Epidemiology Of Acute Otitis Media Research Articles

Etiology of acute otitis media and phenotypic-molecular characterization of Streptococcus pneumoniae isolated from children in Liuzhou, China

BackgroundThe etiology and epidemiology of acute otitis media (AOM) are poorly understood in China. This study aimed to describe the etiology of AOM and the phenotypic and molecular characteristics of AOM-causing Streptococcus pneumoniae (S.pneumoniae) recovered from Chinese children.MethodsA retrospective study was conducted to enrol patients younger than 18 years diagnosed as AOM. Middle ear fluid specimens were collected then cultured for bacterial pathogens. All S.pneumoniae isolates were tested for antibiotic susceptibility, serotypes, virulence genes, antibiotic resistant determinants and sequence types.ResultsThe dominant otopathogen among AOM children was S.pneumoniae (54.4%). Among S.pneumoniae isolates, there were 97.3, 97.3 and 75.7% isolates resistant to erythromycin, tetracycline and trimethoprim-sulfamethoxazole, respectively. There was 72.8% S.pneumoniae with multidrug resistance. The dominant sequence types (STs) were ST271 and ST320, whereas the prevailing serotypes were 19F and 19A. The 7-valent and 13-valent pneumococcal conjugate vaccine (PCV) coverage among AOM children were 73.0 and 94.6%, respectively. Additionally, we found that CC271 expressed more of mef(A/E) (P < 0.001), pspA (P = 0.022) and sipA (P < 0.001) than non-CC271 isolates.ConclusionThe high prevalence of international multidrug-resistant clone (Taiwan19F-14) in China necessitates continued dedication to expand PCV13 immunization and better control of antibiotic use in China.

PCV13 普及後の小児急性中耳炎に関する疫学的検討

PCV13 普及後の小児急性中耳炎に関する疫学的検討

Grommets (ventilation tubes) for recurrent acute otitis media in children.

Acute suppurative otitis media is one of the most common infectious diseases in childhood. Recurrent acute otitis media is defined for the purposes of this review as either three or more acute infections of the middle ear cleft in a six-month period, or at least four episodes in a year. Strategies for managing the condition include the assessment and modification of risk factors where possible, repeated courses of antibiotics for each new infection, antibiotic prophylaxis and the insertion of ventilation tubes (grommets).To establish whether ventilation tube insertion reduces the frequency of episodes of recurrent acute otitis media and the proportion of children with symptoms of ear disease.We searched the Cochrane Ear, Nose and Throat Disorders Group Trials Register, the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library, Issue 1 2008), MEDLINE (1950 to 2008), EMBASE (1974 to 2008), CINAHL, mRCT (the metaRegister of Controlled Trials for ongoing/unpublished trials), NRR (National Research Register), LILACs, KoreaMed, IndMed, PakMediNet, Zetoc, ISI Proceedings and Cambridge Scientific Abstracts. Reference lists of articles retrieved from the electronic searches were scanned for further trials. Systematic reviews and other meta-analyses were also searched for and their reference lists scanned. Contact was sought with authors of published trials and other experts in the field. The date of the last search was March 2008.No trials that included a treatment and a control group that met the inclusion criteria were excluded. Abstracts were screened and full text articles of studies that met our inclusion criteria obtained. Two authors independently applied the inclusion criteria. Studies included in the review underwent quality assessment performed independently by all authors adapting the methods outlined in the Cochrane Handbook for Systematic Reviews of Interventions.Data were extracted independently by the authors and synthesised descriptively. Five randomised controlled trials were identified, of which two fulfilled the inclusion criteria.Two studies involving 148 children were included in the review. One of these studies, involving 95 children, showed that ventilation tube insertion leads to a mean reduction of 1.5 episodes of acute otitis media in the first six months after treatment. This study also showed a significant increase in the proportion of children with no episodes of AOM (p < 0.001) in the ventilation tube group. The other included study also found a higher proportion of patients in the ventilation tube group had no episodes of AOM in the six months after intervention, but the difference did not reach statistical significance (p = 0.16).Ventilation tubes have a significant role in maintaining a 'disease-free' state in the first six months after insertion. Further research is required to investigate the effect beyond six months. Clinicians should consider the possible adverse effects of grommet insertion before surgery is undertaken.

Epidemiology of Acute Otitis Media in the Postpneumococcal Conjugate Vaccine Era.

To study the epidemiology of acute otitis media (AOM), especially the otitis-prone condition, during the pneumococcal conjugate vaccines 7 and 13 era. 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. 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. We conclude that the epidemiology but not the risk factors for AOM have undergone substantial changes since the introduction of pneumococcal conjugate vaccines.

Association of Streptococcus pneumoniae nasopharyngeal colonization and other risk factors with acute otitis media in an unvaccinated Indian birth cohort.

In order to study the epidemiology of acute otitis media (AOM) and Streptococcus pneumoniae nasopharyngeal colonization in the first 2 years of life, we followed up an unvaccinated birth cohort monthly and at visits when sick, with otoscopy to detect AOM and performed nasopharyngeal swabbing to detect S. pneumoniae. Serotyping of positive cultures was also performed. Of 210 babies who were enrolled at birth, 61 (29·05%) experienced 128 episodes of AOM [relative risk 2·63, 95% confidence interval (CI) 1·21-5·75] with maximum incidence in the second half of the first year of life. Episodes ranged from 1 to 7 (mean 2·1 episodes). Most (86·9%) babies with AOM had a positive culture swab giving an odds ratio (OR) of 1·93 (95% CI 1·03-3·62, P = 0·041) for this association. Other risk factors identified for AOM were winter season (OR 3·46, 95% CI 1·56-7·30, P = 0·001), upper respiratory infection (OR 2·43, 95% CI 1·43-4·51, P = 0·005); residents of small households were less likely to develop AOM (OR 0·32, 95% CI 0·17-0·57, P < 0·01). Common S. pneumoniae serotypes isolated during episodes were 19, 6, 15, 35, 7, 23, 9 and 10 which indicated a theoretical coverage for pneumococcal vaccines PCV10 and PCV13 constituent serotypes of 62·8%. We conclude that AOM in Indian infants is often associated with S. pneumoniae colonization of the nasopharynx as well as other risk factors.

The incidence of acute otitis media in New Zealand children under five years of age in the primary care setting

Acute otitis media (AOM) is a common childhood infection. Baseline data are required to evaluate potential changes in the epidemiology of AOM with new public health measures. To estimate the incidence of AOM in children under five years of age in primary care in New Zealand. Using a cohort study design, consultation notes from 1 November 2008 to 31 October 2009 from 63 primary care facilities were analysed for new and recurrent episodes of AOM, complications, antimicrobial use and outcome. There were 19 146 children in the sample. The raw incidence of AOM was 273 per 1000 children (27.3%; 95% CI 216-330). Of the 3885 children, 2888 (74%) had one episode of AOM and 152 (4%) of these children developed recurrent AOM. Incidence declined with age. There was no difference in incidence between Maori, Pacific and 'Other' ethnicities. Antibiotics were used to treat 2653 (51%) AOM episodes and 113 (4.3%) of these children re-presented within three days of antibiotic therapy for persistent symptoms. Tympanic membrane perforation was the only complication noted, observed in 62 (1%) episodes. These data indicate that AOM is an important and frequent childhood infection in New Zealand. The show a significant decline in the use of antibiotics to manage AOM in concordance with accepted best practice. The complication rate of AOM is likely under-represented. This study enables future research into the effectiveness of current and future immunisations and changing management practices in New Zealand.

The Impact of the Heptavalent Pneumococcal Conjugate Vaccine on the Epidemiology of Acute Otitis Media Complicated by Otorrhea

The heptavalent pneumococcal conjugate vaccine (PCV7) has a considerable effect on the epidemiology of pneumococcal disease. The aim of this observational hospital-based study was to examine the effect of the PCV7 (introduced in our settings in 2004) on the epidemiology of spontaneously draining acute otitis media. Results of all middle ear fluid cultures (n = 3446) obtained from children with acute otitis media complicated with otorrhea before the introduction of immunization (between 2000 and 2003) were compared with those (n = 2134) obtained during a similar post-PCV7 period (between 2005 and 2008). Results of cultures obtained between 2006 and 2008 were examined prospectively, whereas those obtained in previous years were retrospectively reviewed. Following PCV7 immunization, the rates of otorrhea visits per 10,000 emergency department visits decreased by 38% from 133 to 83 (95% confidence interval of the difference, 42-53; P < 0.001), mainly as a result of the decrease in the incidence of pneumococcal disease (48% decrease-25 vs. 13 per 10,000 emergency department visits; P < 0.001). Otorrhea due to Haemophilus influenzae decreased by 20% (20-16 per 10,000 visits; P < 0.001). Serotype 19A accounted for 1 of 47 (2%) pneumococcal strains in 2006, for 5 of 34 (15%) in 2007, and for 13 of 53 (25%) in 2008 (P for trend: 0.001). In the postvaccine years, penicillin-resistant pneumococcal strains (minimum inhibitory concentration ≥ 2 μg/mL) increased from 4% to 13% (P < 0.001). However, the proportion of pneumococci resistant to macrolides decreased (44% vs. 35%; P = 0.01). After the introduction of immunization, otorrhea incidents decreased considerably, mainly because of the decrease in pneumococcal disease. H. influenzae is now the predominant organism. Serotype 19A has increased significantly and is the most common nonvaccine pneumococcal serotype. Penicillin resistance has increased in recent years.

Serotype 19A is the Most Common Streptococcus pneumoniae Isolate in Children With Chronic Sinusitis

The introduction of the heptavalent pneumococcal conjugate vaccine has altered the epidemiology of acute otitis media and invasive pneumococcal disease in children. However, sparse data regarding pediatric sinusitis are available since the licensure of pneumococcal conjugate vaccine. In this study, sinus cultures which grew Streptococcus pneumoniae at Texas Children's Hospital were evaluated with regard to pneumococcal serotype, antimicrobial susceptibility, and frequency of coinfecting organisms. S. pneumoniae isolates from sinus cultures were identified from January 1, 2007 to July 31, 2008. A retrospective chart review was performed and information including age, ethnicity, gender, and comorbidities was collected. Isolates were serotyped and their susceptibility to oral penicillin, cefotaxime, erythromycin, clindamycin, and trimethoprim-sulfamethoxazole was determined. During the study period, 24 pneumococcal isolates were recovered from endoscopic sinus surgery cultures; 23 isolates were nonvaccine serotypes. Serotype 19A accounted for 50% of isolates. Eleven of the 12 serotype 19A isolates were nonsusceptible to oral penicillin as compared with 6 isolates of the other serotypes. Five of 12 serotype 19A isolates were nonsusceptible to cefotaxime; in comparison, all of the other serotypes were susceptible to cefotaxime. One third of the 19A isolates were nonsusceptible to all 5 antimicrobials tested. Other organisms were coisolated in 87% of cases. Serotype 19A has become the most common pneumococcal serotype isolated from chronic or recurrent pneumococcal sinusitis in children at Texas Children's Hospital. Serotype 19A isolates have high rates of antimicrobial resistance and are frequently isolated along with multiple other organisms.

Evolving Microbiology and Molecular Epidemiology of Acute Otitis Media in the Pneumococcal Conjugate Vaccine Era

The addition of the 7-valent pneumococcal conjugate vaccine (PCV7) to the routine immunization schedule in the United States for infants has produced a much more favorable impact on the incidence of acute otitis media (AOM) than anticipated. Because the serotypes included in PCV7 were those most frequently expressing antibiotic resistance in 2001, predictions were made that up to 98% of pneumococcal AOM episodes would be caused by penicillin susceptible strains. However, recent studies have shown that the benefits of PCV7 are becoming eroded. Replacement serotypes of pneumococci have emerged, expressing polysaccharide capsules different from those included in PCV7, with increasing frequency. These replacement strains are coming to dominate in the nasopharynx and in AOM isolates (and in invasive disease). Expansion in the isolation of serotypes 3, 7F, 15B/C/F, 19A, 22F, 33F, and 38 has been described in various surveillance systems. Pneumococcal strains expressing non-PCV7 capsular serotypes also appear to be rapidly acquiring resistance to penicillin and other antibiotics. Emergence of strains of pneumococci expressing non-PCV7 capsular serotypes is occurring by multiple mechanisms including capsular switching as suggested by molecular epidemiology studies. Expansion of the number of serotypes included in pneumococcal conjugate vaccines is needed to sustain a long-term benefit from immunization against these bacteria.

Acute otitis media in an era of increasing antimicrobial resistance and universal administration of pneumococcal conjugate vaccine.

The last decade has witnessed a shift in the epidemiology of acute otitis media (AOM) with an earlier onset of disease and a greater proportion of children with recurrent episodes before 1 year of age. In addition antimicrobial resistance to beta-lactams, macrolides and trimethoprim-sulfamethoxazole among otopathogens has increased significantly. Most recently universal administration of a seven valent pneumococcal conjugate vaccine has been endorsed by the American Academy of Pediatrics and the Advisory Committee on Immunization Practices. Earlier onset of disease and the decrease in antimicrobial susceptibility among pediatric respiratory bacterial pathogens is likely to increase the risk of failure among young children with AOM. A seven valent pneumococcal conjugate vaccine (PCV7) has demonstrated efficacy for prevention of serotype-specific pneumococcal otitis; however, increase in disease caused by nonvaccine serotypes and Haemophilus influenzae has been reported. With these events as the background, I have reviewed the strategies most likely to be successful for the treatment of AOM in 2002.

Epidemiology of acute otitis media among Saudi children

An epidemiological survey was carried out with 9540 children aged up to 12 years to study the prevalence of acute suppurative otitis media and the rate of hearing impairment. A total of 100 (1.05%) were diagnosed with acute otitis media (AOM). The incidence was found to be higher among young children up to 4-years-old and lower in the age group 8–12 years. The male children had slightly higher rate of AOM as compared with female (1.36 and 0.80%), respectively, ( P<0.01). The prevalence of AOM in the children from the different provinces varied, being higher in those from the Southern and Central regions. Also it was found that the prevalence of ASOM was higher among children whose parents were cousins compared with non-relative parents (1.38 and 0.74%) ( P>0.001). Those with poor socio-economic condition showed higher rate especially those living in the Southern part with poor or inadequate health services provided. ASOM was significantly associated with hearing impairment ( P<0.00001).

Étude de l'épidémiologie bactérienne de l'otite moyenne aiguë de l'enfant observée en ville dans la région Nord Pas-de-Calais

Background – The aim of this work is the study of the bacteriologic epidemiology of acute otitis media in infants observed at home in Nord Pas-de-Calais area, and the analysis of bacteria associated to recurrent otitis and clinical failure.Observations – A total of 295 specimens of ear pus specimens were collected from children (mean age: 18 months; average: one month–12 years). Pneumococcus strains were isolated from 52% of samples and 80% of these showed resistance to penicillin. H. influenzae was found in 35% of specimens and the half produced a β lactamase. Pneumococcus is the predominant pathogen isolated in prolonged otitis media, while H. influenzae is preferentialy found during recurrent otitis media. The main bacteriologic cause of failure traitement was penicillin-intermediate or -resistant pneumococci. The therapy administred 48 to 72 hours before collection of ear pus sample in therapeutic failure was ineffective (oral cephalosporins or macrolides), or administred to low dosage (50 mg/kg/j).Conclusion – Our results demonstrate, in opposition to other studies, Streptococcus pneumoniae as the most frequent pathogen in acute otitis media. They also show the excellent correlation between antibiotic therapy and clinical failures.

Pathogens isolated during treatment failures in otitis.

A prospective study in the Paris region to evaluate the clinical and bacteriologic epidemiology of acute otitis media in infants in whom oral antibiotic therapy resulted in clinical failure. The study included 186 children with a mean age of 17.5 +/- 13.1 months. Two-thirds of them attended a day-care center and 40.8% had a history of recurrent otitis media. The most frequently prescribed prior antibiotics were amoxicillin-clavulanic acid (43% of cases), an oral third generation cephalosporin (22.6%), erythromycin-sulfisoxazole (11.8%) and a first generation cephalosporin (10.2%). The average duration of antibiotic therapy was 6.9 +/- 2.65 days. Specimens for bacterial cultures included 188 samples of middle ear fluid obtained by tympanocentesis and 37 collected from otorrhea fluid. One hundred forty-one samples (62.7%) from 126 children yielded 170 bacterial isolates. In 60 children (32.3%) the culture of the ear pus was sterile. Among the 170 bacterial isolates: 67 (39.4%) were Streptococcus pneumoniae (59 patients), of which 77.6% had reduced susceptibility to penicillin (PRSP with penicillin MIC > or = 0.125 mg/l); 61 (35.9%) were Haemophilus influenzae (56 patients) of which 49.2% were beta-lactamase producers; and 8 were Moraxella catarrhalis (8 patients), of which 87.5% were beta-lactamase producers. Thirty-six patients were infected by S. pneumoniae with penicillin MIC > or =1 mg/l. In our study attending day-care center (P = 0.04), temperature >38 degrees C with signs of otalgia (P = 0.02), age <2 years (P = 0.048) and prior antibiotic treatment with erythromycin-sulfisoxazole (P = 0.006) were independently predictive risk factors for patients infected with penicillin-resistant S. pneumoniae. Pneumococcal serogroups 23, 14 and 19 were predominant (25.4, 25.4 and 23.8%, respectively). Penicillin resistance was mainly associated with serogroups 23 and 14. Penicillin-resistant S. pneumoniae isolates are frequently responsible for therapeutic failure in cases of acute otitis media in the Paris region.

Age-specific patterns of diagnosis of acute otitis media.

A retrospective review of clinical experience with the diagnosis of acute otitis media (AOM) in a large pediatric population (age, 0-12 years old) reveals two age-specific patterns of diagnosis: one in preschool children and one in schoolage children. In the population as a whole, AOM is diagnosed most frequently in the first 5 years of life; rates of diagnosis vary with gender (male: female ratio = 1.10) and season (fall/winter peak). In a linear regression model, age, gender, season, and interactions among these account for 52 percent of the variability in diagnostic rates. In children less than 5 years of age, rates of diagnosis vary strikingly with gender and season; the regression model accounts for 55 percent of observed variability in diagnostic rates. In schoolage children (5-11 years old), however, males and females are equally likely to be diagnosed to have AOM, and seasonal variability is blunted; among these children, the regression model predicts only 22 percent of diagnostic rate variability. These findings buttress existing knowledge of the epidemiology of AOM and have important implications for clinical practice, health planning, and pediatric research.

Epidemiology of Acute Otitis Media in Children in An Urban Population

The epidemiology of acute otItIs media (AOM) in children is still to a great deal inadequately explored ( Hinchcliffe , 1972; McEldowney and Kessner , 1972; Manning et al ., 1974). Most earlier studies have been carried out in small selected groups of children. A few great incidence studies over I year have been published earlier (Medical Research Council, 1957; Pukander , 1982). There are very few cohort studies penetrating the relationship between AOM and demographic, medical and socio-economic factors ( Pukander , 1982; Paterson and MacLean , 1970; Teele et al ., 1980). Prospective investigations in a sufficiently large cohort of unselected children from a weel-defined population have been recommended ( Kudrjavcev and Schoenberg , 1979). Malmo, Sweden, is a well-defined geographic unit with unique conditions for epidemiologic studies. The aim of the present investigation was to study the incidence rate of AOM in children in a prospective cohort study with a special reference to children with recurrent episodes of AOM early in life.