Middle ear disease and the practice of pediatrics. Burden during the first five years of life.

To determine the burden on pediatricians imposed by disease of the middle ear, we analyzed data from 2,570 children followed up prospectively since birth. Disease of the middle ear accounted for a large proportion of all visits made during the first five years of life, rising from 22.7% during the first year to about 40% in years 4 and 5. About one visit in three made for illness of any kind resulted in the diagnosis of disease of the middle ear. Approximately three fourths of all visits to follow up any illness were made to follow up disease of the middle ear. Disease of the middle ear was diagnosed at between 5% and 10% of all well-baby visits. Children from private practice averaged fewer visits for all reasons than did children using a large neighborhood health center, but the proportions of visits accounted for by disease of the middle ear were similar in both settings.

Use of pneumococcal vaccine for prevention of recurrent acute otitis media in infants in Boston. The Greater Boston Collaborative Otitis Media Study Group.

The efficacy of pneumococcal polysaccharide vaccine for children suffering from recurrent acute otitis media (AOM) was determined by administration, in a randomized double-blind fashion, of one of two polyvalent vaccines to 124 children aged five to 21 months. The octavalent vaccine contained serotypes commonly associated with AOM: 1, 3, 6A, 7F, 14, 18C, 19F, and 23F. The heptavalent control contained serotypes not commonly associated with AOM: 2, 4, 5, 8, 9N, 12F, and 24F. Recipients of the octavalent vaccine experienced significantly (P less than 0.05) less AOM due to serotyes contained in the octavalent vaccine than did children who received the control vaccine. Although the recipients of octavalent vaccine suffered less from AOM due to types in that vaccine than did controls, their clinical experience with AOM was not different. Both groups of children were equally likely to experience at least one episode of AOM after vaccination (70% for octavalent vaccine and 78% for heptavalent vaccine). The mean numbers of episodes of AOM after vaccination also were similar (2.1 for octavalent vaccine and 2.3 for heptavalent vaccine). Similarly, the period of effusion in the middle ear after pneumococcal AOM was identical for both groups. Although immunization with pneumococcal vaccine appeared to reduce the number of episodes of AOM due to serotypes contained in octavalent vaccine, the clinical experience of the children was not favorably affected by this vaccine.