Otitis Media Practice During the COVID-19 Pandemic

Marom, Tal; Pitaro, Jacob; Shah, Udayan K.; Torretta, Sara; Marchisio, Paola; Kumar, Ayan; Barth, Patrick; Tamir, Sharon

doi:10.3389/fcimb.2021.749911

Cited by 17 publications

(10 citation statements)

References 81 publications

(85 reference statements)

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“…Our findings align well with other reports showing a substantial reduction in AOM burden during the first COVID year, 14–18 but we showed an increase in AOM episode rate during the second COVID year, which has not been reported so far. Nevertheless, the AOM burden during the second COVID year did not reach pre-pandemic levels.…”

Section: Discussionsupporting

confidence: 93%

Fluctuations in Pediatric Acute Otitis Media Burden During the First Two COVID-19 Years in Israel

Zloczower

Pitaro

Hazan

et al. 2022

Pediatric Infectious Disease Journal

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Background: To study pediatric acute otitis media (AOM) burden fluctuations before and during the first two COVID years, which were characterized by measures to reduce the spread of airborne diseases. We used urinary tract infection (UTI) as a comparison infection. Methods: This was a cross-sectional study encompassing three pre-COVID years (March 1, 2017–February 29, 2020) and the first two COVID years (March 1, 2020–February 28, 2021, and March 1, 2021-February 28, 2022). Records were retrieved from the Clalit Health Services database, Israel’s largest healthcare maintenance organization. Children 0–15 years with AOM and UTI episodes were categorized according to age (1>, 1–4, 5–15 years). We collected demographics, seasonality, AOM complications, antibiotic prescriptions, and recent COVID-19 infections. The average AOM/UTI rates of the three pre-COVID years vs. two COVID years were used to calculate the incidence rate ratios (IRRs). Results: We identified 1,102,826 AOM and 121,263 UTI episodes. The median age at AOM diagnosis was 2.0 years (IQR, 1.1–4.1). Male predominance, age at presentation, and the dominant age group of 1–4 years did not change during the COVID years. While UTI episode rates decreased during the COVID years (IRR 0.76, 95% CI, 0.68–0.84, P < 0.001), the reduction in AOM episode rates was >2-fold (IRR 0.46, 95% CI, 0.34–0.63, P < 0.001). The largest decrease was observed among children 1–4 years old during the first COVID year (β=−1,938 AOM episodes/100,00 children, 95% CI, −2,038 to −1,912, P < 0.001). Recent COVID-19 infection was associated with low AOM morbidity (IRR 0.05, 95% CI 0.05–0.05, P < 0.001). Conclusions: AOM burden substantially decreased during the first COVID year but almost reached pre-pandemic levels during the second year.

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Section: Discussionsupporting

confidence: 93%

Fluctuations in Pediatric Acute Otitis Media Burden During the First Two COVID-19 Years in Israel

Zloczower

Pitaro

Hazan

et al. 2022

Pediatric Infectious Disease Journal

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“…The decrease in AOM burden varied and ranged between 1 and 97%, depending on the setting, degree of lockdown measures undertaken, population size, and coding of AOM. The COVID year was also characterized by increased use of telehealth services for AOM (27).…”

Section: Discussionmentioning

confidence: 99%

Trends in Pediatric Acute Otitis Media Burden During the First COVID-19 Year

et al. 2022

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ObjectiveTo study the changes in acute otitis media (AOM) pediatric emergency department (PED) visits and pediatric admission before and during the first coronavirus disease 2019 (COVID-19) year.Study DesignRetrospective case review.SettingSecondary care center.PatientsChildren younger than 18 years with all-cause and AOM-related PED visits and pediatric admissions for 3 years (March 1, 2018–January 28, 2021) were identified. Children were categorized according to age (0–2, 2–6, and 6–18 yr) and their date of presentation: pre–COVID-19 (yearly average of visits/admissions during the 2 prepandemic years: March 1, 2018–February 28, 2019 and March 1, 2019–February 29, 2020) or COVID-19 year (visits/admissions between March 1, 2020–February 28, 2021).InterventionPre– and post–COVID-19 emergence, alternating lockdowns, kindergarten and school closures, and increased hygiene measures.Main Outcome MeasurePost– versus pre–COVID-19 AOM PED visit and pediatric admission incidence rate ratios (IRRs), using a generalized estimating equation model with a negative binomial regression calculation, while controlling for monthly fluctuations.ResultsAnnual AOM visits/admissions during the pre–COVID-19 and COVID-19 years were 517 and 192 and 256 and 94, respectively (p < 0.05 for both). For children aged 0 to 2 years, AOM visits/admissions significantly decreased during the first COVID-19 year, compared with the pre-COVID years (β = −1.11 [IRR, 0.33; 95% confidence interval [CI], 0.26–0.42; p < 0.005] and β = −1.12 [IRR, 0.33; 95% CI, 0.25–0.42; p < 0.005]). Relatively to all-cause of children aged 0 to 2 years, AOM visits/admissions decreased during the first COVID-19 year versus the pre–COVID-19 years (β = −2.14 [IRR, 0.12; 95% CI, 0.08–0.17; p < 0.005] and β = −1.36 [IRR, 0.26; 95% CI, 0.23–0.29; p < 0.005]) and had monthly fluctuations coinciding with the lockdown/relaxation measures. For children aged 2 to 6 years, the reduction in AOM admissions was significant (β = −1.70, IRR, 0.18; 95% CI, 0.09–0.37; p < 0.005). No significant differences were observed for children aged 6 to 18 years because of the small sample size.ConclusionPediatric AOM burden substantially decreased during the first COVID-19 year.

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“…4 The decline in the incidence of respiratory infections and antibiotic prescriptions and, thus, the incidence of AOM was surprisingly steep, approximately 60% to 90% according to current estimates. 19,24,[26][27][28][29] We recalculated the sample size during the study, and although the total number of AOM episodes decreased, the power of this study was sufficient to assess the efficacy of S salivarius K12 products in preventing AOM. Despite the very low incidence of AOM, we were able to conduct a relatively precise estimate of the efficacy.…”

Section: Discussionmentioning

confidence: 99%

“…The incidence rate of AOM before the COVID-19 pandemic was approximately 0.9 to 1.6 per PYR in children aged 0 to 2 years . The decline in the incidence of respiratory infections and antibiotic prescriptions and, thus, the incidence of AOM was surprisingly steep, approximately 60% to 90% according to current estimates . We recalculated the sample size during the study, and although the total number of AOM episodes decreased, the power of this study was sufficient to assess the efficacy of S salivarius K12 products in preventing AOM.…”

Section: Discussionmentioning

confidence: 99%

Streptococcus salivarius Probiotics to Prevent Acute Otitis Media in Children

Sarlin,

Koskela,

Honkila

et al. 2023

JAMA Netw Open

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ImportanceNew approaches for the prevention of acute otitis media (AOM), the most common reason for antibiotic use in children, are needed.ObjectiveTo assess the efficacy of the Streptococcus salivarius K12 oral probiotics in the primary prevention of AOM.Design, Setting, and ParticipantsThis double-blind, randomized placebo-controlled clinical trial was conducted from August 1, 2020, to May 31, 2021, at 50 day care centers in the Oulu region of Finland. A total of 827 children aged 1 to 6 years attending day care were included. The exclusion criteria consisted of ongoing antimicrobial prophylaxis or immunodeficiency. The follow-up time was 6 months and was completed on May 31, 2021. Data were analyzed from October 24, 2022, to September 16, 2023, based on intention to treat.InterventionEligible participants were randomly allocated to receive 1 daily dose of a S salivarius K12 product or placebo every evening for 6 months. A daily dose was defined as 1 sachet of soluble oral powder for children younger than 3 years or 1 chewable tablet for children 3 years or older containing 1 × 109 colony-forming units of S salivarius K12.Main Outcomes and MeasuresThe primary outcome was the proportion of children with at least 1 episode of AOM requiring antimicrobial therapy within 6 months of randomization. All physician visits and purchases of antimicrobial drugs were retrieved from the electronic national medical record and prescription register. The primary outcome was met if the legal guardian had purchased an antimicrobial prescription for AOM.ResultsA total of 827 children with a mean (SD) age of 4.1 (1.6) years (433 boys [52.4%]) were randomized to S salivarius K12 oral products (n = 413) or placebo (n = 414). Thirty-four children (8.2%) in the S salivarius group and 24 children (5.8%) in the placebo group experienced at least 1 episode of AOM requiring antimicrobial therapy during the 6-month follow-up period (relative risk, 1.42 [95% CI, 0.86-2.34]; proportion difference, −2.44% [95% CI, −5.94% to 1.09%]; P = .17). Time to first AOM episode did not differ between the groups (174 [95% CI, 171-177] days in the S salivarius group vs 176 [95% CI, 173-179] days in the placebo group; P = .18).Conclusions and RelevanceIn this randomized placebo-controlled clinical trial, the daily use of the S salivarius K12 products for 6 months did not reduce the occurrence of AOM. New approaches for primary prevention of AOM among children are needed.Trial RegistrationClinicalTrialsRegister.eu Identifier: 2020-001076-14

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Otitis Media Practice During the COVID-19 Pandemic

Cited by 17 publications

References 81 publications

Fluctuations in Pediatric Acute Otitis Media Burden During the First Two COVID-19 Years in Israel

Fluctuations in Pediatric Acute Otitis Media Burden During the First Two COVID-19 Years in Israel

Trends in Pediatric Acute Otitis Media Burden During the First COVID-19 Year

Streptococcus salivarius Probiotics to Prevent Acute Otitis Media in Children

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