal and Torres Strait Islander children in remote Far North Queensland: findings of the Paediatric Outreach Service. MJA. 2007;186:519–521. - PubMed
    1. WHO/CIBA Foundation Prevention of hearing impairment from chronic otitis media. Presented at a WHO/CIBA Foundation Workshop. 1996. pp. 19–21.http://www.noiseandhealth.org/article.asp?issn=1463-1741;year=1998;volum...
    1. Leach AJ, Mackenzie GA, Hare K, Stubbs E, Beissbarth J, Kennedy M, Wigger C, Gadil JR, Morris P. Microbiology of acute otitis media with perforation (AOMwiP) in Aboriginal children living in remote communities – monitoring the impact of 7-valent pneumococcal conjugate vaccine (7vPCV) In: Sriprakash KS, editor. Streptococci: New Insights into an Old Enemy: 25–29 September 2005; Palm Cove. Elsevier Science: Philadelphia; 2006. pp. 89–92.
    1. Leach AJ. PhD thesis. University of Sydney; 1996. Prospective studies of respiratory pathogens, particularly Streptococcus pneumoniae, in Aboriginal and non-Aboriginal infants: impact of antibiotic use and implications for otitis media.

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