Skip to main content Accessibility help

What effect has pneumococcal vaccination had on acute mastoiditis?

  • M Daniel (a1) (a2), S Gautam (a1), T A Scrivener (a3), C Meller (a1), B Levin (a1) and J Curotta (a1)...



Streptococcus pneumoniae is a frequent cause of acute mastoiditis. Despite the recent (2005) introduction of pneumococcal vaccination, mastoiditis incidence and severity may be increasing. This study aimed to assess the incidence, severity and microbiology of acute mastoiditis over an 11-year period.


Retrospective review of paediatric acute mastoiditis cases seen at our institution (2000–2010), comparing patients seen prior to vaccination introduction (period one, 2000–2004), around the time of vaccine introduction (period two, 2005–2007) and post-vaccination (period three, 2008–2010).


We reviewed 84 children. In periods one, two and three, respectively: mean annual case load was 8.4, 5 and 9 children; pneumococcal isolates were seen in 40.5, 6.7 and 29.6 per cent of cases; highest recorded fever was 38.6, 38.9 and 38.2°C and highest leukocyte count 18.9, 15.0 and 15.6 × 109/l; incidence of intracranial complications was 11.9, 0 and 7.4 per cent; mean duration of intravenous antibiotics was 6.0, 4.1 and 4.2 days; proportion treated surgically was 71.4, 60.0 and 48.1 per cent; and mean length of in-patient stay shortened.


Pneumococcal mastoiditis admission rates appeared to fall when vaccination was introduced, with concomitant reduction in overall mastoiditis incidence and intracranial complications; subsequently, however, admission rates rapidly returned to pre-vaccination levels.


Corresponding author

Address for correspondence: Dr Matija Daniel, Department of Paediatric Otorhinolaryngology Head and Neck Surgery, The Children's Hospital at Westmead, Locked Bag 4001, Westmead, NSW, Australia 2145 Fax: +61 (0)2 9845 2078 E-mail:


Hide All

Presented orally at the Australian Society of Otolaryngology Head and Neck Surgery Meeting, 31 March 2012 to 4 April 2012, Adelaide, Australia, and as a poster at the European Society of Pediatric Otorhinolaryngology Meeting, 20 May 2012 to 23 May 2012, Amsterdam, The Netherlands



Hide All
1Osborne, AJ, Blaser, S, Papsin, BC. Decisions regarding intracranial complications from acute mastoiditis in children. Curr Opin Otolaryngol Head Neck Surg 2011;19:478–85
2Kværner, KJ, Bentdal, Y, Karevold, G. Acute mastoiditis in Norway: no evidence for an increase. Int J Pediatr Otorhinolaryngol 2007;71:1579–83
3Austin, B, Work, WP. Intracranial complications of otitic origin. Laryngoscope 1966;76:288308
4Schwartz, MW, ed. The 5-minute Pediatric Consult, 5th edn.Philadelphia, USA: Lippincott Williams & Wilkins, 2008
5Van Den Aardweg, M, Rovers, MM, Alexander de Ru, J, Albers, FWJ, Schilder, AGM. A systematic review of diagnostic criteria for acute mastoiditis in children. Otol Neurotol 2008;29:751–7
6O'Connor, TE, Perry, CF, Lannigan, FJ. Complications of otitis media in Indigenous and non-indigenous children. Med J Aust 2009;191:60–4
7Bahadori, RS, Schwartz, RH, Ziai, M. Acute mastoiditis in children: an increase in frequency in Northern Virginia. Pediatr Infect Dis J 2000;19:212–15
8Spratley, J, Silveira, H, Alvarez, I, Pais-Clemente, M. Acute mastoiditis in children: review of the current status. Int J Pediatr Otorhinolaryngol 2000;56:3340
9Katz, A, Leibovitz, E, Greenberg, D, Raiz, S, Greenwald-Maimon, M, Leiberman, A et al. Acute mastoiditis in Southern Israel: a twelve-year retrospective study (1990 through 2001). Pediatr Infect Dis 2003;22:878–82
10Nussinovitch, M, Yoeli, R, Elishkevitz, K, Varsano, I. Acute mastoiditis in children: epidemiologic, clinical, microbiologic, and therapeutic aspects over past years. Clin Pediatr 2004;43:261–7
11Antonelli, PJ, Dhanani, N, Giannoni, CM, Kubilis, PS. Impact of resistant pneumococcus on rates of acute mastoiditis. Otolaryngol Head Neck Surg 1999;121:190–4
12Roddy, MG, Glazier, SS, Agrawal, D. Pediatric mastoiditis in the pneumococcal conjugate vaccine era. Pediatr Emerg Care 2007;23:779–84
13Quesnel, S, Nguyen, M, Pierrot, S, Contencin, P, Manach, Y, Couloigner, V. Acute mastoiditis in children: a retrospective study of 188 patients. Int J Pediatr Otorhinolaryngol 2010;74:1388–92
14Zangeneh, TT, Baracco, G, Al-Tawfiq, JA. Impact of conjugate pneumoccal vaccines on the changing epidemiology of pneumococcal infections. Expert Rev Vaccines 2011;10:345–53
15Gladstone, RA, Jefferies, JM, Faust, SN, Clarke, SC. Continued control of pneumococcal disease in the UK – the impact of vaccination. J Med Microbiol 2011;60:18
16Stamboulidis, K, Chatzaki, D, Poulakou, G, Loannidou, S, Lebessi, E, Katsarolis, I et al. The impact of the heptavalent pneumococcal conjugate vaccine on the epidemiology of acute otitis media complicated by otorrhea. Pediatr Infect Dis J 2011;30:551–5
17Block, SL, Hedrick, J, Harrison, CJ, Tyler, R, Smith, A, Findlay, R et al. Community-wide vaccination with the heptavalent pneumococcal conjugate significantly alters the microbiology of acute otitis media. Pediatr Infect Dis J 2004;23:829–33
18Eskola, J, Kilpi, T, Palmu, A, Jokinen, J, Eerola, M, Haapakoski, J et al. Finnish Otitis Media Study Group. Efficacy of a pneumococcal conjugate vaccine against acute otitis media. N Engl J Med 2001;344:403–9
19Weinberger, DM, Malley, R, Lipsitch, M. Serotype replacement in disease after pneumococcal vaccination. Lancet 2011;378:1962–73
20Ansaldi, F, Florentis, D, Canepa, P, Bandettini, R, Diana, MC, Martini, M et al. Epidemiological changes after PCV7 implementation in Italy: perspective for new vaccines. Hum Vaccin 2011;7(suppl):211–16
21Ongkasuwan, J, Valdez, TA, Hulten, KG, Mason, EO, Kaplan, SL. Pneumococcal mastoiditis in children and the emergence of multidrug-resistant serotype 19a isolates. Pediatrics 2008;122:34–9
22Jacobs, MR, Good, CE, Bajaksouzian, S, Windau, A. Emergence of streptococcus pneumoniae serotypes 19A, 6C and 22F and serogroup 15 in Cleveland, Ohio, in relation to introduction of the protein-conjugated pneumococcal vaccine. Clin Infect Dis 2008;47:1388–95
23Lynch, JP, Zhanel, GG. Streptococcus pneumoniae: epidemiology and risk factors, evolution of antimicrobial resistance, and impact of vaccines. Curr Opin Pulm Med 2010;16:217–25
24Choi, SS, Lander, L. Pediatric acute mastoiditis in the post-pneumococcal conjugate vaccine era. Laryngoscope 2011;121:1072–80
25Singleton, RJ, Hennessey, TW, Bulkow, LR, Hammitt, LL, Zulz, T, Hurlburt, DA et al. Invasive pneumococcal disease caused by nonvaccine serotypes among Alaska native children with high levels of 7-valent pneumococcal conjugate vaccine coverage. JAMA 2007;297:1784–92
26Pang, LH, Barakate, MS, Havas, TE. Mastoiditis in a paediatric population: a review of 11 years experience in management. Int J Pediatr Otorhinolaryngol 2009;73:1520–4


Related content

Powered by UNSILO

What effect has pneumococcal vaccination had on acute mastoiditis?

  • M Daniel (a1) (a2), S Gautam (a1), T A Scrivener (a3), C Meller (a1), B Levin (a1) and J Curotta (a1)...


Altmetric attention score

Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed.