Fluctuations in Pediatric Acute Otitis Media Burden during the First Two COVID-19 Years in Israel

Elchanan Zloczower, Jacob Pitaro, Itai Hazan, Meir Warman, Oren Ziv, Omer Yaakov, Tal Marom

    Research output: Contribution to journalArticlepeer-review

    6 Scopus citations


    Background: To study pediatric acute otitis media (AOM) burden fluctuations before and during the first two COVID years, which were characterized by measures to reduce the spread of airborne diseases. We used urinary tract infection (UTI) as a comparison infection. Methods: This was a cross-sectional study encompassing three pre-COVID years (March 1, 2017-February 29, 2020) and the first two COVID years (March 1, 2020-February 28, 2021, and March 1, 2021-February 28, 2022). Records were retrieved from the Clalit Health Services database, Israel's largest healthcare maintenance organization. Children 0-15 years with AOM and UTI episodes were categorized according to age (1>, 1-4, 5-15 years). We collected demographics, seasonality, AOM complications, antibiotic prescriptions, and recent COVID-19 infections. The average AOM/UTI rates of the three pre-COVID years vs. two COVID years were used to calculate the incidence rate ratios (IRRs). Results: We identified 1,102,826 AOM and 121,263 UTI episodes. The median age at AOM diagnosis was 2.0 years (IQR, 1.1-4.1). Male predominance, age at presentation, and the dominant age group of 1-4 years did not change during the COVID years. While UTI episode rates decreased during the COVID years (IRR 0.76, 95% CI, 0.68-0.84, P < 0.001), the reduction in AOM episode rates was >2-fold (IRR 0.46, 95% CI, 0.34-0.63, P < 0.001). The largest decrease was observed among children 1-4 years old during the first COVID year (β=-1,938 AOM episodes/100,00 children, 95% CI, -2,038 to -1,912, P < 0.001). Recent COVID-19 infection was associated with low AOM morbidity (IRR 0.05, 95% CI 0.05-0.05, P < 0.001). Conclusions: AOM burden substantially decreased during the first COVID year but almost reached pre-pandemic levels during the second year.

    Original languageEnglish
    Pages (from-to)146-151
    Number of pages6
    JournalPediatric Infectious Disease Journal
    Issue number2
    StatePublished - 1 Feb 2023


    • acute otitis media
    • burden
    • coronavirus-19
    • urinary tract infection

    ASJC Scopus subject areas

    • Microbiology (medical)
    • Infectious Diseases
    • Pediatrics, Perinatology, and Child Health


    Dive into the research topics of 'Fluctuations in Pediatric Acute Otitis Media Burden during the First Two COVID-19 Years in Israel'. Together they form a unique fingerprint.

    Cite this