Drop in Ear Infections Attributed to Pneumococcal Vaccine

A reduction in pediatric health care visits related to otitis media between 2001 and 2011 appears to be due to uptake of the pneumococcal conjugate vaccine, according to the results of a new study.

Ear infections are the most common reason children make health care visits, receive antibiotics, or undergo surgery, but efforts to reduce their prevalence may be working. A study published online on November 25, 2013, in JAMA Pediatrics finds that health care use related to pediatric ear infections decreased from 2001 to 2011 and suggests that this reduction may be partially credited to the pneumococcal conjugate vaccine.

The 7-valent pneumococcal conjugate vaccine was introduced in the United States in 2000 and was associated with significant decreases in pediatric health care visits related to otitis media. However, due to serotype replacement, a broader 13-valent pneumococcal conjugate vaccine (PCV13) was introduced in 2010. The study aimed to evaluate the potential effect of the vaccines on otitis media—related health care use, complications, and surgery from 2001 to 2011.

Using an insurance claims database of a nationwide managed health care plan, the researchers identified children aged 6 and younger with health care visit claims with a primary diagnosis of otitis media. Children with 3 or more ear infection visits within a 6 month period were considered to have recurrent otitis media. Surgery and complications stemming from ear infections, including tympanic membrane perforation, otorrhea, and acute mastoiditis, were also studied.

Throughout the 11-year study period, 7.82 million children made 6.21 million otitis media-related health care visits. Visit rates decreased from 2004 to 2011, with a significant drop coinciding with the introduction of PCV13 in 2010. From 2010 to 2011, ear infection visits dropped at a rate of 0.14 child-years annually and health care visits dropped more sharply at a rate of 0.27 child-years annually. Children younger than 2 years had the highest incidence of otitis media. Using the visit rates observed before the introduction of PCV13, the researchers calculated what visit rates might have been from 2010 to 2011 had the vaccine not been introduced. The observed reductions in visit rates among children younger than 2 were significantly lower than the predicted rate, suggesting the vaccine’s efficacy.

Recurrent ear infections, complications, and surgery also decreased gradually throughout the study period. Tympanic membrane perforation and otorrhea were the most common complications, and their rates gradually increased throughout the study. However, the increases in these complications were only significant in children aged 2 and older. Mastoiditis was the next-most-common complication, and its incidence rates decreased significantly from 2009 to 2011. In addition, ventilation tube insertions decreased by 19% from 2010 to 2011.

As PCV13 continues to be used, serotypes may change and more studies will be needed to evaluate the long-term effects of the vaccine on pediatric ear infection visits.