Fewer physician visits in the United States after introduction of 13-valent pneumococcal conjugate vaccine
In the United States for the period from 2001 to 2011 there is a clear trend to reduce the frequency of pediatrician visits for acute otitis media, especially after the introduction of the 13-valent pneumococcal conjugate vaccine.
Acute otitis media (OSA) is the leading cause of pediatrician visits to the United States and the most common disease in which children receive antibiotic therapy or undergo surgery (usually tympanocentesis). Each year, about $ 4 billion is spent in the United States to help patients with CCA. In recent years, a number of measures have been introduced to reduce the burden of CCA.
One such measure is the introduction into general practice of the 13-valent pneumococcal conjugate vaccine (PCV-13), which has been licensed in the United States for use in children 6 weeks to 6 months of age as of March 2010. Currently, approximately 90% of PCV-13 children vaccinated in the United States for 2 years.
The purpose of the study, conducted in the United States, was to assess trends in medical care for patients with CAC for the period from 2001 to 2011. and especially after the widespread introduction of the 13-valent pneumococcal conjugate vaccine (PCV-13). The results of this study were published in the November issue of JAMA Pediatrics.
During the study, an analysis of the reimbursement database for medical insurance policies was carried out. The study included data from children aged 6 and under who visited pediatricians about CCA.
The main outcome measures assessed during the study were the number of annual physician visits to the OCO, the incidence of complications from acute otitis media, and the frequency of surgery for otitis media. or its complications.
It turned out that, according to the information analyzed on 7.82 million children, 6.21 million initial visits were recorded for the ACC, of which 52% were boys and 48% were children of less than 2 years.
There was a downward trend in the frequency of ACC during the 2004 to 2011 period, with a significant decrease in the frequency of ACC, coinciding with the onset of widespread use of pneumococcal conjugate vaccine 13 valid in 2010. The observed frequency of doctor's visits regarding ACC in 2010 (1.00 / person-years) and 2011 (0.81 / person-years) were lower than in the period 2005- 2009, that is when this vaccine has not been introduced (p less than 0.001). The frequency of recurrent episodes of otitis media (more than 3 visits for otitis media over a 6-month period) decreased by 0.003 / person-year in 2001-2009. and 0.018 / person-year in 2010-2011
After the introduction of PCV-13, a stable indicator of relative risk was observed between physician visits regarding ACC in children under 2 years of age and children 2 to 6 years of age (RR 1, 38, 95% confidence interval 1.38-1.39). In addition, the relative risk decreased considerably (p less than 0.001) during the year of introduction of the vaccine (2010) (RR 1.32, 95% CI 1.31-1.33) and the following year (2011) (RR 1 01, 95% CI 1.00-1.02).
The frequency of perforation of the tympanic membrane and the occurrence of otorrhea increased from 3,721 per 100,000 person-years in 2008 to 4,542 per 100,000 person-years in 2011 (p less than 0.001), but the increase was only significant in children in the oldest age group.
The frequency of mastoiditis has decreased considerably (from 61 per 100,000 person-years in 2008 to 37 per 100,000 person-years in 2011, p less than 0.001).
Thus, for the period from 2001 to 2011. In the United States, there is a clear trend towards a reduction in the frequency of medical visits for acute otitis media. A statistically significant decrease in the frequency of pediatrician visits in 2010-2011. in children under 2 years of age coincided with the introduction of PCV-13.