Kaur Ravinder, Morris Matthew, Pichichero Michael E
Center for Infectious Diseases and Immunology, Rochester General Hospital Research Institute, Rochester, New York.
Center for Infectious Diseases and Immunology, Rochester General Hospital Research Institute, Rochester, New York
Pediatrics. 2017 Sep;140(3). doi: 10.1542/peds.2017-0181. Epub 2017 Aug 7.
To study the epidemiology of acute otitis media (AOM), especially the otitis-prone condition, during the pneumococcal conjugate vaccines 7 and 13 era.
Six hundred and fifteen children were prospectively managed from 6 to 36 months of life during a 10-year time frame (June 2006-June 2016). All clinical diagnoses of AOM were confirmed by tympanocentesis and bacterial culture of middle ear fluid.
By 1 year of age, 23% of the children experienced ≥1 episode of AOM; by 3 years of age, 60% had ≥1 episodes of AOM, and 24% had ≥3 episodes. The peak incidence occurred at 6 to 12 months of life. Multivariable analysis of demographic and environmental data revealed a significantly increased risk of AOM associated with male sex, non-Hispanic white race, family history of recurrent AOM, day care attendance, and early occurrence of AOM. Risk factors for stringently defined (tympanocentesis-confirmed) otitis proneness, in which children suffered at least 3 episodes of AOM in a 6-month period or at least 4 within a year, were male sex, day care attendance, and family history of AOM, whereas breastfeeding in the first 6 months of life was protective. Stringently defined otitis prone children were also likely to experience their first AOM episode at a younger age. The proportion of , and causing AOM had dynamic changes during the past decade.
We conclude that the epidemiology but not the risk factors for AOM have undergone substantial changes since the introduction of pneumococcal conjugate vaccines.
研究在7价和13价肺炎球菌结合疫苗时代急性中耳炎（AOM）的流行病学，尤其是中耳炎易患情况。
在10年时间框架内（2006年6月至2016年6月）对615名6至36个月大的儿童进行前瞻性管理。所有AOM的临床诊断均通过鼓膜穿刺术和中耳液细菌培养得以证实。
到1岁时，23%的儿童经历过≥1次AOM发作；到3岁时，60%的儿童有≥1次AOM发作，24%的儿童有≥3次发作。发病高峰出现在6至12个月大时。对人口统计学和环境数据的多变量分析显示，AOM风险显著增加与男性、非西班牙裔白人种族、复发性AOM家族史、日托出勤以及AOM早期发作有关。严格定义（鼓膜穿刺术确诊）的中耳炎易患情况的风险因素为男性、日托出勤和AOM家族史，而出生后头6个月进行母乳喂养具有保护作用。严格定义的中耳炎易患儿童也更可能在较小年龄首次发生AOM发作。在过去十年中，导致AOM的、和的比例发生了动态变化。
我们得出结论，自引入肺炎球菌结合疫苗以来，AOM的流行病学发生了重大变化，但风险因素未变。
