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Does pneumococcal conjugate vaccination affect onset and risk of first acute otitis media and recurrences? A primary care-based cohort study

Fortanier, AC; Venekamp, RP; Hoes, AW; Schilder, AGM; (2019) Does pneumococcal conjugate vaccination affect onset and risk of first acute otitis media and recurrences? A primary care-based cohort study. Vaccine , 37 (11) pp. 1528-1532. 10.1016/j.vaccine.2019.01.064. Green open access

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Abstract

Background: It has been hypothesized that widespread implementation of pneumococcal conju-gate vaccination (PCV) in infancy reduces early AOM and thereby prevents further AOM epi-sodes and associated health care resource use. Methods: We tested this hypothesis by applying an extension of the original Cox proportional hazards model (Prentice, Williams and Petersons’ total time) to individual AOM episodes record-ed in pseudonymised primary care electronic health records of 18,237 Dutch children born be-tween 2004 and 2015. Children were assigned to three groups: no-PCV (January 2004-March 2006), PCV7 (April 2006-February 2011) and PCV10 (March 2011-February 2015). Results: Of the 18,237 newborns, 6,967 (38%) experienced at least one GP-diagnosed AOM episode up to the age of four years (median age at first AOM: 12 months, interquartile range: 12; total number of AOM episodes: 14,689). Time-to-first AOM was longest in the PCV10 group compared with the PCV7 and no-PCV groups (log rank test: P<0.001); in these groups 30% had experienced a first AOM at 20, 17 and 15 months, respectively. Children in the PCV10 group had a 21% lower risk of experiencing a first AOM episode than those in the no-PCV group (haz-ard ratio (HR): 0.79, 95% confidence interval (CI): 0.72 to 0.86), while the effect was less pro-nounced for the PCV7 group (HR: 0.94, 95% CI: 0.87 to 1.02). Neither PCV7 nor PCV10 re-duced the risk of AOM recurrences. Compared to no-PCV, HRs for overall AOM were 1.00 (95% CI: 0.95 to 1.06) and 0.89 (95% CI: 0.84 to 0.95) for PCV7 and PCV10, respectively. Conclusion: Our cohort study suggests that PCV postpones the onset and reduces the risk of first AOM without affecting recurrences. The impact of PCV on overall AOM in children up to the age of four years seems therefore largely attributable to the prevention of a first AOM epi-sode.

Type: Article
Title: Does pneumococcal conjugate vaccination affect onset and risk of first acute otitis media and recurrences? A primary care-based cohort study
Open access status: An open access version is available from UCL Discovery
DOI: 10.1016/j.vaccine.2019.01.064
Publisher version: https://doi.org/10.1016/j.vaccine.2019.01.064
Language: English
Additional information: This version is the author accepted manuscript. For information on re-use, please refer to the publisher’s terms and conditions.
Keywords: pneumococcal conjugate vaccine, acute otitis media, onset, children, cohort study
UCL classification: UCL
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Brain Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Brain Sciences > The Ear Institute
URI: https://discovery.ucl.ac.uk/id/eprint/10072935
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