Impact of pneumococcal conjugate vaccines on childhood otitis media in the United Kingdom
File(s)
Accepted version
Author(s)
Type
Journal Article
Abstract
Background
Studies have demonstrated a reduction for otitis media (OM) following the introduction of seven-valent pneumococcal conjugate vaccine (PCV7), but this has not been evaluated in the United Kingdom (UK). Moreover, there are limited data on any additional impact of PCV13 introduction in 2010.
Methods
We conducted an observational cohort study to investigate the trends in OM incidence and associated antibiotic prescriptions in children aged <10 year-olds during 2002–2012 using a national primary care database. Three time-periods were defined to estimate monthly incidence: pre-PCV7 (January 2002–August 2006), post-PCV7 (September 2007–March 2010), and post-PCV13 (April 2011–December 2012).
Results
Overall annual OM incidence declined by 51.3% from 135.8 episodes/1000 person-years in 2002 to 66.1 episodes/1000 person-years in 2012; antibiotic prescription rates for OM declined by 72.9% from 57.9 prescriptions/1000 person-years to 15.7 prescriptions/1000 person-years, respectively. PCV7 introduction was associated with significant decline in OM rates across all age-groups (21.8%; 95% CI, 20.2–23.4), including <2 year-olds (19.8%; 95% CI, 16.0–23.5%); 2–4 year-olds (23.0%; 95% CI, 20.4–25.4%) and 5–9 year-olds (20.2%; 95% CI, 17.6–22.7%). There was an additional significant reduction in OM (18.5%; 95% CI, 16.7–20.2%) and associated antibiotic prescribing (12.2%; 95% CI, 8.6–15.6%) after the introduction of PCV13 across all age-groups.
Conclusion
The introduction of PCV7 was associated with a 22% significant reductions in OM in children aged <10 year-olds with an additional 19% reductions after PCV13 introduction. These declines are equivalent to 592,000 and 15,700 fewer consultations and OM-related hospitalizations, respectively, in England and Wales every year. Although the continuing decline in OM rates in our study suggests that further reduction may continue to occur, it is important to monitor long-term trends in all pneumococcal diseases, including OM and pneumonia, because of increasing replacement of non-vaccine pneumococcal serotypes in carriage and disease.
Studies have demonstrated a reduction for otitis media (OM) following the introduction of seven-valent pneumococcal conjugate vaccine (PCV7), but this has not been evaluated in the United Kingdom (UK). Moreover, there are limited data on any additional impact of PCV13 introduction in 2010.
Methods
We conducted an observational cohort study to investigate the trends in OM incidence and associated antibiotic prescriptions in children aged <10 year-olds during 2002–2012 using a national primary care database. Three time-periods were defined to estimate monthly incidence: pre-PCV7 (January 2002–August 2006), post-PCV7 (September 2007–March 2010), and post-PCV13 (April 2011–December 2012).
Results
Overall annual OM incidence declined by 51.3% from 135.8 episodes/1000 person-years in 2002 to 66.1 episodes/1000 person-years in 2012; antibiotic prescription rates for OM declined by 72.9% from 57.9 prescriptions/1000 person-years to 15.7 prescriptions/1000 person-years, respectively. PCV7 introduction was associated with significant decline in OM rates across all age-groups (21.8%; 95% CI, 20.2–23.4), including <2 year-olds (19.8%; 95% CI, 16.0–23.5%); 2–4 year-olds (23.0%; 95% CI, 20.4–25.4%) and 5–9 year-olds (20.2%; 95% CI, 17.6–22.7%). There was an additional significant reduction in OM (18.5%; 95% CI, 16.7–20.2%) and associated antibiotic prescribing (12.2%; 95% CI, 8.6–15.6%) after the introduction of PCV13 across all age-groups.
Conclusion
The introduction of PCV7 was associated with a 22% significant reductions in OM in children aged <10 year-olds with an additional 19% reductions after PCV13 introduction. These declines are equivalent to 592,000 and 15,700 fewer consultations and OM-related hospitalizations, respectively, in England and Wales every year. Although the continuing decline in OM rates in our study suggests that further reduction may continue to occur, it is important to monitor long-term trends in all pneumococcal diseases, including OM and pneumonia, because of increasing replacement of non-vaccine pneumococcal serotypes in carriage and disease.
Date Issued
2015-09-22
Date Acceptance
2015-08-07
Citation
Vaccine, 2015, 33 (39), pp.5072-5079
ISSN
0264-410X
Publisher
Elsevier
Start Page
5072
End Page
5079
Journal / Book Title
Vaccine
Volume
33
Issue
39
Copyright Statement
© 2015, Elsevier. Licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International http://creativecommons.org/licenses/by-nc-nd/4.0/
Sponsor
National Institute for Health Research
National Institute for Health Research
National Institute for Health Research
National Institute for Health Research
National Institute for Health Research
Grant Number
DRF-2009-02-78
CDF-2011-04-048
NIHR-CDF-2011-04-048
09GP01
09GP01
Subjects
Science & Technology
Life Sciences & Biomedicine
Immunology
Medicine, Research & Experimental
Research & Experimental Medicine
Otitis media
Pneumococcal conjugate vaccines
Children
Primary care
General practitioners
RESPIRATORY-TRACT INFECTIONS
SEROTYPE REPLACEMENT
CONTROLLED-TRIAL
RISK-FACTORS
CHILDREN
TRENDS
INFANTS
STATES
CARE
VACCINATION
Publication Status
Published