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Fewer Ambulatory Visits for OM Linked to PCVs

J Pediatr; ePub 2018 Jun 26; Kawai, Adil, Barrett, et al

A recent nationwide study shows that ambulatory visits for children with otitis media (OM) have declined following the introduction of 7-valent and 13-valent pneumococcal conjugate vaccines (PCV7 and PCV13). Researchers examined OM-associated ambulatory visits in children, using the National Ambulatory Medical Care Survey and National Hospital Ambulatory Medical Care Survey. They found:

  • A total of 24,148 OM-related visits were identified from 363,240 ambulatory visits.
  • OM visits accounted for 9.5% of all ambulatory visits in 1997-1999, 7.1% in 2002-2009, and 5.5% in 2012-2014.
  • Between the pre-PCV7 and the post-PCV13 period, annual physician's office visits for OM declined from 826 to 387 visits per 1,000 children among children aged <2 years.
  • Compared with the pre-PCV7 period, office visit rates for OM significantly declined by 51% among children aged <2 years and by 37% among children aged 2-4 years during the post-PCV13 period.
  • Among children aged <2 years, emergency department visits for OM declined by 47% during the post-PCV13 period, and hospital outpatient visits declined by 30% during the PCV13-transition period.
  • OM-related visits declined across sex, race/ethnicity, health insurance status, and geographic region.

Citation:

Kawai K, Adil EA, Barrett D, Manganella J, Kenna MA. Ambulatory visits for otitis media before and after the introduction of pneumococcal conjugate vaccination. [Published online ahead of print June 26, 2018]. J Pediatr. doi:10.1016/j.jpeds.2018.05.047.

Commentary:

Otitis media (OM) is caused by many different bacteria, but Streptococcus pneumoniae has always been the primary causative organism. We know that pneumococcal conjugate vaccine has significantly reduced meningitis and pneumonia since its use, but the impact on OM has not been so clear. This study looks at a large population over 17 years and shows the significant impact of PCV7 and PCV13 on reduction in OM across all populations and geographic regions. More data are needed on current causative bacteria for OM in the post PCV13 era, as well as antibiotic sensitivity, for optimal treatment.—Sarah Rawstron, MB, BS, FAAP, FIDSA; Pediatric Residency Program Director, The Brooklyn Hospital Center, NY; Clinical Associate Professor, Icahn School of Medicine, Mount Sinai, NY.

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