小児肺炎球菌ワクチンによる難治性中耳炎発症抑制

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  • 國本 優
    広島大学大学院医系科学研究科耳鼻咽喉科学・頭頸部外科 耳鼻咽喉科くにもと医院
  • 小川 結衣
    広島大学大学院医系科学研究科耳鼻咽喉科学・頭頸部外科
  • 竹野 幸夫
    広島大学大学院医系科学研究科耳鼻咽喉科学・頭頸部外科

書誌事項

タイトル別名
  • Efficacy of Pediatric Pneumococcal Conjugate Vaccines in Preventing Complex Otitis Media
  • ショウニ ハイエン キュウキン ワクチン ニ ヨル ナンチセイ チュウジエン ハッショウ ヨクセイ

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<p>Numerous previous studies have suggested that introduction of pneumococcal conjugate vaccines (PCVs) has led to a reduction in the incidence of myringotomy with tympanostomy tube insertion (MTTI), although few reports mention the efficacy in relation to the patient age or the underlaying reason. Herein, we report the results of a post-hoc analysis conducted based on data collected over a 10-year period, including periods before and after the introduction of PCVs in the national vaccine program, registered in the JMDC Claims Database, a nationwide database; the results include those for ages subdivided into 3-month age groups and a comparison of the MTTI incidence between the PCV7 era and PCV13 era. In addition, the change in the incidence of simple myringotomy (sMyr) for otitis media with effusion (OME) is also reported. We analyzed total of the 7,600 cases of MTTI without adenoidectomy and 13,700 cases of sMyr with OME registered from 2008 to 2017, comparing the incidence by calendar year and age (in years) by the chi-square test. Analysis of the 10-year data revealed a two-humped peak in the frequency of MTTI: in the age groups of 1–2 years and age group of 4–6 years. Comparison of the overall incidence of MTTI by age divided into 3-month age groups between the PCV and pre-PCV eras revealed a reduced incidence in the PCV era in the 12–14 months and 24–26 months age groups. The overall incidence of MTTI in 1-year olds was significantly lower (P < 0.01) in the PCV era as compared with that in the pre-PCV. Comparison of the incidence of MTTI between the PCV7 and PCV13 era revealed no consistent trends. Comparison of the total incidence of sMyr between the PCV and pre-PCV eras showed a significant decrease in the incidence of sMyr in 1-year olds in the PCV era (P < 0.001). Our results indicate that the frequency of MTTI showed a peak in 1- to 2-year-olds, and that PCVs were effective for reducing the frequency of MTTI in the age group of 1 to 2 years 2 months, and significantly decreasing the incidence of sMyr for OME in 1-year olds. These results suggest that bacterial infection might play a significant role in the pathogenesis for OME requiring surgical treatment in 1-year olds.</p>

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