Background
This systematic literature review (SLR) evaluated the incidence and bacterial etiology of acute otitis media (AOM) in children.
Methods
Epidemiological studies in English reporting on AOM incidence (published 2008–2023) or the distribution of Streptococcus pneumoniae (Spn) including serotypes, Haemophilus influenzae (Hi), and Moraxella catarrhalis (Mcat) in children (<18 years) with AOM (published 2010–2023) were identified from Embase, MEDLINE, LILACS, and SciELO databases. Random-effect models were used to determine the pooled AOM incidence rates (IR), pooled prevalence of each bacterium and individual serotypes/strains, and the corresponding 95% confidence intervals. When feasible, the estimates were stratified by age group, geographical location, and pneumococcal vaccination status. Heterogeneity was assessed by the I2 statistic.
Findings
The SLR identified 37 publications reporting on AOM incidence, of which 25 were included in the meta-analysis, and 34 publications reporting on prevalence of bacterial pathogens in middle ear fluid. AOM IRs (per 100 person-years) were 18.77 in ≤2-year-olds, 10.39 in >2 to ≤5-year-olds, and <3 in children aged >5 years. In ≤2-year-olds, AOM IR was 16.07 among those who received a pneumococcal conjugate vaccine (PCV) and 34.26 among those who did not. Among ≤2-year-olds, Hi contributed to 31.81% of AOM cases, followed by 19.35% for Spn, and 3.00% for Mcat. Across all ages, frequently reported Spn serotypes among Spn-AOM cases were 3 (10.81%), 19F (10.65%), 19A (10.43%), 23A (4.60%), 35B (4.38%), and 21 (3.23%) whereas 78.2% of Hi-AOM cases were caused by non-typeable Hi (NTHi).
Interpretation
A substantial AOM burden in children remains during the PCV era, with disproportionately higher incidence among children ≤2 years old. Select PCV- and non-PCV pneumococcal serotypes and NTHi have contributed significantly to the AOM burden. Vaccines offering improved protection against remaining PCV serotypes, emerging pneumococcal serotypes, and NTHi are needed to reduce the existing AOM burden in children.
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