Pneumococcal vaccination for preventing acute middle ear inf | Figure 1

%27%3e%3cg%20id=%27Group-14%27%20transform=%27translate(13.000000,%20103.176124)%27%3e%3cg%20id=%27Group-Copy-5%27%20transform=%27translate(0.000000,%20182.676124)%27%3e%3crect%20id=%27Rectangle-8%27%20fill=%27%23E2E0DE%27%20x=%270%27%20y=%270%27%20width=%2736%27%20height=%2736%27%20rx=%2718%27%3e%3c/rect%3e%3cpath%20d=%27M28,27.6503435%20C28,22.127496%2023.5228474,17.6503435%2018,17.6503435%20C12.4771525,17.6503435%208,22.127496%208,27.6503435%20M18,16.3472505%20C20.8165136,16.3472505%2023.099749,14.0640151%2023.099749,11.2475015%20C23.099749,8.43098783%2020.8165136,6.1477524%2018,6.1477524%20C15.1834863,6.1477524%2012.9002509,8.43098783%2012.9002509,11.2475015%20C12.9002509,14.0640151%2015.1834863,16.3472505%2018,16.3472505%20Z%27%20id=%27Combined-Shape%27%20fill=%27%23FFFFFF%27%20fill-rule=%27nonzero%27%3e%3c/path%3e%3c/g%3e%3c/g%3e%3c/g%3e%3c/g%3e%3c/svg%3e)

Deleted account

Some actions are only available when you log in.

Report case

Report this to our moderators

Pneumococcal vaccination for preventing acute middle ear infections in children

You can view up to 4 cases without signing up Sign up for unlimited access

Review question

We reviewed the evidence for the effect of vaccination against Streptococcus pneumoniae (pneumococcus, a type of bacterium) for preventing acute middle ear infections in children.

Background

Before nationwide implementation of vaccination against S pneumoniae with pneumococcal conjugate vaccines (PCVs), pneumococcus was the most frequent cause of acute middle ear infections in children. Vaccination against this bacterium with PCVs may therefore lead to fewer acute middle ear infections in children. However, ongoing monitoring of the effects of PCVs on acute middle ear infections is warranted, since recent studies report a shift in bacteria causing acute middle ear infections towards pneumococcal types not included in the vaccines and other bacteria.

Study characteristics

The evidence is current up to 11 June 2020. We included 11 trials of PCVs versus control vaccines (meningococcus type C conjugate vaccine in three trials, and hepatitis A or B vaccine in eight trials) involving a total of 60,733 children. The PCVs used in the trials contained 7 to 11 different types of pneumococcus. None of the trials used the newer PCV containing 13 different types. Most trials were funded by pharmaceutical companies. Overall, risk of bias was low. In seven trials (59,415 children), children received PCVs in early infancy, whilst four trials included 1318 children aged one year and over who were either healthy or who had previous respiratory illness.

Key results

When a licenced vaccine containing seven different types of pneumococcus (CRM197‐PCV7) was given during early infancy, the risk of experiencing acute middle ear infections increased by 5% in high‐risk infants and decreased by 6% in low‐risk infants. When administrating a licenced vaccine containing 10 types of pneumococcus together with a carrier protein from another bacterium called Haemophilus influenzae (PHiD‐CV10), the risk of experiencing acute middle ear infections decreased by 6% to 15%, however neither of these estimates reached significance.

Giving PCV7 after early infancy (children aged one year and above) and in older children with a history of respiratory illness or frequent acute middle ear infections was not associated with reductions in acute middle ear infections.

Mild local reactions (redness, swelling), fever, and pain/tenderness were common and occurred more frequently in children receiving PCV than in those receiving control vaccines. More severe local reactions (redness and swelling > 2.5 cm) and fever (> 39 °C) occurred far less frequently and did not differ between vaccine groups. Serious adverse events judged to have been related to vaccination were rare and did not differ significantly between vaccine groups.

Certainty of the evidence

We assessed the certainty of the evidence for CRM197‐PCV7 in early infancy to be moderate (further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate). We judged the certainty of the evidence for PHiD‐CV10 to be low (further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate). We judged the certainty of the evidence for PCV7 in older children with or without a history of respiratory illness to be moderate (further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate).

Read the full Cochrane Review

Comment

Sign up to add a comment

More about this case

ResolvedVerified literatureRare

Why you should join Figure 1

Sign up to explore now

Similar cases

\ \ Do children with recurring acute middle ear infections benefit from placement of grommets in both ears?\ Cochrane Review; 5 randomised controlled trials (805 children).\ Key results:\ Grommets vs. active monitoring\ Low-quality evidence that fewer children treated with grommets had ear infections at 6 and 12 months follow-up than those managed with active monitoring; three and eight children needed to be treated with grommets to benefit one, respectively. The number of ear infections at 6 and 12 months follow-up was also lower in the grommets group; the difference was, however, at best modest with around one fewer episode at 6 months and a less noticeable effect by 12 months (low to very low-quality evidence). Children treated with grommets did not have better quality of life at 4 or 12 months follow-up (low-quality evidence).\ Grommets vs. antibiotic prophylaxis\ It is uncertain whether or not grommets are more effective than antibiotic prophylaxis.\ Grommets vs. placebo\ Very low-quality evidence that fewer children treated with grommets had further ear infections at 6 months than those receiving placebo drugs; 3 children needed to be treated with grommets to benefit 1.\ Negative effects of grommets were not systematically reported in the studies.\ Overall, the quality of the evidence was low to very low. Findings should be interpreted with caution.](https://app.figure1.com/case-detail/15991940-5ba9-4b7e-ac97-250f9b2b7353)

\ \ What was the aim of this review?\ The aim of this Cochrane Review was to find out whether racecadotril works for children under five years of age with diarrhoea. Cochrane Review authors collected and analysed all relevant trials to answer this question and included seven trials in this review.\ Key messages\ Racecadotril may reduce the risk of rehydration failure. We are uncertain whether or not it influences number of bowel movements or duration of diarrhoea.\ What was studied in the review?\ Diarrhoea is a leading cause of death in children under five years old, especially in low‐income countries. Children who have diarrhoea often suffer from frequent and watery bowel movements, which might cause excessive loss of fluid and electrolytes (dehydration). Fluid replacement is recommended to prevent and treat dehydration caused by diarrhoea. Racecadotril has been used in addition to fluid replacement for treating diarrhoea in children, as it reduces release of water and electrolytes into the digestive tract. The drug is supposed to improve the symptoms of diarrhoea (shorten duration of diarrhoea or reduce the stool frequency) as well as reduce the risk of rehydration failure. However, it is not clear if racecadotril really works for children with diarrhoea.\ What are the main results?\ The review authors searched for available trials and included seven trials. The trials were conducted in a total of 1140 children aged from 3 months to 5 years. Children who were given racecadotril were compared to a control group (children who, instead of racecadotril, received a placebo (a dummy drug that contains no racecadotril) or no drug). The review shows that when children with diarrhoea were given racecadotril, compared to placebo or no drug:\ • racecadotril may reduce the risk of rehydration failure (low‐certainty evidence);\ • we are uncertain whether or not racecadotril shortens duration of diarrhoea (very low‐certainty evidence);\ • we are uncertain whether racecadotril influences the number of stools (very low‐certainty evidence);\ • racecadotril may reduce weight of stool output (low‐certainty evidence);\ • racecadotril may make little or no difference to length of hospital stay for inpatients (low‐certainty evidence);\ • racecadotril may make little or no difference to rates of side‐effect events (low‐certainty evidence)\ How up to date is this review?\ The review authors searched for trials published up to 4 March 2019.](https://app.figure1.com/case-detail/169a51dd-b895-4282-8f8f-085337ce4e3a)

\ \ What is the aim of this review?\ The aim of this Cochrane Review was to find out if rotavirus vaccines are effective in preventing diarrhoea and deaths in infants and young children. We also aimed to find out if the rotavirus vaccines are safe. We collected and analyzed all relevant studies to answer these questions, and found 55 studies.\ Key messages\ RV1, RV5, and Rotavac prevent episodes of rotavirus diarrhoea (moderate‐ to high‐certainty evidence). We found no increased risk of serious adverse events (moderate‐ to high‐certainty evidence) including intussusception (where the bowel telescopes on itself, and can cause obstruction) (very low to low‐certainty evidence).\ What was studied in the review?\ Rotavirus infection is a common cause of diarrhoea in infants and young children, and can cause mild illness, hospitalization, and death. Since 2009, the World Health Organization (WHO) has recommended that a rotavirus vaccine be included in all national infant and child immunization programmes, and 95 countries have so far followed this recommendation. In the years before infants and children started receiving rotavirus vaccine, rotavirus infection resulted in about half a million deaths a year in children aged under five years, mainly in low‐ and middle‐income countries.\ In this review we included randomized controlled trials in infants and young children that evaluated a monovalent rotavirus vaccine (RV1; Rotarix, GlaxoSmithKline) or a pentavalent rotavirus vaccine (RV5; RotaTeq, Merck). These vaccines have been evaluated in several large trials and are approved for use in many countries. We also included trials that evaluated another monovalent rotavirus vaccine (Rotavac; Bharat Biotech), which is used in India only. The rotavirus vaccines were compared with placebo or with no vaccine. The included studies did not allow comparisons between the vaccines.\ What are the main results of the review?\ We found 55 relevant studies with 216,480 participants. The trials took place in several locations worldwide. These studies compared a rotavirus vaccine versus placebo or versus no vaccine for infants and young children. The vaccines tested were RV1 (36 trials with 119,114 participants), RV5 (15 trials with 88,934 participants), and Rotavac (four trials with 8432 participants). Fifty‐one studies were funded or co‐funded by vaccine manufacturers, while four were independent of manufacturer funding.\ In the first two years of life, RV1:\ ●prevents more than 80% of severe cases of rotavirus diarrhoea in countries with low death rates (high‐certainty evidence)\ ●prevents 35% to 63% of severe rotavirus diarrhoea in countries with high death rates (high‐certainty evidence)\ ●probably prevents 37% to 41% of severe cases of diarrhoea from all causes (such as any viral infection, bacterial infection, or parasitic infection) in countries with low death rates (moderate‐certainty evidence)\ ●probably prevents 18% to 27% of severe cases of diarrhoea from all causes in countries with high death rates (moderate‐ to high‐certainty evidence).\ In the first two years of life, RV5:\ ●probably prevents 82% to 92% of severe cases of rotavirus diarrhoea in countries with low death rates (moderate‐certainty evidence)\ ●prevents 41% to 57% of severe cases of rotavirus diarrhoea in countries with high death rates (high‐certainty evidence)\ ●probably prevents 15% of severe cases of diarrhoea from all causes in countries with high death rates (moderate‐ to high‐certainty evidence); we did not identify any studies that reported on diarrhoea from all causes in countries with low death rates.\ In the first two years of life, Rotavac:\ ●probably prevents more than 50% of severe cases of rotavirus diarrhoea in India, a country with high death rates (moderate‐certainty evidence)\ ●probably prevents 18% of severe cases of diarrhoea from all causes in India (moderate‐certainty evidence). Rotavac has not been evaluated in a randomized controlled trial in a country with low death rates.\ We found little or no difference in the number of serious adverse events (moderate‐ to high‐certainty evidence), or intussusception cases (low‐ to very low‐certainty evidence), between those receiving RV1, RV5, or Rotavac compared with placebo or no intervention.\ How up‐to‐date is this review?\ We searched for studies that had been published up to 4 April 2018.](https://app.figure1.com/case-detail/2169afe9-8fd0-4d28-9fd2-01d5a37c6bd4)

\ \ Vagus nerve stimulation for focal seizures\ The aim of this review was to find the current evidence on how effective vagus nerve stimulation is in reducing the frequency of epileptic seizures, and any side effects associated with the treatment.\ We included five multicentre, randomised controlled trials (RCTs) which recruited a total of 439 participants, and compared different types of VNS therapy. Three compared high‐level stimulation to low‐level stimulation in participants from 12 to 60 years old. One trial examined high frequency stimulation versus low frequency stimulation in children. One trial examined three different stimulation frequencies.\ What did we find?\ VNS seems to be an effective treatment for people with intractable focal epilepsy. High‐level stimulation seems to reduce the number of seizures people had compared to low‐level stimulation.\ Common side effects were voice alteration and hoarseness, pain, shortness of breath, cough, feeling sickly, tingling sensation, headache, or infection at the site of the operation. Shortness of breath, voice alteration and hoarseness were more common in people receiving high‐level stimulation compared to people receiving low‐level stimulation.\ What are the limitations of the evidence?\ The evidence for the effectiveness and side effects of VNS therapy was limited and imprecise. There were a small number of studies and participants included in the review, and details about the design and conduct of the trials was sometimes lacking. We rated the evidence as moderate or low certainty. This means that further research is likely, or very likely, to have an important impact on our confidence in the estimate of the effect, and may change the estimate.](https://app.figure1.com/case-detail/454f37f1-ec86-4db1-babc-4fb35190f3a4)

Trending now

\ \ A 52-year-old man presented with a 20-minute history of chest pain radiating to the left shoulder and neck, associated with dyspnea and diaphoresis.\ He had a history of hypertension, long-term smoking, and a sedentary lifestyle.\ On physical examination, bibasilar crackles were noted on lung auscultation. An electrocardiogram (ECG) was performed in the primary care setting, and the patient was promptly referred to the emergency department.](https://app.figure1.com/case-detail/ae0fe999-6875-4474-94f0-ad823dbb9b3a)

\ \ A 28-year-old woman presented with a 3-day history of intense pruritus over the lower back. She reported no recent travel or exposure to new environments. She cares for a small kennel with approximately eight dogs rescued from the streets.\ Physical examination revealed multiple small vesicles, some clustered and others scattered, predominantly involving the lumbar region and the left gluteal area.](https://app.figure1.com/case-detail/c271070f-2bc7-4052-9895-635277e1a7d5)

\ \ A 4-month-old male infant presented with skin lesions localized to the chin for the past 3 days. Physical examination revealed multiple small pustules with surrounding inflammatory signs on the chin, along with a few scattered papules on the chest.](https://app.figure1.com/case-detail/48f41642-b9db-4089-b120-a94ee52328de)

\ \ patient in late teens presenting after a collapse, no chest pain, no previous cardiac history, no history of sudden death in family, are there any features in this ekg that would warrant further work-up or is this just a pediatric ekg?](https://app.figure1.com/case-detail/2af390e1-ace8-40ed-ba1c-98fb2d72f4c5)