1. The prevalence of acute otitis media (AOM) has decreased from 18%, 30-39%, and 61% at ages 3, 6, and 12 months, in the late 1980s and 1990s, to 6%, 23%, and 46% by 2014.
2. Risk factors identified for AOM included lack of breast feeding, frequent viral URIs, and pathogenic bacterial colonization.
Evidence Rating Level: 2 (Good)
Study Rundown: Infants commonly acquire viral upper respiratory tract infections (URIs), which can be complicated by superimposed bacterial infections, AOMs, and lower respiratory tract infections (LRIs). The prevalence of these viral respiratory infections is decreasing with the introduction of new vaccines. This study sought to update the prevalence of URIs, LRIs, and AOMs in American infants in the pneumococcal conjugated vaccine and influenza vaccine era. Infants were followed for up to 12 months or their first episode of AOM, between October 2008 and March 2014. Results indicated that about half of these infants had their first episode of AOM in the first year of life, with the majority occurring in the second half of the first year. By the end of this study, it was found that the prevalence of AOM had decreased steadily since the 1980s: from 18%, 30-39%, and 61% at ages 3, 6, and 12 months, respectively, to 6%, 23%, and 46%. This study was limited by the complex nature of interactions between virus and bacteria and by the small number of patients who remained in the study after their first episode of AOM. These findings may encourage providers to be aware of patients at high risk for developing AOM.
In-Depth [prospective cohort]: A total of 367 healthy infants under 1 month of age were recruited from the newborn nursery or primary care practice of the University of Texas Medical Branch. Infants were followed for the first 6 months of their life or until their first episode of AOM. Those infants that did not have an episode of AOM in the first 6 months were followed until 12 months of age. Parents notified the study team at the onset of each URI and the infant was seen by the study physician 3 to 5 days later. AOM as a complication of a URI was defined as an episode occurring 28 days after the onset of URI. Nasopharyngeal swabs were tested for bacteria by culture and for viruses by PCR. Results indicated that the prevalence of URI, LRI and AOM in the first year of life was 3.2, 0.25, and 0.67 respectively, per child-year. The specific prevalence of URIs was 3.7 and 3.2 in the first 6 and 12 months, respectively. The rate of LRI complicating URI was 7.6%. The rate of AOM after URI was 21%, with an incidence of 6%, 23%, and 46% by ages 3, 6 and 12 months. This was a significant decrease from previous studies with similar designs. Risk of URI and AOM were both reduced by breastfeeding (p<0.05). Colonization rates with pathogenic bacteria were significantly increased in infants with AOM (p<0.05).
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