Reduction of frequent otitis media and pressure-equalizing tube insertions in children after introduction of pneumococcal conjugate vaccine.
OBJECTIVE
Streptococcus pneumoniae is an important cause of otitis media in children. In this study we estimated the effect of routine childhood immunization with heptavalent pneumococcal conjugate vaccine on frequent otitis media (3 episodes in 6 months or 4 episodes in 1 year) and pressure-equalizing tube insertions.


METHODS
The study population included all children who were enrolled at birth in TennCare or selected upstate New York commercial insurance plans as of July 1998 and continuously followed until 5 years old, loss of health plan enrollment, study outcome, or end of the study. We compared the risk of developing frequent otitis media or having pressure-equalizing tube insertion for 4 birth cohorts (1998-1999, 1999-2000, 2000-2001, and 2001-2002) by using Cox regression analysis. We used data from the National Immunization Survey to estimate the heptavalent pneumococcal conjugate vaccine uptake for children in these 4 birth cohorts in Tennessee and New York.


RESULTS
The proportion of children in Tennessee and New York who received at least 3 doses of heptavalent pneumococcal conjugate vaccine by 2 years of age increased from < or = 1% for the 1998-1999 birth cohort to approximately 75% for the 2000-2001 birth cohort. By age 2 years, 29% of Tennessee and New York children born in 2000-2001 had developed frequent otitis media, and 6% of each of these birth cohorts had pressure-equalizing tubes inserted. Comparing the 2000-2001 birth cohort to the 1998-1999 birth cohort, frequent otitis media declined by 17% and 28%, and pressure-equalizing tube insertions declined by 16% and 23% for Tennessee and New York children, respectively. For the 2000-2001 to the 2001-2002 birth cohort, frequent otitis media and pressure-equalizing tubes remained stable in New York but increased in Tennessee.


CONCLUSIONS
After heptavalent pneumococcal conjugate vaccine introduction, children were less likely to develop frequent otitis media or have pressure-equalizing tube insertions.
Poehling
Katherine A
KA
Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee, USA. kpoehlin@wfubmc.edu
Szilagyi
Peter G
PG
Grijalva
Carlos G
CG
Martin
Stacey W
SW
LaFleur
Bonnie
B
Mitchel
Ed
E
Barth
Richard D
RD
Nuorti
J Pekka
JP
Griffin
Marie R
MR
D017677:Age Distribution; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D000069443:Heptavalent Pneumococcal Conjugate Vaccine; D006801:Humans; D015994:Incidence; D007223:Infant; D008297:Male; D022401:Meningococcal Vaccines / Q000008:administration & dosage*; D008876:Middle Ear Ventilation / Q000379:methods / Q000706:statistics & numerical data*; D009518:New York / Q000453:epidemiology; D010034:Otitis Media with Effusion / Q000453:epidemiology* / Q000382:microbiology / Q000601:surgery*; D011008:Pneumococcal Infections / Q000453:epidemiology / Q000517:prevention & control*; D022242:Pneumococcal Vaccines / Q000008:administration & dosage*; D016016:Proportional Hazards Models; D018570:Risk Assessment; D055502:Secondary Prevention; D017678:Sex Distribution; D013296:Streptococcus pneumoniae / Q000302:isolation & purification; D013714:Tennessee / Q000453:epidemiology; D014611:Vaccination / Q000706:statistics & numerical data*
D000069443:Heptavalent Pneumococcal Conjugate Vaccine; D022401:Meningococcal Vaccines; D022242:Pneumococcal Vaccines