Epidemiology of Acute Otitis Media in the Postpneumococcal Conjugate Vaccine Era

Abstract

Objectives: To study the epidemiology of acute otitis media (AOM), especially the otitis-prone condition, during the pneumococcal conjugate vaccines 7 and 13 era.

Methods: Six hundred and fifteen children were prospectively managed from 6 to 36 months of life during a 10-year time frame (June 2006-June 2016). All clinical diagnoses of AOM were confirmed by tympanocentesis and bacterial culture of middle ear fluid.

Results: By 1 year of age, 23% of the children experienced ≥1 episode of AOM; by 3 years of age, 60% had ≥1 episodes of AOM, and 24% had ≥3 episodes. The peak incidence occurred at 6 to 12 months of life. Multivariable analysis of demographic and environmental data revealed a significantly increased risk of AOM associated with male sex, non-Hispanic white race, family history of recurrent AOM, day care attendance, and early occurrence of AOM. Risk factors for stringently defined (tympanocentesis-confirmed) otitis proneness, in which children suffered at least 3 episodes of AOM in a 6-month period or at least 4 within a year, were male sex, day care attendance, and family history of AOM, whereas breastfeeding in the first 6 months of life was protective. Stringently defined otitis prone children were also likely to experience their first AOM episode at a younger age. The proportion of Streptococcus pneumoniae, Haemophilus influenzae, and Moraxella catarrhalis causing AOM had dynamic changes during the past decade.

Conclusions: We conclude that the epidemiology but not the risk factors for AOM have undergone substantial changes since the introduction of pneumococcal conjugate vaccines.

FIGURE 1

Age at first episode of AOM in 615 children.

FIGURE 2

(A) The frequency of otopathogens isolated from MEF during AOM from 1995 to 2016. (B) The changes in otopathogen prevalence in different vaccine eras (* P < .05). Spn, S pneumonia; Hflu, H influenzae; and Mcat, M catarrhalis.

FIGURE 3

Otopathogens isolated from MEF during AOM visits in NOP (n = 256) and otitis-prone (n = 267) children. Spn, S pneumonia; Hflu, H influenzae; and Mcat, M catarrhalis. NS, not significant.