Otitis media in children vaccinated during consecutive 7-valent or 10-valent pneumococcal conjugate vaccination schedules

Amanda Leach, Christine Wigger, Ross Andrews, Mark Chatfield, Heidi Smith-Vaughan, Peter Morris

    Research output: Contribution to journalArticleResearchpeer-review

    5 Downloads (Pure)

    Abstract

    Background: In 2001 when 7-valent pneumococcal conjugate vaccine (PCV7) was introduced, almost all (90%) young Australian Indigenous children living in remote communities had some form of otitis media (OM), including 24% with tympanic membrane perforation (TMP). In late 2009, the Northern Territory childhood vaccination schedule replaced PCV7 with 10-valent pneumococcal Haemophilus influenzae protein D conjugate vaccine (PHiD-CV10).

    Methods: 
    We conducted regular surveillance of all forms of OM in children in remote Indigenous communities between September 2008 and December 2012. This analysis compares children less than 36 months of age who received a primary course of at least two doses of PCV7 or PHiD-CV10, and not more than one dose of another pneumococcal vaccine.

    Results: 
    Mean ages of 444 PCV7- and 451 PHiD-CV10-vaccinated children were 20 and 18 months, respectively. Bilaterally normal middle ears were detected in 7% and 9% respectively. OM with effusion was diagnosed in 41% and 51% (Risk Difference 10% [95% Confidence Interval 3 to 17] p = 0.002), any suppurative OM (acute OM or any TMP) in 51% versus 39% (RD −12% [95% CI −19 to −5] p = 0.0004], and TMP in 17% versus 14% (RD −3% [95% CI −8 to 2] p = 0.2), respectively. Multivariate analyses described a similar independent negative association between suppurative OM and PHiD-CV10 compared to PCV7 (Odds Ratio = 0.6 [95% CI 0.4 to 0.8] p = 0.001). Additional children in the household were a risk factor for OM (OR = 2.4 [95% CI 2 to 4] p = 0.001 for the third additional child), and older age and male gender were associated with less disease. Other measured risk factors were non-significant. Similar clinical results were found for children who had received non-mixed PCV schedules.

    Conclusions: 
    Otitis media remains a significant health and social issue for Australian Indigenous children despite PCV vaccination. Around 90% of young children have some form of OM. Children vaccinated in with PHiD-CV10 had less suppurative OM than children vaccinated with PCV7. Ongoing surveillance during the PCV13 era, and trials of early intervention including earlier and mixed vaccine schedules are warranted. 
    Original languageEnglish
    Pages (from-to)1-11
    Number of pages11
    JournalBMC Pediatrics
    Volume14
    Issue number1
    DOIs
    Publication statusPublished - 2014

    Fingerprint

    Otitis Media
    Appointments and Schedules
    Vaccination
    Tympanic Membrane Perforation
    Suppurative Otitis Media
    Conjugate Vaccines
    Pneumococcal Vaccines
    Northern Territory
    Otitis Media with Effusion
    Middle Ear
    Vaccines
    Multivariate Analysis
    Odds Ratio
    Confidence Intervals

    Cite this

    @article{a4ced144ec58423c831d473958975fd2,
    title = "Otitis media in children vaccinated during consecutive 7-valent or 10-valent pneumococcal conjugate vaccination schedules",
    abstract = "Background: In 2001 when 7-valent pneumococcal conjugate vaccine (PCV7) was introduced, almost all (90{\%}) young Australian Indigenous children living in remote communities had some form of otitis media (OM), including 24{\%} with tympanic membrane perforation (TMP). In late 2009, the Northern Territory childhood vaccination schedule replaced PCV7 with 10-valent pneumococcal Haemophilus influenzae protein D conjugate vaccine (PHiD-CV10).Methods: We conducted regular surveillance of all forms of OM in children in remote Indigenous communities between September 2008 and December 2012. This analysis compares children less than 36 months of age who received a primary course of at least two doses of PCV7 or PHiD-CV10, and not more than one dose of another pneumococcal vaccine.Results: Mean ages of 444 PCV7- and 451 PHiD-CV10-vaccinated children were 20 and 18 months, respectively. Bilaterally normal middle ears were detected in 7{\%} and 9{\%} respectively. OM with effusion was diagnosed in 41{\%} and 51{\%} (Risk Difference 10{\%} [95{\%} Confidence Interval 3 to 17] p = 0.002), any suppurative OM (acute OM or any TMP) in 51{\%} versus 39{\%} (RD −12{\%} [95{\%} CI −19 to −5] p = 0.0004], and TMP in 17{\%} versus 14{\%} (RD −3{\%} [95{\%} CI −8 to 2] p = 0.2), respectively. Multivariate analyses described a similar independent negative association between suppurative OM and PHiD-CV10 compared to PCV7 (Odds Ratio = 0.6 [95{\%} CI 0.4 to 0.8] p = 0.001). Additional children in the household were a risk factor for OM (OR = 2.4 [95{\%} CI 2 to 4] p = 0.001 for the third additional child), and older age and male gender were associated with less disease. Other measured risk factors were non-significant. Similar clinical results were found for children who had received non-mixed PCV schedules.Conclusions: Otitis media remains a significant health and social issue for Australian Indigenous children despite PCV vaccination. Around 90{\%} of young children have some form of OM. Children vaccinated in with PHiD-CV10 had less suppurative OM than children vaccinated with PCV7. Ongoing surveillance during the PCV13 era, and trials of early intervention including earlier and mixed vaccine schedules are warranted. ",
    keywords = "10 valent pneumococcal haemophilus influenzae protein d conjugate vaccine, beta lactam antibiotic, Haemophilus influenzae vaccine, hemoglobin variant, macrolide, Pneumococcus vaccine, unclassified drug, 10-valent pneumococcal conjugate vaccine, heptavalent pneumococcal conjugate vaccine, vaccine, Article, child, clinical assessment, controlled study, coughing, cross-sectional study, eardrum perforation, female, femininity, household, human, impetigo, infection risk, major clinical study, male, middle ear effusion, otalgia, otitis media, pneumococcal infection, prevalence, rhinorrhea, tympanometry, Australia, complication, epidemiology, ethnology, evaluation study, health survey, immunization, infant, mass immunization, multivariate analysis, newborn, Oceanic ancestry group, preschool child, risk factor, statistical model, treatment outcome, Tympanic Membrane Perforation, Child, Child, Preschool, Cross-Sectional Studies, Female, Humans, Immunization Schedule, Infant, Infant, Newborn, Logistic Models, Male, Mass Vaccination, Multivariate Analysis, Oceanic Ancestry Group, Otitis Media, Pneumococcal Vaccines, Prevalence, Public Health Surveillance, Risk Factors, Treatment Outcome, Vaccines, Conjugate",
    author = "Amanda Leach and Christine Wigger and Ross Andrews and Mark Chatfield and Heidi Smith-Vaughan and Peter Morris",
    year = "2014",
    doi = "10.1186/1471-2431-14-200",
    language = "English",
    volume = "14",
    pages = "1--11",
    journal = "BMC Pediatrics",
    issn = "1471-2431",
    publisher = "BioMed Central",
    number = "1",

    }

    Otitis media in children vaccinated during consecutive 7-valent or 10-valent pneumococcal conjugate vaccination schedules. / Leach, Amanda; Wigger, Christine; Andrews, Ross; Chatfield, Mark; Smith-Vaughan, Heidi; Morris, Peter.

    In: BMC Pediatrics, Vol. 14, No. 1, 2014, p. 1-11.

    Research output: Contribution to journalArticleResearchpeer-review

    TY - JOUR

    T1 - Otitis media in children vaccinated during consecutive 7-valent or 10-valent pneumococcal conjugate vaccination schedules

    AU - Leach, Amanda

    AU - Wigger, Christine

    AU - Andrews, Ross

    AU - Chatfield, Mark

    AU - Smith-Vaughan, Heidi

    AU - Morris, Peter

    PY - 2014

    Y1 - 2014

    N2 - Background: In 2001 when 7-valent pneumococcal conjugate vaccine (PCV7) was introduced, almost all (90%) young Australian Indigenous children living in remote communities had some form of otitis media (OM), including 24% with tympanic membrane perforation (TMP). In late 2009, the Northern Territory childhood vaccination schedule replaced PCV7 with 10-valent pneumococcal Haemophilus influenzae protein D conjugate vaccine (PHiD-CV10).Methods: We conducted regular surveillance of all forms of OM in children in remote Indigenous communities between September 2008 and December 2012. This analysis compares children less than 36 months of age who received a primary course of at least two doses of PCV7 or PHiD-CV10, and not more than one dose of another pneumococcal vaccine.Results: Mean ages of 444 PCV7- and 451 PHiD-CV10-vaccinated children were 20 and 18 months, respectively. Bilaterally normal middle ears were detected in 7% and 9% respectively. OM with effusion was diagnosed in 41% and 51% (Risk Difference 10% [95% Confidence Interval 3 to 17] p = 0.002), any suppurative OM (acute OM or any TMP) in 51% versus 39% (RD −12% [95% CI −19 to −5] p = 0.0004], and TMP in 17% versus 14% (RD −3% [95% CI −8 to 2] p = 0.2), respectively. Multivariate analyses described a similar independent negative association between suppurative OM and PHiD-CV10 compared to PCV7 (Odds Ratio = 0.6 [95% CI 0.4 to 0.8] p = 0.001). Additional children in the household were a risk factor for OM (OR = 2.4 [95% CI 2 to 4] p = 0.001 for the third additional child), and older age and male gender were associated with less disease. Other measured risk factors were non-significant. Similar clinical results were found for children who had received non-mixed PCV schedules.Conclusions: Otitis media remains a significant health and social issue for Australian Indigenous children despite PCV vaccination. Around 90% of young children have some form of OM. Children vaccinated in with PHiD-CV10 had less suppurative OM than children vaccinated with PCV7. Ongoing surveillance during the PCV13 era, and trials of early intervention including earlier and mixed vaccine schedules are warranted. 

    AB - Background: In 2001 when 7-valent pneumococcal conjugate vaccine (PCV7) was introduced, almost all (90%) young Australian Indigenous children living in remote communities had some form of otitis media (OM), including 24% with tympanic membrane perforation (TMP). In late 2009, the Northern Territory childhood vaccination schedule replaced PCV7 with 10-valent pneumococcal Haemophilus influenzae protein D conjugate vaccine (PHiD-CV10).Methods: We conducted regular surveillance of all forms of OM in children in remote Indigenous communities between September 2008 and December 2012. This analysis compares children less than 36 months of age who received a primary course of at least two doses of PCV7 or PHiD-CV10, and not more than one dose of another pneumococcal vaccine.Results: Mean ages of 444 PCV7- and 451 PHiD-CV10-vaccinated children were 20 and 18 months, respectively. Bilaterally normal middle ears were detected in 7% and 9% respectively. OM with effusion was diagnosed in 41% and 51% (Risk Difference 10% [95% Confidence Interval 3 to 17] p = 0.002), any suppurative OM (acute OM or any TMP) in 51% versus 39% (RD −12% [95% CI −19 to −5] p = 0.0004], and TMP in 17% versus 14% (RD −3% [95% CI −8 to 2] p = 0.2), respectively. Multivariate analyses described a similar independent negative association between suppurative OM and PHiD-CV10 compared to PCV7 (Odds Ratio = 0.6 [95% CI 0.4 to 0.8] p = 0.001). Additional children in the household were a risk factor for OM (OR = 2.4 [95% CI 2 to 4] p = 0.001 for the third additional child), and older age and male gender were associated with less disease. Other measured risk factors were non-significant. Similar clinical results were found for children who had received non-mixed PCV schedules.Conclusions: Otitis media remains a significant health and social issue for Australian Indigenous children despite PCV vaccination. Around 90% of young children have some form of OM. Children vaccinated in with PHiD-CV10 had less suppurative OM than children vaccinated with PCV7. Ongoing surveillance during the PCV13 era, and trials of early intervention including earlier and mixed vaccine schedules are warranted. 

    KW - 10 valent pneumococcal haemophilus influenzae protein d conjugate vaccine

    KW - beta lactam antibiotic

    KW - Haemophilus influenzae vaccine

    KW - hemoglobin variant

    KW - macrolide

    KW - Pneumococcus vaccine

    KW - unclassified drug

    KW - 10-valent pneumococcal conjugate vaccine

    KW - heptavalent pneumococcal conjugate vaccine

    KW - vaccine

    KW - Article

    KW - child

    KW - clinical assessment

    KW - controlled study

    KW - coughing

    KW - cross-sectional study

    KW - eardrum perforation

    KW - female

    KW - femininity

    KW - household

    KW - human

    KW - impetigo

    KW - infection risk

    KW - major clinical study

    KW - male

    KW - middle ear effusion

    KW - otalgia

    KW - otitis media

    KW - pneumococcal infection

    KW - prevalence

    KW - rhinorrhea

    KW - tympanometry

    KW - Australia

    KW - complication

    KW - epidemiology

    KW - ethnology

    KW - evaluation study

    KW - health survey

    KW - immunization

    KW - infant

    KW - mass immunization

    KW - multivariate analysis

    KW - newborn

    KW - Oceanic ancestry group

    KW - preschool child

    KW - risk factor

    KW - statistical model

    KW - treatment outcome

    KW - Tympanic Membrane Perforation

    KW - Child

    KW - Child, Preschool

    KW - Cross-Sectional Studies

    KW - Female

    KW - Humans

    KW - Immunization Schedule

    KW - Infant

    KW - Infant, Newborn

    KW - Logistic Models

    KW - Male

    KW - Mass Vaccination

    KW - Multivariate Analysis

    KW - Oceanic Ancestry Group

    KW - Otitis Media

    KW - Pneumococcal Vaccines

    KW - Prevalence

    KW - Public Health Surveillance

    KW - Risk Factors

    KW - Treatment Outcome

    KW - Vaccines, Conjugate

    UR - http://www.scopus.com/inward/record.url?scp=84906834902&partnerID=8YFLogxK

    U2 - 10.1186/1471-2431-14-200

    DO - 10.1186/1471-2431-14-200

    M3 - Article

    VL - 14

    SP - 1

    EP - 11

    JO - BMC Pediatrics

    JF - BMC Pediatrics

    SN - 1471-2431

    IS - 1

    ER -