Question

• Does influenza vaccine given to children ages 6 to 30 months prevent episodes of acute otitis media?

Clinical Bottom Lines

1. Viruses play a key role in the pathogenesis of acute otitis media.(3)
2. Influenza vaccine may prevent episodes of acute otitis media in high-risk (i.e. children attending daycare) during influenza season. (1)
3. Season to season variability of influenza virus strains and vaccine virus strains make hard-and-fast conclusions difficult; trends over time may be more helpful. (1, 2, 3)
4. Tympanostomy tubes showed benefit for all study groups. (1)

Summary of Key Evidence

1. In a prospective cohort study, investigators asked if influenza vaccine prevented otitis media in children age 6-30 months attending daycare; excluded patients with acute or chronic illness, including fever. (1)
2. Valid study in so far as: patients representative, other than being in daycare; 2 groups similar other than intervention; follow-up sufficient, both before and after flu season; analysis adjusted for independent prognostic factors, i.e. TM tubes. (1)
3. In an adjusted regression analysis, the vaccine (intervention) group showed benefit for prevention acute otitis media; specifically, OR = 0.69; CI = 0.49-0.98; NNT = 12; CI 7-214. (1)
4. In the same regression analysis, the vaccine group showed no statistically significant benefit for prevention of serous otitis media. (1)
5. Lastly, the analysis showed that tympanostomy tubes were associated with lower risk of both acute and serous otitis media in all study groups. (1)

Additional Comments

• Recent evidence (yet to be published) may show no benefit for prevention of otitis media in a less selective (i.e. non-daycare) population. (4)
• Recent AAP policy statement suggests all children age 6-24 months receive influenza vaccine; requires two doses if patient naïve to vaccine. (5)

Citation

1. Clements DA, Langdon L, Bland C, Walter E. Influenza A vaccine decreases the incidence of otitis media in 6- to 30-month-old children in day care. Arch Pediatr Adol Med 1995;149:1113-7.
2. Heikkinen T, Ruuskanen O, et.al. Influenza vaccination in the prevention of acute otits media in children. Am J Dis Child 1991;145;445-8.
3. Heikkinen T. Role of viruses in the pathogenesis of acute otitis media. Pediatr Infect Dis J 2000;19:217-23.
4. Hoberman A, Green berg DP, et.al. Efficacy of influenza vaccine in the prevention of acute otitis media (Abstract 906). Pediatr Res 2002;51:156A.
5. Committee on Infectious Disesases. AAP Policy statement: Reduction of the influenza burden in children. Pediatrics 2002;110:1246-52.

CAT Author: Michael Gaglia, MD

CAT Appraisers: John G. Frohna, MD, MPH

Date appraised: January 13, 2003