Implementation of PCV7/PCV13 in Israel Had a Significant Impact on both Pneumococcal and Non-Pneumococcal Complex Otitis Media (OM) Rates
Background: Pre-licensure and post implementation pneumococcal conjugate vaccine (PCV) studies have demonstrated that PCV impact on recurrent, non-responsive and chronic OM cases (complex-OM; COMP-OM) was significantly larger (up to 40%) than when all-cause OM or first OM were measured. COMP-OM is frequently caused by non-pneumococcal pathogens, often forming biofilm, in which non-typable Haemophilus influenzae (NTHi) is the most frequent. We assessed the impact of PCV7/PCV13 introduction on all-cause COMP-OM enriched OM episodes, as well as specifically pneumococcal, NTHi and culture-negative episodes.
Methods: These were previously described (Dagan et al, 49th IDSA, Abstr. 1344, 2012). The surveillance period was Jul-2004 through Dec-2013. PCV7 was introduced to the National Immunization Program (NIP; with catch-up) in Jul-2009 and has been gradually replaced by PCV13 since Nov-2010.
Results: Overall, 6,250 OM episodes for which information was available, were submitted for culture. ≥1 factors associated with COMP-OM were present in 2685/3996 (67%) children: 2165/3331 (65%) in culture-positive children and 520/665 (78%) in culture-negative patients. Incidences (per 1,000 children <2 years) of PCV7+6A serotypes, serotypes 1, 3, 5, 7F, 19A, non-PCV13 serotypes and overall pneumococcal OM by 6 month-intervals and rate reduction calculations are shown in Figure 1. Incidences of NTHi, culture-negative and all-cause OM as well as rate reduction calculations are shown in Figure 2.
Conclusion: All OM cases, including pneumococcal, NTHi and culture-negative episodes enriched with COMP-OM were markedly reduced in children <2 years after PCV7/PCV13 introduction.
Pfizer: Consultant, Grant Investigator, Scientific Advisor and Speaker's Bureau, Consulting fee, Research grant and Speaker honorarium
MSD: Consultant, Grant Investigator and Scientific Advisor, Consulting fee and Research grant
GSK: Consultant and Speaker's Bureau, Consulting fee and Speaker honorarium
E. Leibovitz, Pfizer: Speaker's Bureau, Speaker honorarium
N. Givon-Lavi, None