Infectious Disease
Reductions in recurrent otitis media and outpatient antibiotic use related to 13-valent pneumococcal conjugate vaccine Laura M King* Laura King Hilary L Colbeth Rouselinne Gómez Sara Y Tartof Joseph A Lewnard
Introduction: In the pre-pneumococcal conjugate vaccine (PCV) era, recurrent disease (4 episodes/year) accounted for a meaningful proportion of acute otitis media (AOM). Implementation of 13-valent PCV (PCV13) in routine infant immunization schedules in the US in 2010 is associated with reductions in both AOM incidence and antibiotic use; the extent to which these reductions are driven by decreases in recurrent AOM is unknown. We aimed to evaluate the effect of PCV13 on recurrent AOM and associated antibiotic use in a US pediatric cohort.
Methods: We measured AOM-associated outpatient visits and antibiotic prescriptions from the Optum Clinformatics™ DataMart for children aged 0–4 years in 2008–2018. We categorized children with 4 AOM visits in a year as having recurrent AOM and we categorized children born 2011 as post-PCV13 and children born 2011 as pre-PCV13. We estimated proportions of children with recurrent AOM and the average number of AOM episodes per child in pre- and post-PCV13 periods. Generalized estimating equations were used to evaluate associations of PCV13 and AOM visits and antibiotic prescriptions.
Results: In the pre-PCV13 period, 5.4% of children had recurrent AOM, compared with 4.6% in the post-PCV13 period (Figure). Across periods, children with recurrent AOM received approximately 3.6 antibiotics prescriptions per child-year compared with 0.4 prescriptions per child-year in those without recurrent AOM. Compared with the pre-PCV13 period, children in the post-PCV13 period had an 11% decrease in the odds of recurrent AOM (OR 0.89, 95% CI 0.85, 0.94), and an average of 0.06 (95% CI 0.04, 0.08) fewer AOM visits and 0.03 (95% CI 0.1, 0.5) fewer AOM antibiotic prescriptions per child-year.
Conclusions: In our study population, PCV13 was associated with notable decreases in recurrent AOM and associated antibiotic use. Our findings may inform AOM prevention and antibiotic stewardship as next-generation PCVs are implemented.
