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Master of Public Health

Changes in otitis media episodes and pressure equalization tube insertions among young children following introduction of the 13-valent pneumococcal conjugate vaccine: A birth-cohort based study

AUTHORS

Wiese AD , Huang X , Yu C , Mitchel EF , Kyaw MH , Griffin MR , Grijalva CG , . Clinical infectious diseases : an official publication of the Infectious Diseases Society of America. 2019 2 16; ().

ABSTRACT

INTRODUCTION: The impact of 13-valent pneumococcal conjugate vaccine (PCV13) introduction on the occurrence of first and subsequent otitis media (OM) episodes in early childhood is unclear. We compared the risk of OM episodes among children age <2 years before and after PCV13 introduction accounting for the dependence between OM episodes.

METHODS: We identified consecutive annual (July-June) cohorts of Tennessee Medicaid-enrolled children (2006-2014) from birth through age two years. We identified OM episodes using coded diagnoses (we classified diagnoses <21 days apart as the same episode). We modeled adjusted hazard ratios (aHR) for OM comparing PCV7 (2006-2010) and PCV13 (2011-2014) era birth cohorts accounting for risk factors and dependence between first and subsequent episodes. Secondary analyses examined pressure equalization tube (PET) insertions and compared the risk of recurrent OM (≥3 episodes in 6 months or ≥4 in 12 months) between PCV7 and PCV13 era birth cohorts.

RESULTS: We observed 618,968 OM episodes and 24,875 PET insertions among 368,063 children. OM and PET insertion rates increased during the PCV7 years and declined after PCV13 introduction. OM and PET insertion risks were lower in the 2013-2014 cohort compared to the 2009-2010 cohort [aHR: 0.92 (95% CI:0.91-0.93) and aHR: 0.76 (95% CI:0.72-0.80), respectively]. PCV13 introduction was associated with declines in the risk of first, subsequent, and recurrent OM.

CONCLUSION: The transition from PCV7 to PCV13 was associated with a decline of OM among children <2 years due to a reduction in the risk of both the first and subsequent OM episodes.

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