5 years ago

Reduction in all-cause otitis media-related outpatient visits in children after PCV10 introduction in Brazil

Elier B. Cristo, José L. F. Antunes, Otaliba L. Morais-Neto, Ruth Minamisava, Cristiana M. Toscano, Ana L. Sartori, Ana Lucia Andrade, Eliane T. Afonso, Ana L. Bierrenbach

by Ana L. Sartori, Ruth Minamisava, Ana L. Bierrenbach, Cristiana M. Toscano, Eliane T. Afonso, Otaliba L. Morais-Neto, José L. F. Antunes, Elier B. Cristo, Ana Lucia Andrade

Few studies have reported the effect of 10-valent pneumococcal conjugate vaccine (PCV10) on otitis media (OM) in infants. In particular, no population-based study in upper-middle income countries is available. In 2010, Brazil introduced PCV10 into its routine National Immunization Program using a 3+1 schedule. We measured the impact of PCV10 on all-cause OM in children. An interrupted time-series analysis was conducted in Goiânia/Brazil considering monthly rates (per 100,000) of all-cause OM outpatient visits in children aged 2–23 months. We used case-based data from the Outpatient Visits Information System of the Unified Health System coded for ICD-10 diagnosis for the period of August/2008 to July/2015. As a comparator, we used rates of outpatient visits due to all-other causes. The relative reduction of all-cause OM and all-other causes of outpatient visits were calculated as the difference between the predicted and observed cumulative rates of the PCV10 post-vaccination period. We then subtracted the relative reduction of all-other causes of outpatient visits from all-cause OM to obtain the impact of PCV10 on OM. In total, 6,401 OM outpatient visits were recorded in 4,793 children aged 2–23 months. Of these, 922 (19.2%) children had more than one OM episode. A significant reduction in all-cause OM visits was observed (50.7%; 95%CI: 42.2–59.2%; p = 0.013), while the reduction in visits due to all-other causes was 7.7% (95% CI 0.8–14.7%; p<0.001). The impact of PCV10 on all-cause OM was thus estimated at 43.0% (95%CI 41.4–44.5). This is the first study to show significant PCV10 impact on OM outpatient visits in infants in a developing country. Our findings corroborate the available evidence from developed countries.

Publisher URL: http://journals.plos.org/plosone/article

DOI: 10.1371/journal.pone.0179222

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