Impact of the 13-valent pneumococcal conjugate vaccine (PCV13) on acute mastoiditis in children in southern Israel: A 12-year retrospective comparative study (2005–2016)

Aviad Sapir, Oren Ziv, Eugene Leibovitz, Sophia Kordeluk, Ehud Rinott, Sabri El-Saied, David Greenberg, Daniel M. Kaplan

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3 Scopus citations


Objectives: To define the trends in acute mastoiditis (AM) incidence, microbiology, complications and management in children, before and after the 13-valent pneumococcal conjugate vaccine (PVC13) introduction. Methods: Medical records of all AM patients <15 years of age diagnosed during 2005–2016 were reviewed. The study years were divided into three periods: pre-vaccination (2005–2008), interim (2009–2011) and post-PCV13 vaccination (2012–2016). Results: 238 patients (53.4% males) were enrolled, 81, 56 and 101 in the 3 time periods, respectively. Overall, 177/238 (75.2%) of children were <5 years of age. Mean AM incidence in the whole population was 10.32/100,000, with no changes during the study years. Ninety-three (45.6%) of 204 evaluable patients had positive middle ear fluid/mastoid cultures; S. pneumoniae (SP) was isolated in 47/93 (50.5%) cases. Mean incidence of SP-AM during the study years was 2.49 cases/100,000. A trend for decrease in mean incidence of SP-AM was recorded between the pre and the post-vaccination periods (3.05/100,000 vs. 1.82/100,000, P = 0.069). Among patients <5 years, SP-AM rates decreased from pre to post-vaccination period (19/50, 38% vs. 15/73, 20.6%, P = 0.034). No changes were reported in percentages of culture negative-AM and of AM complications in the post-PCV13 period compared with the pre-vaccine period. A significant decrease in distribution of PCV13 serotypes was recorded (17/19, 89.5% vs. 8/12, 66.6% and vs. 7/16, 43.75% during the 3 study periods, P = 0.015) accompanied by a complementary increase in non-vaccine serotypes. Conclusions: The introduction of PCV13 was accompanied by a significant decrease in SP-AM cases among children <5 years of age. PCV13 serotypes decreased significantly as etiologic agents of SP-AM while non-vaccine serotypes and culture negative-AM became more common in the postvaccination period.

Original languageEnglish
Article number110485
JournalInternational Journal of Pediatric Otorhinolaryngology
StatePublished - Jan 2021
Externally publishedYes

Bibliographical note

Publisher Copyright:
© 2020 Elsevier B.V.


This study was conducted as MD thesis of Aviad Sapir, as part of the requirements for graduation from the Medical School of the Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel.

FundersFunder number
Medical School of the Faculty of Health Sciences
Ben-Gurion University of the Negev


    • Children
    • Mastoiditis
    • PCV13
    • Serotypes
    • Streptococcus pneumoniae


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