Pneumococcal conjugate vaccine - Impact on otitis media and otolaryngology

In February 2000, the new 7-valent pneumococcal polysaccharide-protein conjugate vaccine (PCV7) (Prevnar; Wyeth Lederle Vaccines, Pearl River, NY) was approved by the Food and Drug Administration (FDA) for the prevention of invasive pneumococcal disease leg, meningitis and bacteremia) in infants and young children. This long-awaited event has received widespread applause from pediatric infectious disease experts who anticipate a dramatic decrease in these potentially fatal serious infections as the infants and young children who are at high risk become immunized.(1.2) The Centers for Disease Control and Prevention Advisory Committee on Immunization Practices (ACIP) recommends that the vaccine be given to all infants aged 2 to 23 months and to children aged 24 to 59 months who are at increased risk for pneumococcal disease, such as those who have sickle cell disease, human immunodeficiency disease virus infection, and other immunocompromising or chronic medical conditions.(3) The ACIP also recommends that the vaccine be considered for all other children aged 24 to 59 months, with priority given to (1) those who are 24 to 35 months old; (2) those who are of Alaska Native, American Indian, or African American descent; and (3) those who attend group day care centers. Even though the vaccine has been demonstrated to be safe and effective in preventing invasive pneumococcal infections, the prevention of otitis media is another potential advantage. However, there is uncertainty among clinicians as to the impact this vaccine will have in preventing pneumococcal otitis media; thus, we otolaryngologists should be knowledgeable when we counsel parents and caregivers of infants and children who have acute otitis media (AOM) on what to realistically expect from the immunization.