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Pediatric acute mastoiditis in the era of pneumococcal vaccination
Kareem O Tawfik1, Stacey L Ishman1,2,3, Meredith E Tabangin4
1Department of Otolaryngology-Head and Neck Surgery, University of Cincinnati College of Medicine, Cincinnati, Ohio, U.S.A.
Insights
Pediatric acute mastoiditis hospitalization rates remained stable overall after pneumococcal vaccine introduction. However, rates declined in very young children between 2009-2012, suggesting a benefit from the 13-valent pneumococcal vaccine.
Area of Science:
- Pediatric infectious diseases
- Vaccinology
- Public health surveillance
Background:
- Acute mastoiditis is a serious bacterial infection of the temporal bone, predominantly affecting children.
- The introduction of pneumococcal conjugate vaccines (PCV) aimed to reduce the incidence of invasive pneumococcal diseases, including those complicated by mastoiditis.
- Trends in pediatric acute mastoiditis hospitalizations following PCV introduction require ongoing evaluation.
Purpose of the Study:
- To analyze trends in annual hospitalization prevalence for pediatric acute mastoiditis.
- To assess the impact of the 7-valent pneumococcal vaccine (PCV7) introduced in 2000 and the 13-valent pneumococcal vaccine (PCV13) introduced in 2010 on these trends.
Main Methods:
- Utilized a cross-sectional retrospective analysis of the Kids' Inpatient Database (2000-2012).
- Extracted nationally weighted data on hospitalizations for acute mastoiditis in children under 21 years.
- Performed trend analysis on hospitalization rates from 2000 to 2012.
Main Results:
- Overall hospitalization rates for pediatric acute mastoiditis showed no significant trend between 2000 and 2012.
- Hospitalization rates significantly declined in children younger than 1 year and those aged 1-2 years between 2000 and 2012.
- From 2009 to 2012, significant declines were observed in children aged 0-2 years, while rates increased in older age groups (5-9 and 10-20 years).
Conclusions:
- Despite the introduction of PCV7 and PCV13, overall pediatric acute mastoiditis hospitalization rates did not decrease from 2000 to 2012.
- Declining hospitalization rates in children aged 0-2 years between 2009 and 2012 may indicate a protective effect of the PCV13 vaccine.
- Further research is needed to understand the increasing trends in older children and the specific impact of different vaccine formulations.
Objectives/Hypothesis:
The objective was to describe trends in the annual prevalence of hospitalization for pediatric acute mastoiditis since introduction of the 7-valent pneumococcal vaccine in 2000 and the 13-valent vaccine in 2010.
Study Design:
Cross-sectional retrospective data analysis.
Methods:
The Kids' Inpatient Database from years 2000 to 2012 was analyzed. To determine the annual prevalence of hospitalization for acute mastoiditis, nationally weighted frequencies of hospitalization for children <21 years with acute mastoiditis diagnoses were collected. Trend analysis of hospitalization rates from 2000 to -2012 was performed.
Results:
From 2000 to 2012, there was no significant trend in hospitalization rates for acute mastoiditis overall (1.38 and 1.43 per 100,000 persons in 2000 and 2012, respectively; P = .86) or by age group. When comparing hospitalization rates at time points 2000 and 2012, children <1 year (4.65 and 3.27 per 100,000 persons, P = .0023) and 1 to 2 years of age (3.95 and 3.18 per 100,000 persons, respectively; P = .0107) demonstrated declines in hospitalization over time. Between 2009 and 2012, hospitalization rates also significantly declined for children aged <1 year (4.50 to 3.27 per 100,000 persons, P = .0056) and 1 to 2 years (4.30 to 3.18 per 100,000 persons, P = .0002) but increased for children 5 to 9 years (1.10 to 1.81 per 100,000 persons, P < .0001) and 10 to 20 years of age (0.41 to 0.72 per 100,000 persons, P < .0001).
Conclusions:
Despite introduction of two pneumococcal vaccines, rates of hospitalization for pediatric acute mastoiditis did not decline between 2000 and 2012. Between 2009 and 2012, however, children 0 to 2 years of age showed declining hospitalization rates, possibly reflecting the protective benefit of the 13-valent pneumococcal vaccine.
Level Of Evidence:
4. Laryngoscope, 128:1480-1485, 2018.
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