Childhood ear infection big disease burden in Asia-Pacific
MedWire News: Otitis media (OM) is associated with a significant burden of childhood disease and economic cost in most Asia-Pacific countries, report researchers.
The burden of OM disease is substantial in Pacific Island children living in New Zealand, and is highest in indigenous Australians, in whom the percentage of young children (less than 3 years of age) with any OM exceeds 90%, they say.
Pneumococcal conjugate vaccines have shown efficacy in preventing acute OM (AOM) and are currently recommended for use in Australia, New Zealand, Singapore, and the Pacific Islands. However, the epidemiology of OM is not uniform and baseline data on OM disease burden will be important for countries considering vaccination and for assessing vaccine effects on disease epidemiology, explain the authors.
Shyan Vijayasekaran (University of Western Australia, Perth) and colleagues therefore reviewed published and unpublished literature between 1995 and 2010 describing the burden of disease caused by OM across a range of Asia-Pacific countries.
They identified 87 studies in the Philippines, Singapore, Thailand, Taiwan, Vietnam, Australia, Indonesia, Japan, Malaysia, New Zealand, and the Pacific Islands.
As reported in the International Journal of Pediatric Otorhinolaryngology, the prevalence of OM in school-age children varied between 3% in Thailand and 12% in Philippines, and was highest in Aboriginal Australian children, at 42%.
Chronic suppurative OM (CSOM), a persisting discharge through a perforated tympanic membrane as a result of AOM, was prevalent in 5.4% in children of any age in Indonesia, in 2-4% of those in Thailand, Philippines, Malaysia, and Vietnam, and in 15% of Aboriginal Australian children.
"The epidemiology of OM is markedly different among aboriginal and non-Aboriginal Australian children," reports the team. "In a survey of 29 remote communities conducted in 2001, OM was detected in 91% of children between 6 and 30 months of age. Almost one quarter (24%) had TM perforation and 15% had CSOM."
The authors say that, in line with reports from other countries, Streptococcus pneumoniae and Haemophilus were the most frequently identified etiologic agents in AOM, and were present in 28-48% of children. Furthermore, one study of bacteria isolated from 67 children with OM effusion showed that all S. pneumoniae and 82% of Haemophilus isolates were amoxicillin sensitive.
The team also reports that the health-related cost estimates for OM were substantial. One analysis of international data showed that the cost of treating uncomplicated OM in children aged less than 5 years in 2008 was estimated between US$ 166.1 and 407.7 million (€ 126.3-310 million], with the bulk of these costs due to general practitioner visits and medications.
"Large, prospective community-based studies are needed to better assess the disease burden, including evaluation of Spn [Streptococcus pneumonia] serotypes implicated in OM," write Vijayasekaran et al.
They say the review highlights the need for additional research, and provides a basis on which to build and develop regional guidelines for OM management.
By Sally Robertson