The number of ambulatory visits for otitis media in pediatric patients declined after administration of the 7-valent pneumococcal conjugate vaccine (PCV7) and to a more significant degree after administration of the 13-valent pneumococcal conjugate vaccine (PCV13), according to a study published in the Journal of Pediatrics.

A team of investigators from Boston Children’s Hospital searched the National Ambulatory Medical Care Survey and the National Hospital Ambulatory Medical Care Survey — databases from the National Center for Health Statistics at the Centers for Disease Control and Prevention — to identify ambulatory visits associated with a diagnosis of otitis media in children aged ≤18 years from 1997 to 2014. Visits were categorized as occurring in a clinician’s office, hospital emergency department, or hospital outpatient center. Information was captured on patient age (<2 years, 2 to 4 years, 5 to 18 years), sex, race, ethnicity, insurance status, and geographic region in the United States. Five periods of time were identified to further analyze the results: before PCV7 (1997 to 1999); transition to PCV7 (2000 to 2001); post-PCV7 (2002 to 2009); migration to PCV13 (2010 to 2011); and post-PCV13 (2012 to 2014).

Of the 363,240 pediatric visits assessed, a total of 24,148 visits (media age, 1.7 years; 54% male) associated with a diagnosis of otitis media were identified. A diagnosis of otitis media was associated with 9.5% of ambulatory visits during 1997 to 1999, 7.1% during 2002 to 2009, and 5.5% during 2012 to 2014. The rate of visits to any care center increased annually from 2776 to 3291 between the time periods of 1997 to 1999 and 2010 to 2011.

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Across all time periods (pre-PCV7 to post-PCV13), the annual rate of ambulatory visits to a clinician office for a diagnosis of otitis media among children aged <2 years decreased from 826 per 1000 children to 387 per 1000 children. During that same time period, emergency department visits for a diagnosis of otitis media declined from 187 to 114 visits per 1000 children per year for patients aged <2 years and from 47 to 39 visits per 1000 children per year among children aged 2 to 4 years. Hospital outpatient visits declined as well, from 108 to 77 visits per 1000 children per for those aged <2 years and from 29 to 27 visits per 1000 children per year among those aged 2 to 4 years.

Rates of clinician office visit rates for otitis media among children aged <2 years declined by 29% during the post-PCV7 period and by 51% during the post-PCV13 period. Similarly, emergency department visits declined by 47% among children aged <2 years and by 34% among children aged 2 to 4 years during the post-PCV13 period compared to the pre-PCV7 period, respectively. Hospital outpatient visits declined by 30% (<2 years) and by 27% (2 to 4 years) during the PVC13-transition period compared with the pre-PCV period.

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“In this study of nationwide ambulatory care visits, we found that [otitis media] visits declined after the introduction of PCV7 and were reduced to an even greater extent after the introduction of PCV13,” the authors concluded.


Kawai K, Adil EA, Barrett D, Manganella J, Kenna MA. Ambulatory visits for otitis media before and after the Introduction of pneumococcal conjugate vaccination [published online June 26, 2018]. J Pediatr. doi: 10.1016/j.jpeds.2018.05.047