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October 1995, Vol 149, No. 10 >
Article | October 1995

Influenza A Vaccine Decreases the Incidence of Otitis Media in 6- to 30-Month-Old Children in Day Care FREE

Dennis A. Clements, MD, PhD; Lori Langdon; Christina Bland, RN; Emmanuel Walter, MD, MPH
Arch Pediatr Adolesc Med. 1995;149(10):1113-1117. doi:10.1001/archpedi.1995.02170230067009.
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Objective:  To determine if the use of influenza vaccine in children in day care decreases the incidence of otitis media during the influenza season.

Design:  Prospective cohort study.

Setting:  Eight day-care centers in North Carolina.

Participants:  One hundred eighty-six children aged 6 to 30 months.

Intervention:  Half the participants received trivalent subvirion influenza virus vaccine.

Measurements:  Acute otitis media (AOM) and serous otitis media (SOM) were assessed biweekly from mid-November 1993 to mid-March 1994 by visual and tympanometric examinations performed by "blinded" observers. The winter season was divided into three periods—before, during, and after influenza season—and the number of children with AOM or SOM during each period was determined. Unadjusted and adjusted odds ratios (ORs) were computed, while controlling for race and sex using logistic regression methods.

Results:  Influenza vaccine was protective against AOM (OR=0.69, 95% CI, 0.49-0.98) during the influenza season. Although there may have been some protection against SOM (OR=0.75,95% CI, 0.54-1.02) statistical significance was not achieved. Myringotomy tubes were also significantly protective against AOM and SOM during all three time periods, with ORs between 0.34 and 0.52, but the greatest protection was seen during the influenza period.

Conclusions:  Influenza vaccination of 6- to 30-month-old children in day care was associated with a decreased incidence of otitis media during the influenza season. Myringotomy tubes protected against AOM and SOM during all 16 weeks monitored.(Arch Pediatr Adolesc Med. 1995;149:1113-1117)

REFERENCES

1 +
Teele DW, Klein JO, Rosner B, Greater Boston Otitis Media Study Group.  Middle ear disease and the practice of pediatrics: burden during the first five years of life . JAMA . 1983;;249:1026-1029.
2 +
Teele DW, Klein JO, Rosner B, Greater Boston OM Study Group.  Epidemiology of otitis media during the first seven years of life in children in greater Boston: a prospective cohort study . J Infect Dis . 1989;;160:83-94.
3 +
Henderson FW, Giebink GS.  Otitis media among children in day care: epidemiology and pathogenesis . Rev Infect Dis . 1986;;8:533-538.
4 +
Wald ER, Dashefsky B, Byers C, Guerra N, Taylor F.  Frequency and severity of infections in day care . J Pediatr . 1988;;112:540-546.
5 +
Denny FW, Collier AM, Henderson FW.  Acute Respiratory infections in day care . Rev Infect Dis . 1986;;8:527-531.
6 +
McFadden DM, Berwick DM, Feldstein ML, Marter SS.  Age-specific patterns of diagnosis of acute otitis media . Clin Pediatr (Phila) . 1985;;24:571-575.
7 +
Clements DA, Henderson F, Neebe E.  Relationship of viral isolation to otitis media in a research day-care center 1978-1988 . In: Lim DJ, editor-in-chief. Recent Advances in Otitis Media, Proceedings of the Fifth International Symposium . Philadelphia, Pa: BC Decker; 1993;:27-29.
8 +
Teele DW, Klein JO, Rosner BA, the Greater Boston Otitis Study Group.  Day-care and risk for recurrent, acute otitis media in infancy . In: Lim DJ, editor-in-chief. Recent Advances in Otitis Media, Proceedings of the Fifth International Symposium . Philadelphia, Pa: BC Decker, 1993;:5-6.
9 +
Casselbrant ML, Mandel EM, Rockette HE, Bluestone CD.  Incidence of otitis media and bacteriology of acute otitis media during the first two years of life . In: Lim DJ, editor-in-chief. Recent Advances in Otitis Media. Proceedings of the Fifth International Symposium . Philadelphia, Toronto: BC Decker; 1993;: 1-3.
10 +
Chanomaitree T, Owen MJ, Patel JA, Hedgpeth D, Horklick D, Howie VM.  Effect of viral respiratory tract infection on outcome of acute otitis media . J Pediatr . 1992;;120:856-862.
11 +
Henderson FW, Collier AM, Sanyal MA, et al.  A longitudinal study of respiratory viruses and bacteria in the etiology of acute otitis media with effusion . N Engl J Med . 1982;;306:1377-1383.
12 +
Grönroos JA, Vihma L, Salmivalli A, Berglund B.  Coexisting viral (respiratory syncytial) and bacterial (pneumococcus) otitis media in children . Acta Otolaryngol (Stockh) 1968;;65:505-517.
13 +
Ruuskanen O, Arola M, Putto-Laurila A, Mertsola J, et al.  Acute otitis media and respiratory virus infections . Pediatr Infect Dis J . 1989;;8:94-99.
14 +
Chonmaitree T, Howie VM, Truant AL.  Presence of respiratory viruses in middle ear fluids and nasal wash specimens from children with acute otitis media . Pediatrics . 1986;;77:698-702.
15 +
Klein BS, Dollete FR, Yolken RH.  The role of respiratory syncytial virus and other viral pathogens in acute otitis media . J Pediatr (Phila) . 1982;;101:16-20.
16 +
Arolo M, Ziegler T, Ruuskanen O, Mertsola J, Näntö-Salonen K, Halonen Pekka.  Rhinovirus in acute otitis media . J Pediatr (Phila) . 1988;:113:693-695.
17 +
Sanyal MA, Henderson FW, Stempel EC, Collier AM, Denny FW.  Effect of upper respiratory tract infection on eustachian tube ventilatory function in the preschool child . J Pediatr (Phila) . 1980;;97:11-15.
18 +
Pacini DL, Collier AM, Henderson FW.  Adenovirus infections and respiratory illnesses in children in group day care . J Infect Dis . 1987;;156:920-926.
19 +
Suzuki K, Bakaletz LO.  Synergistic efect of adenovirus type 1 and nontypable Haemophilus influenzae in a chinchilla model of experimental otitis media . Infect Immun . 1994;;62:1710-1718.
20 +
Bakaletz LO, Daniels RL, Lim DJ.  Modeling adenovirus type 1-induced otitis media in the chinchilla: effect on ciliary activity and fluid transport function of eustachian tube mucosal epithelium . J Infect Dis . 1993;:168:865-872.
21 +
Skoner DP, Doyle WJ, Hayden F, Buchman CA, Seroky JT, Fireman P. Otitis media (OM) as a manifestation of experimental influenza A virus infection. Abstract 1083, Society for Pediatric Research Annual Meeting, Washington DC. May 3-6, 1993.
22 +
Abramson JS, Giebink GS, Quie PG.  Influenza A virus-induced polymorphonuclear leukocyte dysfunction in the pathogenesis of experimental pneumococcal otitis media . Infect Immun . 1982;;36:289-296.
23 +
Abramson JS, Giebink GS, Mills EL, Quie PG.  Polymorphonuclear leukocyte dysfunction during influenza virus infection in chinchillas . J Infect Dis . 1981;; 143:836-845.
24 +
Centers for Disease Control.  Prevention and Control of Influenza: Part 1, Vaccines . MMWR Morb Mortal Wkly Rep . 1994;;43:1-13.
25 +
Chan L, Long CE, Hall CB.  Influenza infections in the pediatric outpatient population . J Univ Rochester Med Center . 1993;;5:12-16.
26 +
Groothis JR, Levin MJ, Rabalasis GP, Meiklejohn G, Lauer BA.  Immunization of high-risk infants younger than 18 months of age with split-product influenza vaccine . Pediatrics . 1991;;87:823-828.
27 +
Heikkinen T, Ruuskanen O, Waris M, Ziegler T, Arola M, Halonen P.  Influenza vaccination in the prevention of acute otitis media in children . AJDC . 1991;; 145:445-448.
28 +
Keyserling, HL, Anderson EL, Martin JT. Immunogenicity of a tetravalent (types 6B, 14, 19F, 23F) pneumococcal conjugate vaccine in infants. Abstract 1016, Society for Pediatric Research Annual Meeting, Washington DC. May 3-6, 1993.
29 +
Yogel R, Gupta B, Emanuel B, Williams K, Adams J. Safety, Tolerability and immunogenicity of tetravalent (6B, 14, 19F, 23F) pneumococcal (Pn) conjugate vaccine in infants given concurrently with routine immunizations. Abstract 170. Interscience Conference on Antimicrobial Agents and Chemotherapy; October 17-20, 1993; New Orleans, La.

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Country-Specific Mortality and Growth Failure in Infancy and Yound Children and Association With Material Stature

Use interactive graphics and maps to view and sort country-specific infant and early dhildhood mortality and growth failure data and their association with maternal

References

1 +
Teele DW, Klein JO, Rosner B, Greater Boston Otitis Media Study Group.  Middle ear disease and the practice of pediatrics: burden during the first five years of life . JAMA . 1983;;249:1026-1029.
2 +
Teele DW, Klein JO, Rosner B, Greater Boston OM Study Group.  Epidemiology of otitis media during the first seven years of life in children in greater Boston: a prospective cohort study . J Infect Dis . 1989;;160:83-94.
3 +
Henderson FW, Giebink GS.  Otitis media among children in day care: epidemiology and pathogenesis . Rev Infect Dis . 1986;;8:533-538.
4 +
Wald ER, Dashefsky B, Byers C, Guerra N, Taylor F.  Frequency and severity of infections in day care . J Pediatr . 1988;;112:540-546.
5 +
Denny FW, Collier AM, Henderson FW.  Acute Respiratory infections in day care . Rev Infect Dis . 1986;;8:527-531.
6 +
McFadden DM, Berwick DM, Feldstein ML, Marter SS.  Age-specific patterns of diagnosis of acute otitis media . Clin Pediatr (Phila) . 1985;;24:571-575.
7 +
Clements DA, Henderson F, Neebe E.  Relationship of viral isolation to otitis media in a research day-care center 1978-1988 . In: Lim DJ, editor-in-chief. Recent Advances in Otitis Media, Proceedings of the Fifth International Symposium . Philadelphia, Pa: BC Decker; 1993;:27-29.
8 +
Teele DW, Klein JO, Rosner BA, the Greater Boston Otitis Study Group.  Day-care and risk for recurrent, acute otitis media in infancy . In: Lim DJ, editor-in-chief. Recent Advances in Otitis Media, Proceedings of the Fifth International Symposium . Philadelphia, Pa: BC Decker, 1993;:5-6.
9 +
Casselbrant ML, Mandel EM, Rockette HE, Bluestone CD.  Incidence of otitis media and bacteriology of acute otitis media during the first two years of life . In: Lim DJ, editor-in-chief. Recent Advances in Otitis Media. Proceedings of the Fifth International Symposium . Philadelphia, Toronto: BC Decker; 1993;: 1-3.
10 +
Chanomaitree T, Owen MJ, Patel JA, Hedgpeth D, Horklick D, Howie VM.  Effect of viral respiratory tract infection on outcome of acute otitis media . J Pediatr . 1992;;120:856-862.
11 +
Henderson FW, Collier AM, Sanyal MA, et al.  A longitudinal study of respiratory viruses and bacteria in the etiology of acute otitis media with effusion . N Engl J Med . 1982;;306:1377-1383.
12 +
Grönroos JA, Vihma L, Salmivalli A, Berglund B.  Coexisting viral (respiratory syncytial) and bacterial (pneumococcus) otitis media in children . Acta Otolaryngol (Stockh) 1968;;65:505-517.
13 +
Ruuskanen O, Arola M, Putto-Laurila A, Mertsola J, et al.  Acute otitis media and respiratory virus infections . Pediatr Infect Dis J . 1989;;8:94-99.
14 +
Chonmaitree T, Howie VM, Truant AL.  Presence of respiratory viruses in middle ear fluids and nasal wash specimens from children with acute otitis media . Pediatrics . 1986;;77:698-702.
15 +
Klein BS, Dollete FR, Yolken RH.  The role of respiratory syncytial virus and other viral pathogens in acute otitis media . J Pediatr (Phila) . 1982;;101:16-20.
16 +
Arolo M, Ziegler T, Ruuskanen O, Mertsola J, Näntö-Salonen K, Halonen Pekka.  Rhinovirus in acute otitis media . J Pediatr (Phila) . 1988;:113:693-695.
17 +
Sanyal MA, Henderson FW, Stempel EC, Collier AM, Denny FW.  Effect of upper respiratory tract infection on eustachian tube ventilatory function in the preschool child . J Pediatr (Phila) . 1980;;97:11-15.
18 +
Pacini DL, Collier AM, Henderson FW.  Adenovirus infections and respiratory illnesses in children in group day care . J Infect Dis . 1987;;156:920-926.
19 +
Suzuki K, Bakaletz LO.  Synergistic efect of adenovirus type 1 and nontypable Haemophilus influenzae in a chinchilla model of experimental otitis media . Infect Immun . 1994;;62:1710-1718.
20 +
Bakaletz LO, Daniels RL, Lim DJ.  Modeling adenovirus type 1-induced otitis media in the chinchilla: effect on ciliary activity and fluid transport function of eustachian tube mucosal epithelium . J Infect Dis . 1993;:168:865-872.
21 +
Skoner DP, Doyle WJ, Hayden F, Buchman CA, Seroky JT, Fireman P. Otitis media (OM) as a manifestation of experimental influenza A virus infection. Abstract 1083, Society for Pediatric Research Annual Meeting, Washington DC. May 3-6, 1993.
22 +
Abramson JS, Giebink GS, Quie PG.  Influenza A virus-induced polymorphonuclear leukocyte dysfunction in the pathogenesis of experimental pneumococcal otitis media . Infect Immun . 1982;;36:289-296.
23 +
Abramson JS, Giebink GS, Mills EL, Quie PG.  Polymorphonuclear leukocyte dysfunction during influenza virus infection in chinchillas . J Infect Dis . 1981;; 143:836-845.
24 +
Centers for Disease Control.  Prevention and Control of Influenza: Part 1, Vaccines . MMWR Morb Mortal Wkly Rep . 1994;;43:1-13.
25 +
Chan L, Long CE, Hall CB.  Influenza infections in the pediatric outpatient population . J Univ Rochester Med Center . 1993;;5:12-16.
26 +
Groothis JR, Levin MJ, Rabalasis GP, Meiklejohn G, Lauer BA.  Immunization of high-risk infants younger than 18 months of age with split-product influenza vaccine . Pediatrics . 1991;;87:823-828.
27 +
Heikkinen T, Ruuskanen O, Waris M, Ziegler T, Arola M, Halonen P.  Influenza vaccination in the prevention of acute otitis media in children . AJDC . 1991;; 145:445-448.
28 +
Keyserling, HL, Anderson EL, Martin JT. Immunogenicity of a tetravalent (types 6B, 14, 19F, 23F) pneumococcal conjugate vaccine in infants. Abstract 1016, Society for Pediatric Research Annual Meeting, Washington DC. May 3-6, 1993.
29 +
Yogel R, Gupta B, Emanuel B, Williams K, Adams J. Safety, Tolerability and immunogenicity of tetravalent (6B, 14, 19F, 23F) pneumococcal (Pn) conjugate vaccine in infants given concurrently with routine immunizations. Abstract 170. Interscience Conference on Antimicrobial Agents and Chemotherapy; October 17-20, 1993; New Orleans, La.

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