JOURNAL ARTICLE
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Changing Trends of Acute Otitis Media Bacteriology in Israel in the Pneumococcal Conjugate Vaccine Era.

BACKGROUND:: The widespread use of 7-valent pneumococcal conjugate vaccine (PCV7) has changed acute otitis media (AOM) bacteriology. Only scattered data with regards to this effect of PCV13 have been published so far.

METHODS:: We retrospectively identified children younger than 6 years of age who presented with AOM, and had middle ear fluid (MEF) cultures obtained during tympanocentesis or from spontaneous otorrhea during 2008-2013, when PCV7 (2009) and PCV13 (2010) were gradually introduced in the Israeli National Immunization Program (NIP). Data were extracted for demographics, clinical and microbiologic findings, according to vaccination status.

RESULTS:: Of the 295 eligible AOM episodes reported in 279 children, 224 (76%) had MEF cultures from tympanocentesis and 71 (24%) from spontaneous otorrhea. Boys and children less than 2 years of age contributed 178 (60%) and 219 (74%) AOM episodes, respectively. Acute mastoiditis complicated 58 (20%) of these episodes. None of the children were PCV immunized in 2008, but >90% had received ≥1 PCV dose(s) by 2011 or later. Of the 106 (36%) MEF cultures which tested positive for otopathogens, Streptococcus pneumoniae, Haemophilus influenzae, Moraxella catarrhalis and multiple bacteria grew in 60 (57%), 39 (37%), 2 (2%) and 5 (5%) episodes, respectively. S. pneumoniae positive MEF culture rate in unimmunized children (31, 69%) was significantly higher than in PCV7- (22, 59%) or PCV13- (12, 50%) immunized children, p=0.04 and p=0.02, respectively.

CONCLUSION:: PCV7 and PCV13 implementations in the Israeli NIP were associated with a reduction of 'severe' pneumococcal AOM episodes.

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