Acute otitis media (AOM) is one of the most common bacterial infectious diseases among children and is a leading cause of child healthcare visits and antibiotic prescriptions. Few vaccines have the potential to prevent AOM. The newer pneumococcal conjugate vaccines (PCV) offer a larger spectrum of protection against AOM, as well as preventing severe diseases. The main aim of this study was to assess pediatricians' opinions regarding AOM and its prevention by immunization.
Response rate was 50%. Around 60% of respondents estimated that more than 50% of their patients under the age of 3 years would suffer from at least one episode of AOM in the following year. Most respondents (79%) rated consequences of AOM as moderate. Almost all physicians (99%) considered the newer PCV as safe and effective. Most respondents considered their knowledge of the new vaccines was sufficient. More than 90% had a firm intention to recommend newer PCV to their patients. Perceived benefits of AOM prevention by immunization were: reduction of antibiotic administration and reduction of post-AOM complications. More than half of respondents (53%) considered the risk of adverse events as a barrier to AOM prevention by immunization. In multivariate analysis, the main determinant of pediatricians' intention to recommend newer PCV was perceived safety and efficacy of the vaccines (partial R2 = 0.40, p
*Norwegian Institute of Public Health, Oslo †Paediatric Department, Ostfold Hospital Trust, Grålum ‡Oslo University Hospital, Children's Center, Oslo §Department of Pediatric and Adolescent Medicine, Akershus University Hospital, Nordbyhagen
Department of Pediatric Research, Oslo University Hospital, Rikshospitalet, Oslo, Norway.
Breast-feeding may protect against infections, but its optimal duration remains controversial. We aimed to study the association of the duration of full and any breast-feeding with infections the first 18 months of life.
The Norwegian Mother and Child study (MoBa) is a prospective birth cohort which recruited expecting mothers giving birth from 2000 to 2009. We analyzed data from the full cohort (n?=?70,511) and sibling sets (n?=?21,220) with parental report of breast-feeding and infections. The main outcome measures were the relative risks (RRs) for hospitalization for infections from 0 to 18 months by age at introduction of complementary foods and duration of any breast-feeding.
Although we found some evidence for an overall association between longer duration of full breast-feeding and lower risk of hospitalizations for infections, 7.3% of breast-fed children who received complementary foods at 4 to 6 months of age compared to 7.7% of those receiving complementary foods after 6 months were hospitalized (adjusted RR 0.95, 95% confidence interval 0.88-1.03). Higher risk of hospitalization was observed in those breast-fed 6 months or less (10.0%) compared to =12 months (7.6%, adjusted RR 1.22, 95% confidence interval 1.14-1.31), but with similar risks for 6 to 11 months versus =12 months. Matched sibling analyses, minimizing the confounding from shared maternal factors, showed nonsignificant associations and were generally weaker compared with the cohort analyses.
Our results support the recommendation to fully breast-feed for 4 months and to continue breast-feeding beyond 6 months, and suggest that protection against infections is limited to the first 12 months.
Cites: Int J Epidemiol. 2006 Oct;35(5):1146-50 PMID 16926217
Acute otitis media (AOM) nonresponsive to antibiotics is most commonly caused by antibiotic-resistant Streptococcus pneumoniae and Haemophilus influenzae. A strategy for treating these infections with parenteral ceftriaxone was adopted at the Children's Hospital Iceland. The 10-valent pneumococcal H. influenzae protein D-conjugate vaccine was introduced into the vaccination program in Iceland in 2011. The aim was to study its effect on the incidence of AOM with treatment failure.
This retrospective observational study included children who visited the Children's Hospital Iceland because of AOM or received ceftriaxone, regardless of indication from 2008-2015. Incidence rate was calculated for prevaccine (2008-2011) and postvaccine (2012-2015) periods using person-years at risk within the hospital's referral region. Incidence rate ratio of ceftriaxone treatment episodes of AOM was calculated using the Mantel-Haenzel method adjusting for age. Incidence risk ratio of ceftriaxone treatment if presenting to the hospital with AOM was calculated to adjust for rate of AOM visits.
Visits for AOM decreased from 47.5 to 33.9 visits per 1000 person-years, incidence rate ratio (IRR) 0.86 (95% confidence interval [CI]: 0.81-0.91), P
The occurrence of contagious diseases among children attending day care centers (DCCs) is high. The possibility of reducing absences due to infections with an infection prevention program was investigated.
The intervention study was conducted as an open, controlled cluster study. It included 60 municipal DCCs in one of the seven districts of the City of Helsinki; 228 DCCs in the other six districts served as controls. The main indicator was the occurrence of absences due to upper respiratory tract infections, otitis media, eye infection and diarrhea per child-month.
The intervention reduced the absences due to infections by 26% among under 3-year olds, but not among older children. The same phenomenon was observed when similar paired random control DCCs were compared with the intervention DCCs.
Effective prevention of absences due to infections is possible among under 3-year olds by implementing a simple and inexpensive infection control program.
Controversy surrounds whether mothers with multiple sclerosis (MS) who wish to breast-feed their infants should forego breast-feeding in order to resume immunomodulating therapy following birth even though breast-feeding has not been shown to have deleterious effects on these mothers. Knowledge of potential health benefits to infants through breast-feeding could influence health care providers to encourage mothers with MS who wish to breast-feed to do so. This study of 140 breast-feeding and 35 non-breast-feeding mothers with MS identifies the type and prevalence of illnesses experienced by their infants during the first 6 postpartum months and at 9 months and 12 months. Significantly more non-breast-fed than breast-fed infants experienced otitis media, lower respiratory illness, constipation, milk intolerance, and allergy during the 1st year. Study results support the need to encourage mothers with MS who wish to breast-feed their infants to do so and to delay immunomodulating therapy until breast-feeding cessation.
Previous studies have shown that children with recurrent acute otitis media (rAOM) have significantly lower quantities of alpha-haemolytic streptococci (AHS) in the nasopharynx than healthy children. Furthermore children with otitis media have AHS with lower inhibitory activity in vitro on Streptococcus pneumoniae and non-typable Haemophilus influenzae compared with healthy children. A randomised, placebo controlled and double blind clinical study among children with rAOM was designed to determine whether or not a nasal spray, containing AHS with very good inhibitory activity on the three most common OM pathogens, could be an alternative to tympanostomy tube insertion. Forty three children under 4 years of age were included in the study. The children sprayed once daily for 4 months and were monitored for 6 months. Sixteen children in the active group and 20 children in the placebo group were evaluated. The result showed no significant differences regarding the number of episodes of AOM, with seven recurrences in the active group and eight in the placebo group. No significant changes of the nasopharyngeal flora could be detected during the study period regarding the OM pathogens. Nasal spray according to the performed schedule is not yet an alternative to tympanostomy tubes in children with rAOM. The possibility of increasing the efficacy of this ecological treatment, by using pre-treatment antibiotics, more adhesive bacteria and alternative treatment schedules is discussed.