1. Decreased Acute Otitis Media With Treatment Failure After Introduction of the Ten-valent Pneumococcal Haemophilus influenzae Protein D Conjugate Vaccine.
- Author
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Eythorsson E, Hrafnkelsson B, Erlendsdóttir H, Gudmundsson SA, Kristinsson KG, and Haraldsson Á
- Subjects
- Adolescent, Ceftriaxone therapeutic use, Child, Child, Preschool, Haemophilus Infections prevention & control, Haemophilus Vaccines administration & dosage, Humans, Iceland epidemiology, Incidence, Infant, Infant, Newborn, Otitis Media prevention & control, Pneumococcal Infections prevention & control, Pneumococcal Vaccines administration & dosage, Retrospective Studies, Treatment Failure, Anti-Bacterial Agents therapeutic use, Bacterial Proteins immunology, Carrier Proteins immunology, Haemophilus Infections epidemiology, Haemophilus Vaccines immunology, Immunoglobulin D immunology, Lipoproteins immunology, Otitis Media epidemiology, Pneumococcal Infections epidemiology, Pneumococcal Vaccines immunology
- Abstract
Background: Acute otitis media (AOM) nonresponsive to antibiotics is most commonly caused by antibiotic-resistant Streptococcus pneumoniae and Haemophilus influenzae. A strategy for treating these infections with parenteral ceftriaxone was adopted at the Children's Hospital Iceland. The 10-valent pneumococcal H. influenzae protein D-conjugate vaccine was introduced into the vaccination program in Iceland in 2011. The aim was to study its effect on the incidence of AOM with treatment failure., Methods: This retrospective observational study included children who visited the Children's Hospital Iceland because of AOM or received ceftriaxone, regardless of indication from 2008-2015. Incidence rate was calculated for prevaccine (2008-2011) and postvaccine (2012-2015) periods using person-years at risk within the hospital's referral region. Incidence rate ratio of ceftriaxone treatment episodes of AOM was calculated using the Mantel-Haenzel method adjusting for age. Incidence risk ratio of ceftriaxone treatment if presenting to the hospital with AOM was calculated to adjust for rate of AOM visits., Results: Visits for AOM decreased from 47.5 to 33.9 visits per 1000 person-years, incidence rate ratio (IRR) 0.86 (95% confidence interval [CI]: 0.81-0.91), P < 0.001. Fewer AOM episodes were treated with ceftriaxone, decreasing from 6.49 to 2.96 treatment episodes per 1000 person-years, with an overall Mantel-Haenzel adjusted IRR 0.45 (95% CI: 0.37-0.54; P < 0.001). This remained significant after adjusting for the decrease in AOM visits, IRR 0.53 (95% CI: 0.44-0.63; P < 0.001)., Conclusions: Visits for AOM and ceftriaxone use decreased significantly after H. influenzae protein D-conjugate vaccine introduction. The observed decrease in ceftriaxone use is presumed to represent a decline in AOM with treatment failure, secondary to a decrease in resistant infections.
- Published
- 2018
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