Prevalence of prolonged otitis media with effusion among 2 to 3 years old Cameroonian children in the era of 13-valent pneumococcal conjugate vaccines

• Published in: IJID regions Vol. 10; pp. 240 - 247
• Main Authors: Njuma Libwea, John, Ngomba, Viviane Armelle, Taku, Nadesh Ashukem, Ndongo, Chanceline Bilounga, Ngono Noah, Bernadette Dorine, Fointama, Ninying, Kobela, Marie, Huhtala, Heini, Epee, Emilienne, Koulla-Shiro, Sinata, Ndombo, Paul Koki
• Format: Journal Article
• Language: English
• Published: England Elsevier Ltd 01.03.2024; Elsevier
• Subjects: Attributable proportion; Cameroon; Original Report; Otitis media; PCV13; Unvaccinated children; Vaccinated children; Otitis media; PCV13; Vaccinated children; Cameroon; Unvaccinated children; Attributable proportion
• ISSN: 2772-7076; 2772-7076
• DOI: 10.1016/j.ijregi.2023.11.009

•A 40% less risk of contracting otitis media (OM) in 13-valent pneumococcal conjugate vaccines (PCV13)-vaccinated children compared to others.•OM is a polymicrobial disease, with increasing burden in low and middle income countries.•Protection against pneumococcal OM alone remains insufficient.•More research is needed to further elucidate these findings and potential causes.•Prioritization of PCV13 program in the absence of GAVI's funding. There is data scarcity on the overall effects of pneumococcal conjugate vaccines (PCVs) on otitis media (OM) in low- and middle-income countries. The impact of the 13-valent PCV (PCV13) program on OM was evaluated in Cameroon where infant vaccination was implemented in July 2011 using a 3-dose primary series at 6, 10 and 14 weeks of age. Through community-based surveillance, we used a retrospective cohort study design to assess OM prevalence among PCV13-vaccinated children aged 24 to 36 months in 2015. This was compared with a 2013 age-matched cohort of PCV13-unvaccinated children. OM was diagnosed by clinical inspection for chronic suppurative OM (CSOM) and tympanometry for OM with effusion (OME). CSOM was defined as draining of the middle ear with duration of more than 2 weeks and prolonged OME was defined as a flat ‘type B’ tympanogram. PCV13-vaccinated and PCV13-unvaccinated cohorts were compared by calculating prevalence odds ratios for OM and baseline characteristics. Altogether, 111 OM cases were identified; 42/433 (9.7%) in the PCV13-unvaccinated in 2013 and 69/413 (16.7%) in the PCV13-vaccinated cohort in 2015. In the 2013 baseline survey, 3/433 (0.7%) children were identified with unilateral CSOM compared to 9/413 (2.2%) in the PCV13-vaccinated cohort in 2015. Bilateral prolonged OME was diagnosed in 7/433 (1.6%) PCV13-unvaccinated children and in 12/413 (2.9%) in PCV13-vaccinated children. Proportions of children with unilateral prolonged OME were 31/433 (7.2%) in the PCV13-unvaccinated group compared with 48/413 (11.6%) in the PCV13-vaccinated group. Multivariate logistic regression analysis showed evidence that PCV13-vaccinated children in 2015 had 40% less risk of contracting OM compared to PCV13-unvaccinated children in 2013 (adjusted prevalence odds ratios = 0.60 [95% confidence interval: 0.38 to 0.94], P = 0.025). Additionally, attributable proportion estimates show that, 58% of OM infections among the PCV13-vaccinated group would still have occurred despite PCV13 vaccination. Our findings provide significant evidence on the effect of PCV13 in decreasing OM or OME among children in this age group. It also supports justification for government's continuation of PCV13 immunization program in the absence of GAVI's funding. Further research is needed to assess the long-term impact of the PCV13 program on in OM Cameroon.