Impact of pneumococcal conjugate vaccine on pediatric tympanostomy tube insertion in partial immunized population

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

OBJECTIVE

To assess the effect of the pneumococcal vaccine (PCV) toward the surgical management and complications of otitis media.

DATA SOURCES

MEDLINE, EMBASE, PubMed, Scopus, and clinicaltrial.gov.

REVIEW METHODS

A systematic search was performed using a combination of keywords and standardized terms about PCV and surgical management or complications of otitis media. Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, studies were screened by 3 independent reviewers. Risk of bias assessment, followed by meta-analysis in only randomized-controlled trials was conducted. Vaccine efficacy (VE) and 95% confidence interval (CI) were reported.

RESULTS

Of the 2649 abstracts reviewed, 27 studies were included in the qualitative analysis and were categorized into 6 outcomes: tympanostomy tube insertion, otitis media with effusion (OME), mastoiditis, spontaneous tympanic membrane (TM) perforation, recurrent acute otitis media (AOM), and severe AOM. Fifteen studies were included in the meta-analysis to evaluate the rate of tympanostomy tube insertion, OME, and recurrent AOM. PCV was significantly more effective in lowering the rate of tympanostomy tube insertion (VE, 22.2%; 95% CI, 14.6-29.8) and recurrent AOM (VE, 10.06%; 95% CI, 7.46-12.65) when compared with the control group, with no significant difference in reducing the incidence of OME. The qualitative analysis revealed that PCV had efficacy in preventing severe AOM and spontaneous TM perforation but the effect on mastoiditis remained unclear.

CONCLUSION

The PCV was effective in reducing the rate of tympanostomy tube insertion and the incidence of recurrent AOM with a nonsignificant effect in preventing OME in children.

Pneumococcal conjugate vaccines reduce myringotomy with tympanostomy tube insertion in young children in Japan

OBJECTIVE

Pneumococcal conjugate vaccines (PCVs) have been reported to reduce the incidence of myringotomy with tympanostomy tube insertion (MTTI) in children. However, little information is available focusing specific ages. We examined the prophylactic efficacy of PCVs on the onset of complex otitis media (ComOM) that requires MTTI.

METHOD

From 2011, the public support for PCV7 started with the usual four-dose schedule and an emergency schedule for 2- to 4-year-old children in Japan. PCV7 was replaced with PCV13 in 2013. We reviewed the nationwide database obtained from the JMDC Claims Database (https://www.jmdc.co.jp/en/) to examine the MTTI incidence during the era before and after PCV introduction (from 2008 to 2010 and from 2011 to 2017, respectively). Subjects were analyzed by stratified age groups (from 0 to 8 years old) and in subdivided groups of 6 months (from 0 to 35 months old). We compared the MTTI incidence between the groups for each age as well as between those for each calendar year.

RESULTS

A significant reduction in the MTTI incidence was detected in the 1-year-old children of the PCV era compared to those of the pre-PCV era. The reduction rates were more prominent in the 12-17 months group as compared to the 18-23 months group (PCV7 p = .005 and PCV13 p = .011, PCV7 p = .014 and PCV13 p = .153, respectively). The significant difference in the 1-year-old children continued in six of seven calendar years from 2011 to 2017, whereas no significant reduction was detected in children >3 years old.

CONCLUSIONS

The introduction of both PCV7 and PCV13 reduced MTTI incidences in children around 1 year old, and the effects were more prominent during the early half-periods. Our results support etiological evidence that pneumococcal infection in children aged 1 year and younger might play roles in the pathogenesis of ComOM that requires MTTI.

Investigation of Antibiotic Resistance, Serotype Distribution, and Genetic Characteristics of 164 Invasive Streptococcus pneumoniae from North China Between April 2016 and October 2017

BACKGROUND

Streptococcus pneumoniae infections are the major cause of global morbidity and mortality among children and patients aged more than 65 years. This study aimed to investigate the antimicrobial resistance, bacterial serotype distribution, and genetic characteristics of invasive S. pneumoniae from different cities in North China.

MATERIALS AND METHODS

A total of 164 invasive S. pneumoniae strains were collected from 8 hospitals in 5 regions of North China between April 2016 and October 2017. Minimum inhibitory concentrations (MICs) were determined using the agar dilution method. Capsular serotypes were identified using the Quellung reaction test. Molecular epidemiology was investigated using multilocus sequence typing.

RESULTS

S. pneumoniae isolates were highly resistant to macrolides, clindamycin, and tetracycline in all age groups. The overall rate of resistance to penicillin was 56.7%. However, fluoroquinolones and vancomycin maintained excellent antimicrobial activities. The rate of resistance to β-lactam in strains isolated from children aged less than 18 years was significantly higher than that in strains from other age groups. The most prevalent serotypes were 14 (22.6%), 19F (16.5%), non-vaccine types (14.0%), 19A (9.8%), and 23F (9.1%). The coverage for PCV10 and PCV13 was 59.8% and 75.6%, respectively. The vaccine coverage rate was the highest among children aged less than 5 years. The proportion of penicillin-resistant isolates was higher among vaccine-covered strains compared with non-covered strains. S. pneumoniae showed considerable clonal dissemination, and ST876 (28, 17.1%), ST271 (22, 13.4%), ST81 (17, 10.4%) and ST320 (14, 8.5%) were the major STs.

CONCLUSION

All the 164 invasive S. pneumoniae isolates demonstrated high resistance to antibiotics. The coverage of S. pneumoniae vaccine was higher in children than in adults.

Trends in Otitis Media and Myringotomy With Tube Placement Among American Indian and Alaska Native Children and the US General Population of Children After Introduction of the 13-valent Pneumococcal Conjugate Vaccine

BACKGROUND

American Indian/Alaska Native (AI/AN) children have experienced higher otitis media (OM) outpatient visit rates than other US children. To understand recent trends, we evaluated AI/AN OM rates before and after 13-valent pneumococcal conjugate vaccine introduction.

METHODS

We analyzed outpatient visits listing OM as a diagnosis among AI/AN children <5 years of age from the Indian Health Service National Patient Information Reporting System for 2010-2013. OM outpatient visits for the general US child population <5 years of age were analyzed using the National Ambulatory Medical Care and National Hospital Ambulatory Care Surveys for 2010-2011.

RESULTS

The 2010-2011 OM-associated outpatient visit rate for AI/AN children (63.5 per 100/year) was similar to 2010-2011 rate for same-age children in the general US population (62.8) and decreased from the 2003 to 2005 AI/AN rate (91.4). Further decline in AI/AN OM visit rates was seen for 2010-2011 to 2012-2013 (P < 0.0001). The AI/AN infant OM visit rate (130.5) was 1.6-fold higher than the US infant population. For 2010-2011, the highest AI/AN OM visit rate for <5 year olds was from Alaska (135.0).

CONCLUSIONS

AI/AN <5-year-old OM visits declined by one third from 2003-2005 to 2010-2011 to a rate similar to the US general population <5 years. However, the AI/AN infant OM rate remained higher than the US infant population. The highest AI/AN <5-year-old OM rate occurred in Alaska.