title: What effect has pneumococcal vaccination had on acute mastoiditis?
abstract: BACKGROUND
  Streptococcus pneumoniae is a frequent cause of acute mastoiditis. Despite the recent (2005) introduction of pneumococcal vaccination, mastoiditis incidence and severity may be increasing. This study aimed to assess the incidence, severity and microbiology of acute mastoiditis over an 11-year period.
  
  
  METHODS
  Retrospective review of paediatric acute mastoiditis cases seen at our institution (2000-2010), comparing patients seen prior to vaccination introduction (period one, 2000-2004), around the time of vaccine introduction (period two, 2005-2007) and post-vaccination (period three, 2008-2010).
  
  
  RESULTS
  We reviewed 84 children. In periods one, two and three, respectively: mean annual case load was 8.4, 5 and 9 children; pneumococcal isolates were seen in 40.5, 6.7 and 29.6 per cent of cases; highest recorded fever was 38.6, 38.9 and 38.2°C and highest leukocyte count 18.9, 15.0 and 15.6 × 109/l; incidence of intracranial complications was 11.9, 0 and 7.4 per cent; mean duration of intravenous antibiotics was 6.0, 4.1 and 4.2 days; proportion treated surgically was 71.4, 60.0 and 48.1 per cent; and mean length of in-patient stay shortened.
  
  
  CONCLUSIONS
  Pneumococcal mastoiditis admission rates appeared to fall when vaccination was introduced, with concomitant reduction in overall mastoiditis incidence and intracranial complications; subsequently, however, admission rates rapidly returned to pre-vaccination levels.
authors.affiliation: Department of Paediatric Otorhinolaryngology Head and Neck Surgery, The Children's Hospital at Westmead, Sydney, New South Wales, Australia. matija.daniel@nottingham.ac.uk
authors.forename: M
authors.initials: M
authors.lastname: Daniel
authors.forename: S
authors.initials: S
authors.lastname: Gautam
authors.forename: T A
authors.initials: TA
authors.lastname: Scrivener
authors.forename: C
authors.initials: C
authors.lastname: Meller
authors.forename: B
authors.initials: B
authors.lastname: Levin
authors.forename: J
authors.initials: J
authors.lastname: Curotta
mesh_terms: D000208:Acute Disease; D061605:Administration, Intravenous; D000900:Anti-Bacterial Agents / Q000008:administration & dosage / Q000627:therapeutic use; D002675:Child, Preschool; D005260:Female; D005334:Fever / Q000453:epidemiology; D006760:Hospitalization / Q000639:trends; D006801:Humans; D015994:Incidence; D007223:Infant; D007958:Leukocyte Count / Q000706:statistics & numerical data; D008297:Male; D008417:Mastoiditis / Q000453:epidemiology / Q000382:microbiology / Q000517:prevention & control*; D009517:New South Wales / Q000453:epidemiology; D011008:Pneumococcal Infections / Q000453:epidemiology / Q000382:microbiology / Q000517:prevention & control*; D022242:Pneumococcal Vaccines / Q000627:therapeutic use*; D012189:Retrospective Studies; D012720:Severity of Illness Index; D013296:Streptococcus pneumoniae / Q000302:isolation & purification*; D014611:Vaccination
chemical_list: D000900:Anti-Bacterial Agents; D022242:Pneumococcal Vaccines