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Eighteen-Year Longitudinal Study of Uncomplicated and Complex Acute Otitis Media During the Pneumococcal Conjugate

Naoko Fuji1, Frank N Salamone1, Ravinder Kaur1

  • 1Center for Infectious Diseases and Immunology, Rochester General Hospital Research Institute, Rochester, New York, USA.

The Journal of Infectious Diseases
|March 20, 2025
PubMed

Insights

The pneumococcal conjugate vaccine PCV13 significantly reduced complex acute otitis media (AOM) and antibiotic resistance. Haemophilus influenzae remains a key cause of AOM, but overall AOM rates decreased.

Area of Science:

  • Pediatrics
  • Infectious Diseases
  • Otolaryngology

Background:

  • Analysis of demographic and risk factors for uncomplicated acute otitis media (uAOM) and complex AOM (cAOM).
  • Identification of middle ear fluid (MEF) pathogens and pneumococcus serotype distribution over distinct vaccination eras (PCV7, early-PCV13, late-PCV13).
  • Assessment of bacterial antibiotic non-susceptibility trends in pediatric AOM.

Purpose of the Study:

  • To evaluate changes in AOM epidemiology and etiology in children over 18 years.
  • To determine the impact of pneumococcal conjugate vaccines (PCV7 and PCV13) on AOM characteristics.
  • To compare risk factors and pathogens between uncomplicated and complex AOM cases.

Main Methods:

  • Prospective enrollment of 1,537 children aged 6-36 months over an 18-year period.
  • Tympanocentesis for middle ear fluid (MEF) collection and culture upon AOM diagnosis.
  • Analysis of electronic medical records to classify AOM episodes as uncomplicated (uAOM) or complex (cAOM).

Main Results:

  • Male sex, family history of AOM, and daycare attendance were associated with increased odds of cAOM.
  • Streptococcus pneumoniae prevalence decreased significantly post-PCV13 introduction, particularly serotype 19A, reducing penicillin non-susceptibility.
  • Haemophilus influenzae emerged as a more frequent pathogen in cAOM compared to uAOM and remained a dominant cause.

Conclusions:

  • PCV13 vaccination effectively reduced cAOM incidence and associated antibiotic resistance, primarily by targeting S. pneumoniae serotype 19A.
  • Haemophilus influenzae continues to be a significant pathogen in pediatric cAOM.
  • Despite the emergence of non-PCV13 S. pneumoniae serotypes, overall AOM caused by S. pneumoniae remained low post-vaccination.
Abstract

Keywords:
S pneumoniaePCV13complex acute otitis mediatympanocentesisuncomplicated acute otitis media

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