1343. A Rapid Reduction of Acute Otitis Media (AOM) Necessitating Tympanocentesis or Culture of Draining Fluid in Southern Israel after Introduction of PCV7
Session: Oral Abstract Session: Respiratory Infections in Children
Saturday, October 22, 2011: 2:30 PM
Room: 156ABC
Background: PCV7 is efficacious against AOM caused by the vaccine-serotypes (VT) and serotype 6A, but no detailed data are available on rate reduction of AOM with microbiological outcomes post PCV7 implementation.

Methods: A prospective surveillance on AOM visits to clinics and pediatric emergency room with middle ear fluid culture has been conducted since 2000 in southern Israel.  >95% of children are born and served in a single hospital with a single regional microbiology laboratory, allowing a population-based study.  Since July 2004, clinical/demographic data were collected for Jewish children (~7500 annual births).  PCV7 was introduced to the private market in 2007-8 (~25% children < 24 m with ≥2 doses in 2008) and to the National Program in July 2009 (>80% with ≥2 doses in 2010).

Results: Incidence (per 10,000 persons <3 yrs) is shown in the Table.  Compared with the 4 pre-PCV7 introduction years, overall AOM visits with MEF cultures was reduced by 30%, mainly due to the reduction in single SP and mixed SP+NTHi cases, (51% and 60%, respect.).  Among SP, the decrease was mainly due to a 71% decrease in VT (+6A) serotypes.  No increase in other pathogens or culture-negative AOM was observed.

Conclusion: This is the first study describing population-based post-PCV7 rate reduction of microbiologically proven AOM visits enriched with complicated cases.  Our findings show: 1) Overall reduction is mainly by reduction of VT+6A; 2) no replacement with non-VT SP or other pathogens so far.  Further follow-up is being conducted.  

Table: Incidence (per 10,000 population < 3 yrs) and Risk Reduction; 2004-2010

Pathogen

2004-5*

2005-6

2006-7

2007-8

2008-9 (Transition year)

2009-10 (Post PCV7 year)

2009-10/

2004-8

Risk Reduction**

95% CI

P value

All AOM

201.7

167.4

220.5

225.4

173.6

139.6

30%

21 - 38

<0.001

Single SP

44.8

41.2

42.1

54.2

33.6

22.4

51%

34 - 64

<0.001

Single NTHi

48.4

40.3

55.9

58.6

50.4

40.6

15%

0 - 32

0.134

SP + NTHi

26.9

21.9

25.5

22.5

18.5

8.9

60%

37 - 75

<0.001

SP, VT+6A

46.6

43.4

47.0

56.8

29.7

14.0

71%

59 - 80

<0.001

SP, non-VT

26.9

21.9

23.3

22.0

23.7

16.9

24%

0 – 47

0.096

Population

22,305

22,342

22,354

22,711

23,218

23,633

 

 

 

*Each year – July 1st through July 30th   ** Risk Reduction = (1 – odds ratio) x 100


Subject Category: P. Pediatric and perinatal infections

Ron Dagan, MD, Noga Givon-Lavi, PhD, David Greenberg, MD and Eugene Leibovitz, MD, Ben-Gurion Univ. and Soroka Univ. Med. Ctr., Beer-Sheva, Israel

Disclosures:

R. Dagan, Berna/Crucell: Grant Investigator, Investigator, Scientific Advisor and Speaker's Bureau, Consulting fee, Research grant and Speaker honorarium
GlaxoSmithKline: Scientific Advisor and Speaker's Bureau, Consulting fee and Speaker honorarium
MSD: Grant Investigator, Investigator and Scientific Advisor, Consulting fee and Research grant
Novartis: Scientific Advisor, Consulting fee
Protea: Grant Investigator, Investigator and Shareholder, Research grant
Pfizer (Wyeth): Grant Investigator, Investigator, Scientific Advisor and Speaker's Bureau, Consulting fee, Research grant and Speaker honorarium

N. Givon-Lavi, None

D. Greenberg, Pfizer: Speaker's Bureau, Speaker honorarium

E. Leibovitz, None

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