title: Seasonality of acute otitis media and the role of respiratory viral activity in children.
abstract: BACKGROUND
  Acute otitis media (AOM) occurs as a complication of viral upper respiratory tract infections in young children. AOM and respiratory viruses both display seasonal variation. Our objective was to examine the temporal association between circulating respiratory viruses and the occurrence of pediatric ambulatory care visits for AOM.
  
  
  METHODS
  This retrospective study included 9 seasons of respiratory viral activity (2002 to 2010) in Utah. We used Intermountain Healthcare electronic medical records to assess community respiratory viral activity via laboratory-based active surveillance and to identify children <18 years with outpatient visits and International Classification of Diseases, Ninth Revision codes for AOM. We assessed the strength of the association between AOM and individual respiratory viruses using interrupted time series analyses.
  
  
  RESULTS
  During the study period, 96,418 respiratory viral tests were performed; 46,460 (48%) were positive. The most commonly identified viruses were respiratory syncytial virus (22%), rhinovirus (8%), influenza (8%), parainfluenza (4%), human metapneumovirus (3%) and adenovirus (3%). AOM was diagnosed during 271,268 ambulatory visits. There were significant associations between peak activity of respiratory syncytial virus, human metapneumovirus, influenza A and office visits for AOM. Adenovirus, parainfluenza and rhinovirus were not associated with visits for AOM.
  
  
  CONCLUSIONS
  Seasonal respiratory syncytial virus, human metapneumovirus and influenza activity were temporally associated with increased diagnoses of AOM among children. These findings support the role of individual respiratory viruses in the development AOM. These data also underscore the potential for respiratory viral vaccines to reduce the burden of AOM.
authors.affiliation: Department of Pediatrics, Division of Pediatric Infectious Diseases, University of Utah Health Sciences Center, Salt Lake City, UT, USA. Chris.Stockmann@hsc.utah.edu
authors.forename: Chris
authors.initials: C
authors.lastname: Stockmann
authors.forename: Krow
authors.initials: K
authors.lastname: Ampofo
authors.forename: Adam L
authors.initials: AL
authors.lastname: Hersh
authors.forename: Scott T
authors.initials: ST
authors.lastname: Carleton
authors.forename: Kent
authors.initials: K
authors.lastname: Korgenski
authors.forename: Xiaoming
authors.initials: X
authors.lastname: Sheng
authors.forename: Andrew T
authors.initials: AT
authors.lastname: Pavia
authors.forename: Carrie L
authors.initials: CL
authors.lastname: Byington
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007251:Influenza, Human / Q000150:complications*; D008297:Male; D029121:Metapneumovirus / Q000302:isolation & purification; D009975:Orthomyxoviridae / Q000302:isolation & purification; D010033:Otitis Media / Q000453:epidemiology*; D010045:Outpatients; D018184:Paramyxoviridae Infections / Q000150:complications*; D018357:Respiratory Syncytial Virus Infections / Q000150:complications*; D012136:Respiratory Syncytial Viruses / Q000302:isolation & purification; D012141:Respiratory Tract Infections / Q000150:complications* / Q000821:virology*; D012189:Retrospective Studies; D012621:Seasons; D013997:Time Factors; D014589:Utah / Q000453:epidemiology