Epidemiology of Acute Otitis Media in the Postpneumococcal Conjugate Vaccine Era
Epidemiology of Acute Otitis Media in the Postpneumococcal Conjugate Vaccine Era
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DOI：
10.1542/peds.2017-0181
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发表时间：
2017-09-01
期刊：
影响因子：
8
通讯作者：
Pichichero, Michael E.
中科院分区：
文献类型：
--
作者：
Kaur, Ravinder;Morris, Matthew;Pichichero, Michael E.
目的：研究肺炎球菌结合疫苗7和13时代急性中耳炎（AOM），特别是中耳炎易发人群的流行病学。方法：在10年时间框架内（2006年6月- 2016年6月）对615名6至36个月的儿童进行前瞻性管理。所有急性中耳炎的临床诊断均经鼓室穿刺和中耳液细菌培养证实。结果：1岁时，23%的儿童出现了>= 1次急性中耳炎发作；到3岁时，60%的儿童有>= 1次AOM发作，24%有>= 3次AOM发作。发病高峰发生在6至12个月。人口统计学和环境数据的多变量分析显示，男性、非西班牙裔白人、AOM复发家族史、日托服务和AOM的早期发生与AOM的风险显著增加有关。严格定义（鼓膜穿刺确诊）的中耳炎倾向，即儿童在6个月内至少发生3次急性中耳炎发作或在一年内至少发生4次急性中耳炎发作，其危险因素为男性、日托服务和急性中耳炎家族史，而在生命的前6个月母乳喂养具有保护作用。严格定义的中耳炎易感儿童也可能在更年轻的时候经历第一次AOM发作。引起急性中耳炎的肺炎链球菌、流感嗜血杆菌和卡他莫拉菌的比例在近10年间发生了动态变化。结论：我们得出结论，自引入肺炎球菌结合疫苗以来，AOM的流行病学而非危险因素发生了实质性变化。
OBJECTIVES: To study the epidemiology of acute otitis media (AOM), especially the otitis-prone condition, during the pneumococcal conjugate vaccines 7 and 13 era.METHODS: Six hundred and fifteen children were prospectively managed from 6 to 36 months of life during a 10-year time frame (June 2006-June 2016). All clinical diagnoses of AOM were confirmed by tympanocentesis and bacterial culture of middle ear fluid.RESULTS: By 1 year of age, 23% of the children experienced >= 1 episode of AOM; by 3 years of age, 60% had >= 1 episodes of AOM, and 24% had >= 3 episodes. The peak incidence occurred at 6 to 12 months of life. Multivariable analysis of demographic and environmental data revealed a significantly increased risk of AOM associated with male sex, non-Hispanic white race, family history of recurrent AOM, day care attendance, and early occurrence of AOM. Risk factors for stringently defined (tympanocentesis-confirmed) otitis proneness, in which children suffered at least 3 episodes of AOM in a 6-month period or at least 4 within a year, were male sex, day care attendance, and family history of AOM, whereas breastfeeding in the first 6 months of life was protective. Stringently defined otitis prone children were also likely to experience their first AOM episode at a younger age. The proportion of Streptococcus pneumoniae, Haemophilus influenzae, and Moraxella catarrhalis causing AOM had dynamic changes during the past decade.CONCLUSIONS: We conclude that the epidemiology but not the risk factors for AOM have undergone substantial changes since the introduction of pneumococcal conjugate vaccines.