title: [Acute otitis media in ambulatory practice: epidemiological and clinical characteristics after 7 valent pneumococcal conjugate vaccine (PCV7) implementation].
abstract: BACKGROUND
  In US, pneumococcal conjugate vaccine (PCV7) had reduced the burden of AOM and changed the profile of the disease. Prior to PCV7 implementation in France, AOM represented 8% of pediatricians visits and failure rate was 12%. The aim of this study is to describe the epidemiologic characteristics of AOM after PCV7 implementation.
  
  
  METHODS
  From 2007 to 2008, 30 pediatricians enrolled 3141 patients 3 to 36 months old with AOM. Standardized history and physical examination findings were recorded. Factors related to AOM failures were identified by multivariate logistic regression.
  
  
  RESULTS
  AOM accounted for 5.8% of the 43 433 visits or 6.2 cases/week per pediatrician. Among 3141 evaluable AOM cases (mean age 16.7±8 months, peak incidence at 10 months), 99% had been vaccinated with PCV7 and 42.1% attended day care (DCC). Recurrent AOM comprised 24.5% of cases and 51% of children had received ATB in the last 3 months. At the time of diagnosis, 47.1% had fever≥38,5°C, 74.5% otalgia and 4.7% otorrhea. Febrile and painful AOM accounted for 29.5% of cases and cunjunctivitis-otitis syndrome for 18.2%. ATB was prescribed in 98.7% of cases (cefpodoxime proxetil, 59% and amoxicillin/clavulanate, 37%). The failure rate was 6.4% and failure risk was greater in children in DCC (OR=1.50, [1.10;2.05]), young age<18 months (OR=1.47, [1.06;2.04]) and history of recurrent AOM (OR=1.45, [1.02;2.06]).
  
  
  CONCLUSIONS
  Despite PCV7 implementation, AOM remains a very frequent childhood infection and a major reason for ATB prescriptions.
authors.affiliation: Association clinique et thérapeutique infantile du Val-de-Marne (Activ), 27, rue Inkermann, 94100 Saint-Maur-des-Fossés, France. activ@activfrance.fr
authors.forename: C
authors.initials: C
authors.lastname: Levy
authors.forename: F
authors.initials: F
authors.lastname: Thollot
authors.forename: F
authors.initials: F
authors.lastname: Corrard
authors.forename: A
authors.initials: A
authors.lastname: Lécuyer
authors.forename: P
authors.initials: P
authors.lastname: Martin
authors.forename: M
authors.initials: M
authors.lastname: Boucherat
authors.forename: M
authors.initials: M
authors.lastname: Koskas
authors.forename: O
authors.initials: O
authors.lastname: Romain
authors.forename: M
authors.initials: M
authors.lastname: Goldrey
authors.forename: W-P
authors.initials: WP
authors.lastname: Hausdorff
authors.forename: R
authors.initials: R
authors.lastname: Cohen
mesh_terms: D002675:Child, Preschool; D005260:Female; D000069443:Heptavalent Pneumococcal Conjugate Vaccine; D006801:Humans; D007223:Infant; D008297:Male; D010033:Otitis Media / Q000175:diagnosis* / Q000453:epidemiology*; D022242:Pneumococcal Vaccines; D011446:Prospective Studies
chemical_list: D000069443:Heptavalent Pneumococcal Conjugate Vaccine; D022242:Pneumococcal Vaccines