Impact of pneumococcal conjugate vaccination on otitis media: a systematic review

Abstract

Acute otitis media (AOM) is a leading cause of visits to physicians and of antibiotic prescriptions for young children. We systematically reviewed studies on all-cause AOM episodes and physician visits in which impact was attributed to pneumococcal conjugate vaccines, either as efficacy or effectiveness. Of 18 relevant publications found, most used the 7-valent pneumococcal conjugate vaccine (7vCRM). The efficacy of 7vCRM against all-cause AOM episodes or visits was 0%-9% in randomized trials and 17%-23% in nonrandomized trials. In observational database studies, physician visits for AOM were already declining in the 3-5 years before 7vCRM introduction (mean change, -15%; range, +14% to -24%) and continued to decline afterward (mean, -19%; range, +7% to -48%). This vaccine provides some protection against OM, but other factors have also contributed to the recent decline in OM incidence. Future effectiveness studies should thus use better-controlled methods to estimate the true impact of vaccination on AOM.

Figure 1.

Flow chart of the publications evaluated for inclusion in the analysis. Flu, influenza virus; Hib, Haemophilus influenzae type b; IPD, invasive pneumococcal disease; OME, otitis media with effusion; PCV, pneumococcal conjugate vaccine; PPV23, 23-valent pneumococcal polysaccharide vaccine.

Figure 2.

Trends in otitis media rates among observational database studies presenting data for years before and after 7-valent pneumococcal conjugate vaccine introduction in 2000. Asterisks indicate studies for which the midpoint of the reported period was used to generate the graph. The age groups used for analysis are indicated in parentheses. Abbreviations: OM, otitis media; PY, person-years.