title: Acute Otitis Media and Other Complications of Viral Respiratory Infection.
abstract: BACKGROUND
  Viral upper and lower respiratory tract infections (URI, LRI) are common in infants. We determined the prevalence of viral URI and its complications, including acute otitis media (AOM) and LRI, and assessed the effect of bacterial-viral interactions, and genetic and environmental risks on AOM development.
  
  
  METHODS
  Healthy infants were enrolled from near birth and followed to the first episode of AOM up to 12 months of age. Nasopharyngeal specimens were collected at monthly intervals (months 1-6, 9) and during viral URI episodes for bacterial culture and viral polymerase chain reaction studies. Subjects were followed closely for AOM development.
  
  
  RESULTS
  A total of 367 infants were followed for 286 child-years; 887 URI (305 infants) and 180 AOM episodes (143 infants) were documented. Prevalence of URI, LRI, and AOM in the first year was 3.2, 0.25, and 0.67 per child-year, respectively. Cumulative AOM incidence by ages 3, 6, and 12 months was 6%, 23%, and 46%. Infants with and without AOM had 4.7 and 2.3 URI episodes per child-year, respectively (P < .002). Pathogenic bacterial colonization rates by month were significantly higher in infants with AOM (P < .005). Breastfeeding reduced both URI and AOM risks (P < .05). Significant bacterial-viral interactions occurred with Moraxella catarrhalis and a variety of respiratory viruses and altered URI and AOM risks.
  
  
  CONCLUSIONS
  Almost half of infants experienced AOM by age 1. Important AOM risk factors included frequent viral URI, pathogenic bacterial colonization, and lack of breastfeeding. Bacterial-viral interactions may play a significant role in AOM pathogenesis and deserve further investigation.
authors.affiliation: Departments of Pediatrics, Pathology, tchonmai@utmb.edu.
authors.forename: Tasnee
authors.initials: T
authors.lastname: Chonmaitree
authors.affiliation: Departments of Pediatrics.
authors.forename: Rocio
authors.initials: R
authors.lastname: Trujillo
authors.affiliation: Preventive Medicine and Community Health, and.
authors.forename: Kristofer
authors.initials: K
authors.lastname: Jennings
authors.affiliation: Departments of Pediatrics.
authors.forename: Pedro
authors.initials: P
authors.lastname: Alvarez-Fernandez
authors.affiliation: Departments of Pediatrics.
authors.forename: Janak A
authors.initials: JA
authors.lastname: Patel
authors.affiliation: Pathology.
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Loeffelholz
authors.affiliation: Departments of Pediatrics.
authors.forename: Johanna
authors.initials: J
authors.lastname: Nokso-Koivisto
authors.affiliation: Departments of Pediatrics.
authors.forename: Reuben
authors.initials: R
authors.lastname: Matalon
authors.affiliation: Departments of Pediatrics, Microbiology and Immunology, University of Texas Medical Branch, Galveston, Texas.
authors.forename: Richard B
authors.initials: RB
authors.lastname: Pyles
authors.affiliation: Departments of Pediatrics.
authors.forename: Aaron L
authors.initials: AL
authors.lastname: Miller
authors.affiliation: Departments of Pediatrics.
authors.forename: David P
authors.initials: DP
authors.lastname: McCormick
mesh_terms: D000208:Acute Disease; D001424:Bacterial Infections / Q000150:complications; D015897:Comorbidity; D005260:Female; D006801:Humans; D015994:Incidence; D007223:Infant; D008137:Longitudinal Studies; D008297:Male; D009305:Nasopharynx / Q000382:microbiology; D010033:Otitis Media / Q000453:epidemiology / Q000209:etiology*; D012141:Respiratory Tract Infections / Q000150:complications*; D012307:Risk Factors; D014777:Virus Diseases / Q000150:complications*