Effectiveness of Inactivated Influenza Vaccine for Prevention of Otitis Media in Children

Senem Konuk Ozgur, MD; Ufuk Beyazova, MD; Yusuf Kemal Kemaloglu, MD; Isil Maral, MD; Figen Sahin, MD; Aysu Duyan Camurdan, MD; Yusuf Kizil, MD; Erdem Dinc, MD; Hakan Tuzun, MD


Pediatr Infect Dis J. 2006;25(5):401-404. 

In This Article

Abstract and Introduction

Objective: The objective of this study was to evaluate the effectiveness of inactivated influenza vaccine in preventing acute otitis media (AOM) and otitis media with effusion (OME) in children aged 6 to 60 months who attend day care.
Study Design: This prospective, single-blind study was conducted in 8 day care centers in Ankara, Turkey. One hundred nineteen (61 vaccinated and 58 unvaccinated against influenza) healthy children were examined at study entry and at 6-week intervals for 6 months by the same 2 otorhinolaryngologists who were blinded about the vaccination status of the children. The frequency of AOM and OME is compared between the 2 groups and the effect of influenza season on frequency of episodes was evaluated. Based on national influenza laboratory data, the influenza season was determined to be the period between December 15, 2003, and January 31, 2004.
Result: The frequencies of AOM, OME and total otitis media episodes in vaccinated children were 2.3%, 22.8% and 25.2%, respectively, and these frequencies were 5.2%, 31.1% and 36.3% in the unvaccinated group. The difference was statistically significant (P < 0.01). This difference was especially prominent in the influenza season (P < 0.05).
Conclusion: Influenza vaccine is effective in reducing AOM and OME episodes in 6- to 60-month-old day care children, especially during influenza season.

Otitis media (OM) is a common problem in children less than 5 years of age.[1] Although the microorganisms most frequently responsible for the otitis media are Streptococcus pneumoniae, Haemophilus influenzae and Moraxella catarrhalis, some respiratory viruses like respiratory syncytial virus (RSV), rhinovirus and influenza A virus are known to predispose to OM.[2,3] In many cases, OM is preceded by a viral respiratory infection.[4,5] Viral infections predispose to development of acute otitis media (AOM) by inducing some ciliary and mucinous changes that affect middle ear pressure and cause eustachian tube dysfunction.[6] They also suppress the immune system of the host by altering the peripheral blood polymorphonuclear cell functions.[7]

It is reasonable to expect that administration of influenza vaccine might help in reducing the morbidity from OM. This hypothesis was first tested in 1991,[8] and 2 additional studies performed by inactive influenza vaccine[9,10] and one study that tested live vaccine[11] demonstrated that the vaccine significantly reduced AOM episodes during influenza season. A recent, well-designed randomized, controlled trial by Hoberman et al[12] failed to demonstrate the efficacy of inactivated influenza vaccine in children younger than 2 years of age. Among these studies, only one of them[9] studied the prevalence of otitis media with effusion (OME) in addition to AOM in vaccinated children.

We aimed to evaluate the effect of the vaccine in our population, which may be different from the European or American populations of previous studies. We recruited children aged 6 to 60 months. Day care is an important risk factor so we performed our study on day care children. We considered both AOM and OME and effects of influenza season in evaluating the efficacy of the inactivated influenza vaccine.