NEW YORK (Reuters Health) – Administration of pneumococcal conjugate vaccine (PCV) in early infancy substantially reduces the risk of pneumococcal acute otitis media (AOM), according to a new Cochrane review.
“Since AOM is causing a great burden in child health, even a small effect (on risk of disease) could have a big effect on healthcare” spending, said Dr. Roger A. M. J. Damoiseaux from University Medical Center Utrecht, in the Netherlands.
“Important is that PCV only has an effect on AOM when given in infancy,” he told Reuters Health by email. “Since PCV in the western world is part of the national immunization program in most countries, most children will get this anyway and there is no reason to alter the current practice. One could argue to introduce PCV in low- and middle-income countries where infectious diseases are still a greater burden for health in children.”
Dr. Damoiseaux’s team assessed the effect of PCVs in preventing AOM in children up to 12 years of age in their systematic review of 11 randomized controlled trials of PCV versus placebo or control vaccines in 60,733 children.
Administration of 7-valent, 10-valent, or 11-valent PCVs in early infancy was associated with significant reductions (as high as 53%) in the risk of pneumococcal AOM and with variable or no reductions in all-cause AOM, the researchers report in the Cochrane Database of Systematic Reviews on May 28.
In contrast, administration of 7- or 9-valent PCV in high-risk infants, after early infancy, or in older children with a history of respiratory illness had no beneficial effect on all-cause AOM.
Compared with control vaccines, PCVs were associated with an increase in mild local reactions (redness and swelling), fever and pain and/or tenderness, but there was no evidence of a difference in more severe local reactions, fever, or serious adverse events causally related to vaccination.
“New vaccines are being developed with even more subtypes,” Dr. Damoiseaux said. “PCV 13 has never been part of a RCT, and we don’t know if more subtypes will have more effect on preventing AOM. In observational research, there are indications that PCV 10 has a greater impact on AOM than PCV7. But these data should be interpreted with caution because bias cannot be excluded.”
“We should continue performing research with RCTs comparing different PCV to see if they really make a difference,” he said. “Furthermore, we have to monitor causative organisms of AOM to know if the subtypes in the vaccines still cover most cases of AOM when we want to evaluate effects on AOM next to invasive pneumococcal disease (IPD) and pneumonia.”
Cochrane Database Syst Rev 2019.