title: Impact of Widespread Introduction of Pneumococcal Conjugate Vaccines on Pneumococcal and Nonpneumococcal Otitis Media.
abstract: BACKGROUND
  Pneumococcal conjugated vaccines (PCVs) impact on complex otitis media (OM; including recurrent, nonresponsive, and chronic OM with effusion) was greater than that on simple, acute OM in previous studies. Since complex OM is often a polymicrobial disease, we speculated that reduction of complex OM by PCVs would be associated with reduction of non-pneumococcal OM.
  
  
  METHODS
  In a prospective, population-based, active surveillance, all OM episodes submitted for middle ear fluid culture in children <3 years from 2004 through 2015 were included. Three sub-periods were established: pre-PCV, PCV7, and PCV13. Incidence rate ratios (IRRs) comparing the 3 periods were calculated for pneumococcal, nontypable Haemophilus influenzae (NTHi), Moraxella catarrhalis, Streptococcus pyogenes, and culture-negative OM.
  
  
  RESULTS
  Overall, 7475 episodes were included. Of all-NTHi cases in the pre-PCV period, 34% were mixed with Streptococcus pneumoniae IRRs (95% confidence interval) comparing the pre-PCV to the PCV13 period were 0.02 (0.01-0.04), 0.12 (0.08-0.20), and 0.18 (0.15-0.21) for PCV7+6A serotypes, 5 additional PCV13 serotypes, and all-pneumococcal OM, respectively; non-PCV13 serotype episodes were not significantly reduced. IRRs for single NTHi, mixed NTHi + S. pneumoniae, and all-NTHi OM were 0.30 (0.25-0.35), 0.18 (0.13-0.24), and 0.25 (0.22-0.29), respectively. Moraxella catarrhalis, S. pyogenes, and culture-negative episodes were also significantly reduced.
  
  
  CONCLUSIONS
  Both pneumococcal and non-pneumococcal OM episodes, enriched with complex cases, declined substantially in children <3 years following sequential PCV7/PCV13 introduction. The reduction in non-pneumococcal episodes may be attributed to early OM episodes prevention, resulting in a lower rate of complex, often non-pneumococcal OM.
authors.affiliation: Pediatric Infectious Disease Unit, Soroka University Medical Center Faculty of Health Sciences, Ben-Gurion University of the Negev.
authors.forename: Shalom
authors.initials: S
authors.lastname: Ben-Shimol
authors.affiliation: Pediatric Infectious Disease Unit, Soroka University Medical Center Faculty of Health Sciences, Ben-Gurion University of the Negev.
authors.forename: Noga
authors.initials: N
authors.lastname: Givon-Lavi
authors.affiliation: Pediatric Infectious Disease Unit, Soroka University Medical Center Faculty of Health Sciences, Ben-Gurion University of the Negev.
authors.forename: Eugene
authors.initials: E
authors.lastname: Leibovitz
authors.affiliation: Faculty of Health Sciences, Ben-Gurion University of the Negev Department of Otolaryngology, Soroka University Medical Center, Beer-Sheva, Israel.
authors.forename: Simon
authors.initials: S
authors.lastname: Raiz
authors.affiliation: Pediatric Infectious Disease Unit, Soroka University Medical Center Faculty of Health Sciences, Ben-Gurion University of the Negev.
authors.forename: David
authors.initials: D
authors.lastname: Greenberg
authors.affiliation: Faculty of Health Sciences, Ben-Gurion University of the Negev.
authors.forename: Ron
authors.initials: R
authors.lastname: Dagan
mesh_terms: D002675:Child, Preschool; D006192:Haemophilus Infections / Q000453:epidemiology / Q000382:microbiology; D006193:Haemophilus influenzae; D000069443:Heptavalent Pneumococcal Conjugate Vaccine; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D010033:Otitis Media / Q000453:epidemiology / Q000382:microbiology / Q000517:prevention & control; D011008:Pneumococcal Infections / Q000453:epidemiology / Q000382:microbiology / Q000517:prevention & control; D022242:Pneumococcal Vaccines; D011446:Prospective Studies; D014611:Vaccination / Q000706:statistics & numerical data*
chemical_list: C538862:13-valent pneumococcal vaccine; D000069443:Heptavalent Pneumococcal Conjugate Vaccine; D022242:Pneumococcal Vaccines
keywords: children; complicated otitis media; nontypable Haemophilus influenzae; pneumococcal conjugate vaccine; surveillance