Does pneumococcal conjugate vaccination affect onset and risk of first acute otitis media and recurrences?: A primary care-based cohort study
Fortanier, Alexandre C; Venekamp, Roderick P; Hoes, Arno W; Schilder, Anne G M
(2019) Vaccine, volume 37, issue 11, pp. 1528 - 1532
(Article)
Abstract
Background: It has been hypothesized that widespread implementation of pneumococcal conjugate vaccination (PCV) in infancy reduces early AOM and thereby prevents further AOM episodes and associated health care resource use. Methods: We tested this hypothesis by applying an extension of the original Cox proportional hazards model (Prentice, Williams and Petersons’
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total time) to individual AOM episodes recorded in pseudonymised primary care electronic health records of 18,237 Dutch children born between 2004 and 2015. Children were assigned to three groups: no-PCV (January 2004-March 2006), PCV7 (April 2006-February 2011) and PCV10 (March 2011-February 2015). Results: Of the 18,237 newborns, 6967 (38%) experienced at least one GP-diagnosed AOM episode up to the age of four years (median age at first AOM: 12 months, interquartile range: 12; total number of AOM episodes: 14,689). Time-to-first AOM was longest in the PCV10 group compared with the PCV7 and no-PCV groups (log rank test: P < 0.001); in these groups 30% had experienced a first AOM at 20, 17 and 15 months, respectively. Children in the PCV10 group had a 21% lower risk of experiencing a first AOM episode than those in the no-PCV group (hazard ratio (HR): 0.79, 95% confidence interval (CI): 0.72–0.86), while the effect was less pronounced for the PCV7 group (HR: 0.94, 95% CI: 0.87–1.02). Neither PCV7 nor PCV10 reduced the risk of AOM recurrences. Compared to no-PCV, HRs for overall AOM were 1.00 (95% CI: 0.95–1.06) and 0.89 (95% CI: 0.84–0.95) for PCV7 and PCV10, respectively. Conclusion: Our cohort study suggests that PCV postpones the onset and reduces the risk of first AOM without affecting recurrences. The impact of PCV on overall AOM in children up to the age of four years seems therefore largely attributable to the prevention of a first AOM episode.
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Keywords: Acute otitis media, Children, Cohort study, Onset, Pneumococcal conjugate vaccine, General Veterinary, Public Health, Environmental and Occupational Health, Infectious Diseases, Molecular Medicine, General Immunology and Microbiology, Journal Article
ISSN: 0264-410X
Publisher: Elsevier BV
Note: Funding Information: Alexandre Fortanier is an employee of Seqirus Netherlands B.V., Amsterdam, The Netherlands. Seqirus was not involved in any aspect of the submitted work. Arno Hoes is chair of a large (around 600 employees) research and teaching institute within our University Medical Center. The Institute performs both investigator- and industry-driven research projects with a number of pharmaceutical and diagnostic companies. In addition, some of the members of staff receive unrestricted grants for research projects from a number of companies. It is the institute’s explicit policy to work with several companies and not to focus on one or two industrial partners. Arno Hoes receives no personal payment from any industrial partner. Anne Schilder and the evidENT team at University College London are supported by the National Institute of Health Research through the UCLH BRC, programme, and fellowship awards. The team work with a range of industrial partners to develop and test new therapies for ear disease. Anne Schilder receives no personal payment from any industrial partner. Roderick Venekamp has indicated he has no potential conflicts of interest to disclose. Funding Information: We gratefully thank Nicole Boekema-Bakker and Rebecca Stellato (Julius Center for Health Sciences and Primary Care) for data management and statistical support., This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors., Alexandre Fortanier is an employee of Seqirus Netherlands B.V., Amsterdam, The Netherlands. Seqirus was not involved in any aspect of the submitted work. Arno Hoes is chair of a large (around 600 employees) research and teaching institute within our University Medical Center. The Institute performs both investigator- and industry-driven research projects with a number of pharmaceutical and diagnostic companies. In addition, some of the members of staff receive unrestricted grants for research projects from a number of companies. It is the institute's explicit policy to work with several companies and not to focus on one or two industrial partners. Arno Hoes receives no personal payment from any industrial partner. Anne Schilder and the evidENT team at University College London are supported by the National Institute of Health Research through the UCLH BRC, programme, and fellowship awards. The team work with a range of industrial partners to develop and test new therapies for ear disease. Anne Schilder receives no personal payment from any industrial partner. Roderick Venekamp has indicated he has no potential conflicts of interest to disclose., Alexandre Fortanier and Roderick Venekamp designed the study, contributed to data acquisition, interpreted and analysed the data. Alexandre Fortanier drafted the first version of the manuscript. Roderick Venekamp reviewed and revised the manuscript. Anne Schilder and Arno Hoes contributed to data interpretation, reviewed and revised the manuscript. All authors approved the final version of the manuscript. Publisher Copyright: © 2019 Elsevier Ltd
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