title: Incidence survey of acute otitis media in children in Sado Island, Japan--Sado Otitis Media Study (SADOMS).
abstract: BACKGROUND
  Acute otitis media (AOM) is one of the most common forms of bacterial infection and cause for clinic visits in children. The incidence of AOM was 0.9-1.2 episodes per person-year during the first 2 years of life in previous reports conducted before 2000. The aim of this study was to 1) evaluate the latest AOM incidence in pediatric outpatients and 2) identify the bacterial pathogens from these patients and ascertain their serotypes and resistance.
  
  
  METHODS
  The study was conducted in a closed population, involving all pediatricians and otolaryngologists in Sado Island allowing accurate determination of AOM incidence. In each month, one week was assigned as "surveillance week", and all outpatients with acute illness aged 0-18 years examined during the surveillance weeks were enrolled. AOM was diagnosed on the basis of otoscopic findings and clinical symptoms were recorded. Specimens were collected from the nasopharynx or middle ear cavity of AOM patients and examined for bacteria. Antimicrobial susceptibilities, serotypes, and molecular typing for resistance were determined among Streptococcus pneumoniae and Haemophilus influenzae.
  
  
  RESULTS
  In total, 8,283 clinic visits were conducted, and 354 episodes (4.3%, 95% CI: 3.9-4.7%) among 312 children were diagnosed as AOM. The incidence of AOM was highest in children of 1 year of age (0.54 episodes/child/year, 95% CI: 0.44-0.64). Serotype coverage of 7- and 13-valent pneumococcal conjugate vaccines in this study were 38.0% (95% CI: 29.3-47.3) and 62.8% (95% CI: 53.6-71.4), respectively. Of 122 H.influenzae isolates available for typing, 120 were nontypeable and 2 were type b. A high proportion of S. pneumoniae isolates (46%) showed resistance to penicillin. Approximately half of H. influenzae isolates had genetic markers for beta-lactamase-negative ampicillin-resistance.
  
  
  CONCLUSIONS
  Approximately 4-5% of pediatric outpatients, even without AOM-related symptoms, had AOM in our study. Pediatricians as well as otolaryngologists should check the tympanic membrane findings of all pediatric outpatients.
authors.affiliation: Department of Pediatrics, Sado General Hospital, Sado, Niigata, Japan. ootsukataketo@hotmail.com
authors.forename: Taketo
authors.initials: T
authors.lastname: Otsuka
authors.forename: Osamu
authors.initials: O
authors.lastname: Kitami
authors.forename: Kouji
authors.initials: K
authors.lastname: Kondo
authors.forename: Hisayuki
authors.initials: H
authors.lastname: Ota
authors.forename: Shinsuke
authors.initials: S
authors.lastname: Oshima
authors.forename: Akio
authors.initials: A
authors.lastname: Tsuchiya
authors.forename: Takatoshi
authors.initials: T
authors.lastname: Shirai
authors.forename: Koyata
authors.initials: K
authors.lastname: Fujii
authors.forename: Michihide
authors.initials: M
authors.lastname: Nakamure
authors.forename: Yasuhiro
authors.initials: Y
authors.lastname: Shoji
authors.forename: Hisano
authors.initials: H
authors.lastname: Nakamura
authors.forename: Yasuko
authors.initials: Y
authors.lastname: Masuda
authors.forename: Kenichi
authors.initials: K
authors.lastname: Komiyama
authors.forename: Kazunaga
authors.initials: K
authors.lastname: Yoshida
authors.forename: Yukio
authors.initials: Y
authors.lastname: Ishikawa
authors.forename: Atsushi
authors.initials: A
authors.lastname: Iwaya
authors.forename: Sugata
authors.initials: S
authors.lastname: Takahashi
authors.forename: Minoru
authors.initials: M
authors.lastname: Okazaki
authors.forename: Muneki
authors.initials: M
authors.lastname: Hotomi
authors.forename: Noboru
authors.initials: N
authors.lastname: Yamanaka
mesh_terms: D000208:Acute Disease; D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D015897:Comorbidity; D005260:Female; D006192:Haemophilus Infections / Q000175:diagnosis / Q000453:epidemiology; D006193:Haemophilus influenzae / Q000145:classification / Q000302:isolation & purification; D006801:Humans; D015994:Incidence; D007223:Infant; D007231:Infant, Newborn; D007564:Japan / Q000453:epidemiology; D008297:Male; D010033:Otitis Media / Q000175:diagnosis* / Q000453:epidemiology*; D010036:Otolaryngology / Q000379:methods / Q000706:statistics & numerical data; D010045:Outpatients / Q000706:statistics & numerical data*; D010372:Pediatrics / Q000379:methods / Q000706:statistics & numerical data; D011008:Pneumococcal Infections / Q000175:diagnosis / Q000453:epidemiology; D011159:Population Surveillance / Q000379:methods*; D012703:Serotyping; D013296:Streptococcus pneumoniae / Q000145:classification / Q000302:isolation & purification; D013997:Time Factors