Studying PCV impact on clinical presentation of otitis media helps to understand its pathogenesis

Shalom Ben-Shimol, Noga Givon-Lavi, Eugene Leibovitz, David Greenberg, Ron Dagan

Research output: Contribution to journalArticlepeer-review

7 Scopus citations


Background: Complex otitis media (OM) may present with intact tympanic membrane or spontaneous otorrhea. We compared dynamics of intact tympanic membrane and spontaneous otorrhea OM following 7- and 13-valent conjugated vaccines (PCV7, PCV13) implementation, since differences in dynamics may imply different underlying mechanisms. Methods: A prospective, population-based, active surveillance. Episodes with middle-ear fluid cultures in children < 3 years were included. Defined sub-periods were: pre-pneumococcal conjugated vaccines (PCV) (2004–2008); PCV7 (2009–2011); PCV13 (2014–2016). Results: Of 7705 episodes, 57.2% had intact tympanic membrane, 16.8% spontaneous otorrhea, 26.0% unknown. In the pre-PCV period, the spontaneous otorrhea group was older and had higher proportions of factors associated with recurrence/chronicity. During the PCV7 period, spontaneous otorrhea and intact tympanic membrane episodes caused by PCV13 serotypes decreased significantly (43% and 51%, respectively) and those caused by non-PCV13 serotypes and culture-negative episodes increased significantly. However, rates increases were steeper in the spontaneous otorrhea group for both non-PCV13 serotypes (117% vs. 38%) and culture-negative (720% vs. 69%). In the spontaneous otorrhea group, nontypeable Haemophilus influenzae rates increased non-significantly by 10% and all-cause OM rates increased significantly by 56%, while in the intact tympanic membrane group the respective rates decreased significantly by 22% and 11%. These trends were especially pronounced in ages 24–35 months. Despite these differences, after PCV13 introduction, both spontaneous otorrhea and intact tympanic membrane rates declined for all outcomes. Conclusions: Spontaneous otorrhea was associated with older age, frequent history of complex OM and delayed PCV impact, suggesting a higher proportion of advanced-stage complex OM.

Original languageEnglish
Pages (from-to)1-6
Number of pages6
Issue number1
StatePublished - 3 Jan 2019


  • Children
  • Complicated otitis media
  • Dynamics
  • PCV – pneumococcal conjugate vaccine
  • Spontaneous otorrhea
  • Surveillance
  • Tympanocentesis

ASJC Scopus subject areas

  • Molecular Medicine
  • General Immunology and Microbiology
  • General Veterinary
  • Public Health, Environmental and Occupational Health
  • Infectious Diseases


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