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Impact of pneumococcal conjugate vaccination on otitis media: a systematic review
Sylvia Taylor1, Paola Marchisio, Anne Vergison
1GlaxoSmithKline Biologicals, Global Vaccine Development, Wavre, Belgium.
Insights
Pneumococcal conjugate vaccines show limited efficacy against acute otitis media (AOM) in children. While some protection exists, other factors significantly contribute to the decline in AOM incidence, necessitating improved study methods.
Area of Science:
- Pediatrics
- Vaccinology
- Epidemiology
Background:
- Acute otitis media (AOM) is a common childhood illness leading to frequent physician visits and antibiotic prescriptions.
- Pneumococcal conjugate vaccines (PCVs) are widely used, with their impact on AOM incidence being a key area of research.
Purpose of the Study:
- To systematically review the efficacy and effectiveness of pneumococcal conjugate vaccines against all-cause AOM episodes and physician visits.
- To evaluate the impact of the 7-valent pneumococcal conjugate vaccine (7vCRM) on AOM incidence.
Main Methods:
- Systematic review of 18 publications assessing PCV impact on AOM.
- Analysis of randomized controlled trials (RCTs) and nonrandomized trials for vaccine efficacy.
- Examination of observational database studies for trends in physician visits for AOM before and after PCV introduction.
Main Results:
- Efficacy of 7vCRM against AOM was low: 0%-9% in RCTs and 17%-23% in nonrandomized trials.
- Physician visits for AOM showed a declining trend in the years preceding and following 7vCRM introduction.
- Observational data indicated a mean decline of 15% before and 19% after vaccine introduction, with considerable variability.
Conclusions:
- Pneumococcal conjugate vaccines offer some protection against AOM, but their overall impact is less significant than previously assumed.
- Other factors, not solely vaccination, have contributed to the observed decrease in AOM incidence.
- Future research requires more robust methodologies to accurately determine the true effectiveness of PCVs in preventing AOM.
Abstract:
Acute otitis media (AOM) is a leading cause of visits to physicians and of antibiotic prescriptions for young children. We systematically reviewed studies on all-cause AOM episodes and physician visits in which impact was attributed to pneumococcal conjugate vaccines, either as efficacy or effectiveness. Of 18 relevant publications found, most used the 7-valent pneumococcal conjugate vaccine (7vCRM). The efficacy of 7vCRM against all-cause AOM episodes or visits was 0%-9% in randomized trials and 17%-23% in nonrandomized trials. In observational database studies, physician visits for AOM were already declining in the 3-5 years before 7vCRM introduction (mean change, -15%; range, +14% to -24%) and continued to decline afterward (mean, -19%; range, +7% to -48%). This vaccine provides some protection against OM, but other factors have also contributed to the recent decline in OM incidence. Future effectiveness studies should thus use better-controlled methods to estimate the true impact of vaccination on AOM.
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