Incidence of Acute Otitis Media in the Vaccines Era Against Pneumococcus in a City of the Colombia Caribbean Coast: A Cohort Study

Abstract

Background. Acute otitis media (AOM) is one of the main bacterial infection in children. Pneumococcus and nontypeable Haemophilus influenzae (NTHi) are responsible for up to 80% of cases. In Colombia the pneumococcal conjugate vaccine 10 serotype was included in the immunization program since 2011. Our objective was to determine the incidence of AOM in a cohort of newborn in Cartagena, Colombia. Methods. This was a prospective cohort study was performed in a sample of newborn in Cartagena's Maternity Clinic from December 2013 to August 2015 with a follow- up period of 15 months. For the caregivers were surveyed at the time of inclusion and every three months to identify AOM cases. Otolaryngologist evaluated the patients by otoneumatoscopia and according to the American Academy of Pediatrics (AAP) criteria for AOM was considered sampling (timpanoscentesis by CDT Speculum). Isolates of Haemophilus influenzae and pneumococcal were sent to the National Health Institute (NHI) for serotyping. Results. From a population of 1560 newborn, we enrolled a total of 876 newborn. The percentage of loss during the 5 followed up were 0%, 23%, 28.6%, 5.5% and 21.5%. A total of 53.1% were male, 9 of 10 households had a very low socioeconomic status. A total of 23.5% of infants were exposed to cigarette smoke and 44.4% biomass at birth. A total of 67.9% had siblings under 10 years, where 11.1% had AOM. The median of exclusive breastfeeding was 3 months [IQR 2.0-5.0], time of weaning was 5.0 months [IQR 4.0-6.0]. The infants had on timely vaccination schedule at the first, second and fourth of follow up were 61.8%, 59.4% and 58.7%, respectively. 44 cases with AOM were diagnosed. The incidence rate was 29.4% per 1000 infant episodes year. Secretion cultivation was performed in 44.5% of cases, H. influenzae was isolated in 20% (4/20) all reported by NHI as nontypeable negative beta-lactamase. Pneumococcus was isolated in 15% (3/20), only one was serotyping as 6C. S. pyogenes and S. aureus were isolated each in 10% (2/20) of cases. Conclusion. This is the first cohort study about incidence of AOM in the post PCV-10 era. The incidence is lower than other authors; however, it is compatible with the findings of other authors in Latin America, where as the present study, the diagnosis was by otolaryngologist.