CLINICAL AND EPIDEMIOLOGICAL ASSESSMENT OF THE EFFECTIVENESS OF VACCINATION OF CHILDREN AGAINST PNEUMOCOCCAL INFECTION IN THE AMUR REGION

Aim. To study the effectiveness of anti-pneumococcal vaccination of children in the organization of anti-epidemic measures in the areas of the flood in the Amur region. Material and methods. The monitoring program included 4988 children aged 2 to 5 years who have risk factors for pneumococcal infection. Pneumococcal conjugate vaccine Prevenar-13 was used for immunization. Data on the incidence of child with acute respiratory infection, acute otitis media, pneumonia, meningitis during the post-vaccination period were taken into account. To evaluate the effectiveness of vaccination we used indicators and specific criteria (coefficient prophylactic vaccination and infection index). Results. The level of total morbidity of children in post-immunization period decreased by 13.6%; the number of cases of pneumonia in the population of observed children decreased by 2.3 times; the total duration of the illness in children decreased by 14.6%, the number of courses of antibiotic therapy was reduced by 21.3%, the number of hospital admissions of children- 38.4%, the number of days of temporary disability of parents - 11.1%. Direct dependence of the degree of effectiveness of vaccination against pneumococcal disease by the age of children is determined. Conclusion. The findings suggest that implementation of the program of clinical and epidemiological monitoring and prevention of community-acquired pneumonia with use of a vaccine against pneumococcal infections in the territory of the Amur Region has a high level of medical and socio-economic efficiency.

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Analysis of the incidence of community-acquired pneumonia and acute otitis media in children during the first four years of life in different age groups vaccinated with pneumococcal 13-valent vaccine Prevenar

Medical Herald of the South of Russia ◽

10.21886/2219-8075-2019-10-3-49-56 ◽

2019 ◽

Vol 10 (3) ◽

pp. 49-56

Author(s):

S. A. Pyrkova ◽

L. P. Voronina ◽

M. E. Kuzin ◽

V. V. Cherepova ◽

E. A. Polunina

Keyword(s):

Otitis Media ◽

Age Groups ◽

Pneumococcal Infection ◽

Acute Otitis Media ◽

Community Acquired Pneumonia ◽

Good Tolerability ◽

Post Vaccination ◽

High Level ◽

Disease Analysis ◽

Vaccination Period

Objective: to analyze the incidence of community-acquired pneumonia and acute otitis media in children during the first four years of life in different age groups vaccinated with pneumococcal 13-valent vaccine Prevenar.Materials and methods: medical records of 590 children aged 1 to 5 years were analyzed. All subjects were divided into 2 groups. The first group consisted of vaccinated children (n = 490), born in 2014, and vaccinated against pneumococcal 13-valent vaccine Prevenar. The second group consisted of unvaccinated children (n = 100) born in 2013 and not vaccinated. Each group was divided into subgroups depending on the age period (1—2 years, 2—3 years, 3—4 years, 4—5 years).Results: it is established that the conduct of specific prophylaxis of pneumococcal infection vaccine Prevenar-13 in children during the first 4 years of life effectively reduces the incidence of community-acquired pneumonia (in 7,6 times) and acute otitis media (in 8,5 times). The effectiveness of the vaccine was observed in all age groups. In cases of development of an inoculated child acute otitis reduces the risk of severe forms and complications of the disease. Analysis of the course of the post-vaccination period indicates a high level of safety and good tolerability of the vaccine.Conclusion: Implementation of specific prophylaxis of pneumococcal 13-valent vaccine Prevenar in children during the first four years of life according to the calendar of vaccination effectively reduces the incidence of community-acquired pneumonia (87 %) and acute otitis media (42,8 %) in all age subgroups. In cases of development of an inoculated child acute otitis reduces the risk of severe forms and complications of the disease. Analysis of the course of the post-vaccination period indicates a high level of safety and good tolerability of the vaccine.

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The Results of a Three-Year Pneumococcal Vaccination of Children in Russia

Педиатрическая фармакология ◽

10.15690/pf.v15i4.1943 ◽

2018 ◽

Vol 15 (4) ◽

pp. 287-299 ◽

Cited By ~ 2

Author(s):

Nikolay I. Briko ◽

Vladimir A. Korshunov ◽

Leyla S. Namazova-Baranova ◽

Juriy V. Lobzin ◽

Alexander A. Baranov ◽

...

Keyword(s):

Otitis Media ◽

Russian Federation ◽

Pneumococcal Infection ◽

Acute Otitis Media ◽

Pneumococcal Vaccination ◽

Vaccination Schedule ◽

Community Acquired Pneumonia ◽

Morbidity And Mortality ◽

Prophylactic Vaccination ◽

The Russian Federation

Background.After inclusion of pneumococcal vaccination in the National Vaccination Schedule, it is very important to evaluate the efficacy of routine immunisation of the child population for more than 3 years. The obtained results provide opportunity to analyse the problems in achieving the goal, determine their causes, and suggest the ways of overcoming. Our aim was to study the results of a three-year period of pneumococcal vaccination of children.Methods.The quality of immunoprophylaxis of pneumococcal infection in the territory of the Russian Federation were assessed by analysing the coverage of vaccination and timeliness of its conduct after the inclusion of pneumococcal vaccine in the National Vaccination Schedule. The actual epidemiological efficacy of pneumococcal vaccination was assessed based on morbidity and mortality due to community-acquired pneumonia, incidence of acute otitis media among children. By questioning parents (n = 352) who applied to the Federal State Autonomous Institution of the Russian Federation Ministry of Health ‘National Medical Research Centre for Children’s Health, the timeliness of pneumococcal vaccination for infants was established.Results.In most regions, a high level of pneumococcal vaccination coverage was reached (87% of children). Despite the fact that the majority of children (73%) were vaccinated untimely. In particular, the results of a questionnaire survey conducted in the Moscow vaccination centre indicate insufficient awareness of parents for the need to vaccinate infants against pneumococcal infection by primary care professionals and, as a consequence, a low level of timely initiated vaccine introduction (40.1%). The introduction of routine prophylactic pneumococcal vaccination in Russia resulted in a 35% reduction in the death rate of children from community-acquired pneumonia, led to a decrease in the incidence of acute otitis media.Conclusion.The introduction of routine prophylactic vaccination of children against Streptococcus pneumoniae helps to reduce morbidity and mortality from pneumococcal infections. The surveillance system for community-acquired pneumonia requires further improvement. It is advisable to conduct an additional analysis on the reasons for refusals and medical exemptions to vaccination. It is important to increase the professional level of paediatricians in prophylactic vaccination.

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The prevalence of circulating S. pneumoniae serotypes in people older than 18 years: healthy carriers, patients with acute otitis media, community-acquired pneumonia, and invasive pneumococcal infections (epidemiological study «SPECTRUM»)

Clinical Microbiology and Antimicrobial Chemotherapy ◽

10.36488/cmac.2019.4.275-281 ◽

2019 ◽

Vol 21 (4) ◽

pp. 275-281

Author(s):

Alexander A. Muravyev ◽

Aida N. Chagaryan ◽

Nataly V. Ivanchik ◽

Anastasia A. Kurkova ◽

I.A. Tsvetkova ◽

...

Keyword(s):

Otitis Media ◽

Adult Population ◽

Pneumococcal Infection ◽

Acute Otitis Media ◽

Community Acquired Pneumonia ◽

Central Laboratory ◽

Pneumococcal Infections ◽

Serotype 1 ◽

Invasive Pneumococcal Infection ◽

Healthy Carriers

Objective. To estimate the prevalence of S. pneumoniae serotypes in adults aged of 18 years and older, including healthy carriers and patients with acute otitis media (AOM), community-acquired pneumonia (CAP) and invasive pneumococcal infection (IPI). Materials and Methods. A total of 230 isolates of S. pneumoniae from 10 centers were included in the study from 01.06.2019 to 01.10.2019. Re-identification and typing using real-time PCR with 22 primer pairs were performed in the central laboratory (Institute of Antimicrobial Chemotherapy, Russia). Results. In healthy nasopharyngeal carriers (n = 31), the following serotypes of S. pneumoniae were detected: 19F (29.0%), 6А/В (22.6%), 3 (16.1%), 11A/D and 23F (9.7% each), 23A (6.4%), 14 and 15A/F (3.2% each); PCV-13 and PPV-23 covered 80.6% and 90.3% of those serotypes, respectively. In patients with AOM (n = 18), serotypes were: 3 (16.7%), 11A/D and 6A/B (11.1%, each), 16, 19А, 19F, 23F, 7A/F (5.55%, each); PCV-13 and PPV-23 covered 50% and 61.1% of those serotypes, respectively. Among 166 isolates from patients with CAP, the following serotypes were detected: 3 (12.0%), 19F and 6A/B (10.2%, each), 14 and 11A/D (5.4% each), 15A/F and 23A (4.8% each), 9N/L (4.2%), 18 and 22A/F (2.4% each), 19A and 23F (1.8% each), 16, 9V/A (1.2% each), 4 and 33A/33F/37 (0.6% each), non-vaccine serotypes (30.3%); PCV-13 and PPV-23 covered 45.6% and 57.0% of those serotypes, respectively. Isolates from patients with IPI (n=15) belonged to the following serotypes: 3 (26.7%), 12F, 23F and 9N/L (13.3% each), serotypes 4 and 15A/F (6.7%), non-vaccine serotype – 1 isolate (6.7%); PCV-13 and PPV-23 covered 46.7% and 73.3% of those serotypes, respectively. Conclusions. The majority of S. pneumoniae serotypes in adult population in Russia are included in PPV-23, but not in PCV-13 (primarily due to serotype 11A/D). There was a high PCV-13 and PPV-23 coverage of serotypes from healthy nasopharyngeal carriers. PPV-23 covered more than 60% of clinical isolates, whereas PCV-13 covered less than 60% (AOM – 50.0%, CAP – 45.6%, IPI – 46.7%), thus indicating a potentially lower efficacy of PCV-13 in adult population.

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Analysis of Morbidity Dynamics and Factors Influencing the Development of Pneumococcal Infections among the Adult Population of the Sakha Republic (Yakutia)

Epidemiology and Vaccinal Prevention ◽

10.31631/2073-3046-2018-17-4-38-45 ◽

2018 ◽

Vol 17 (4) ◽

pp. 38-45

Author(s):

A. N. Argunova ◽

Zh. V. Bondareva ◽

E. S. Prokopiev ◽

O. М. Nosikhina

Keyword(s):

Adult Population ◽

Pneumococcal Infection ◽

Pneumococcal Vaccination ◽

Mortality Rates ◽

Community Acquired Pneumonia ◽

National Average ◽

Cardiac Insufficiency ◽

Pneumococcal Infections ◽

Sakha Republic ◽

The City

The pneumococcal infection is an important issue due to its prevalence, numerous severe complications, high mortality rate and disability. However modern vaccination allows preventing of the pneumococcal infection and reduces the severity of clinical complications. This article presents the analysis of the morbidity and mortality indicators from community-acquired pneumonia and the effect of pneumococcal vaccination on its dynamic in the at-risk groups within the adult population of the Aldan area and the city of Aldan of the Sakha Republic (Yakutia). In the Aldan area pneumonia morbidity persistently exceeds the national Russian average: in 2015 – 1.5 times (499.3 per 100,000 population) and in 2016 – 1.2 times (500.8 per 100,000 population). The morbidity indicators in Aldan are comparable to the national values. The community-acquired pneumonia mortality rates in the Aldan area were 20.55 per 100,000 population in 2015, and 18.5 per 100,000 population in 2016; these values are, respectively, 4.3 and 3.8 times higher than the national average. In the city of Aldan the community-acquired pneumonia mortality rates were 9.87 per 100,000 population in 2015 and 15.8 per 100,000 population in 2016, which is more than double the national average in the Russian Federation. Pneumococcal vaccinations of the adult population using the conjugate vaccine Prevenar 13 have been observed to lower the pneumonia morbidity and respiratory infections; the vaccinations also reduced the number of hospitalizations due to condition exacerbations or decompensations among adult patients with chronic lung disorders, cardiac insufficiency, and diabetes.

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2700. Evaluation of 10- and 13-Valent Protein Conjugate Pneumococcal Vaccine Effectiveness for Children in Korea

Open Forum Infectious Diseases ◽

10.1093/ofid/ofz360.2377 ◽

2019 ◽

Vol 6 (Supplement_2) ◽

pp. S949-S950

Author(s):

Sangho Sohn ◽

Kwan Hong ◽

Hari Hwang ◽

Byung Chul Chun

Keyword(s):

Pneumococcal Vaccine ◽

Cox Regression ◽

Acute Otitis Media ◽

Pneumococcal Vaccination ◽

Dose Schedule ◽

Vaccine Effectiveness ◽

Pneumococcal Infections ◽

National Health Insurance System ◽

National Immunization ◽

Control And Prevention

Abstract Background Pneumococcal vaccination for infants was introduced to the mandatory National Immunization Program (NIP) of Korea in May 2014. Both 10- and 13-valent protein conjugated vaccines (PCV) have been in use with 3 + 1 dose schedule. We assessed the vaccine effectiveness in protecting children from all-cause pneumonia (ACP), pneumococcal pneumonia (PP), invasive pneumococcal diseases (IPD), and acute otitis media (AOM). Methods The birth cohort of children born between 2013 and 2015 was identified from the national population registry for retrospective observation. Vaccination status was confirmed through NIP registry by Korean Centers for Disease Control and Prevention, and disease occurrence was detected through the National Health Insurance System. Children who finished at least 3-doses of PCV were classified vaccinated while who did not receive any type of pneumococcal vaccine until study end were classified unvaccinated. The outcome of interest was hospital admission from any of pneumococcal infections among ACP, PP, IPD or AOM. After adjusting for high risk and underlying conditions, the vaccine effectiveness (VE) was calculated with Cox regression. VE of different valent PCV was also compared within fully vaccinated (4-doses) children. Results A total of 1,243,432 children were included. Fifty-one percent of children were boys and median age was 30-months. Ninety-eight percent were vaccinated and 89% of them were fully vaccinated. The incidence (per 100,000 person-years) of ACP was 10,982 in vaccinated and 9,276 in unvaccinated, and that of IPD and AOM were 1.0 vs 1.5 and 45.7 vs 31.3, respectively. The vaccine had protective effect for ACP (VE 20.2% [95% CI 19.5–20.9]), PP (VE 25.5% [95% CI 21.1–29.6]), IPD meningitis (VE 93.6% [95% CI 27.1–99.4]) and AOM (VE 4.6% [95% CI 4.1–5.1]). When fully vaccinated with PCV10, compared with PCV13, it was statistically more protective against ACP (VE 22.7% vs. 19.6%, P = 0.033) and PP (VE 50.8% vs. 21.3%, P < 0.001) but not different against AOM (VE 4.2% vs. 6.0%, P = 0.53). Conclusion Four-doses of PCV strategy for children in current mandatory NIP is effective for protecting the vaccinated from ACP, PP, IPD, and AOM. Disclosures All authors: No reported disclosures.

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Pneumonia: Regional experience with prevention programs

Terapevticheskii arkhiv ◽

10.17116/terarkh201688887-92 ◽

2016 ◽

Vol 88 (8) ◽

pp. 87-92 ◽

Cited By ~ 4

Author(s):

A G Chuchalin ◽

G G Onishchenko ◽

V P Kolosov ◽

O P Kurganova ◽

N L Tezikov ◽

...

Keyword(s):

High Efficiency ◽

Viral Infections ◽

Pneumococcal Infection ◽

Prevention Programs ◽

Efficiency Index ◽

Amur Region ◽

Pneumococcal Infections ◽

Epidemiological Monitoring ◽

Comparative Statistical Analysis ◽

Regional Programs

Aim. To generalize the regional experience in implementing a package of organizational and methodical and antiepidemic measures for preventing pneumococcal infections. Materials and methods. How the prevention programs were implemented using the materials and methods of the epidemiological and statistical monitoring of the incidence of pneumonia in the Amur Region was analyzed. Pneumococcal conjugate vaccine (Prevenar-13) and influenza vaccines were used for immunoprophylaxis against acute respiratory viral and pneumococcal infections. Information on the incidence of acute respiratory viral infections and pneumonia over time in the period 2010 to 2015 must be taken into account. Indicators and special criteria are used to evaluate the efficiency of vaccination. Results. The comparative statistical analysis revealed the high efficiency of regional programs using the methods for immunoprophylaxis against pneumococcal infections: the vaccination prophylactic efficiency index in terms of the incidence of pneumonia might be as high as 75—100%. Pneumonia morbidity rates became 2.3 times lower in the vaccinated population of the region. Conclusion. The results of the investigation suggest that the Program for the clinical and epidemiological monitoring and prevention of community-acquired pneumonias, by using the vaccine against pneumococcal infection in the Amur Region, has a high medical and socioeconomic efficiency.

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Pneumococcal infection in Russia: state of the issue

Annals of the Russian academy of medical sciences ◽

10.15690/vramn1404 ◽

2021 ◽

Vol 76 (1) ◽

pp. 28-42

Author(s):

Nikolay I. Briko ◽

Vladimir A. Korshunov ◽

Kirill S. Lomonosov

Keyword(s):

Adult Population ◽

Herd Immunity ◽

Pneumococcal Infection ◽

Community Acquired Pneumonia ◽

Morbidity And Mortality ◽

School Age Children ◽

Economic Significance ◽

Chronic Lung Diseases ◽

One Year ◽

High Level

Background: Pneumococcal disease is common cause of morbidity and mortality in adults and children worldwide. The severity of pneumococcal diseases determines their high socio-economic significance. Aims: Estimate the burden of pneumococcal infection and vaccination coverage in Russia. Methods: The data was obtained from federal surveillance system. The information obtained was analyzed using descriptive statistics methods. Results: The annual incidence of community-acquired pneumonia in Russia was 491.7/100000 in 2011-2019. It ranges from 359.8/100000 among adults of working age to 1505.4/100000 among children 1-2 years old. The upward trend of incidence is observed throughout the period, most expressive among school-age children (7-17 years old). Total 29.2% of all pneumonia have an identified etiology. 94% of pneumonia with known etiology are bacterial, 8.4% among it are pneumococcal. Pneumonia accounts for 57% of all deaths from respiratory diseases among children under five (3.7/100000) and 34% among elderly. The death rate from pneumonia in 2009-2018 tends to decrease. In 2018, 25.5 thousand deaths from pneumonia were registered (17.5/100000). The highest rate is observed among children under one year (14.0 /100000) and elderly (41.2 /100000). There is a downward trend in incidence of otitis media. The incidence in children under 14 was 2612.6/100 000 in 2018. The incidence of bacterial meningitis is 1.4/100 000. Every year 2-3 thousand cases are registered, 43-52% of which are among children (3.04/100000., maximally in children under one year old, 13.2/100000). The level of vaccination against pneumococcal infection is increasing annually, but the proportion of children who have received a completed course of vaccination remains insufficient (64.6% in 2019). Coverage among the adult population was 2.3% (3.8% among those over 60). The main contingents of vaccinated adults are conscripts (coverage 67.4%) and people with chronic lung diseases (coverage 15.1%). Conclusions: The socio-economic and epidemiological burden of diseases associated with pneumococcal infection in Russia remains high. Accurate assessment of morbidity and mortality rates caused by St. pneumoniae diseases isnt possible due to the insufficient level of their ethological identification. Further efforts are required to achieve high level of herd immunity against pneumococcal infection through vaccine prevention during COVID-19 pandemic.

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Pneumococcal Diseases Caused by Serotype Replacement in Colombia: A Cost-Effectiveness Analysis of Pneumococcal Conjugate Vaccines in Infants and Its Herd Protection in Older Adults

10.21203/rs.3.rs-72778/v1 ◽

2020 ◽

Author(s):

Jaime E. Ordóñez ◽

Angélica Ordóñez

Keyword(s):

Older Adults ◽

Acute Otitis Media ◽

Pneumococcal Vaccination ◽

Indirect Costs ◽

Economic Benefits ◽

Community Acquired Pneumonia ◽

Conjugate Vaccines ◽

Pneumococcal Conjugate Vaccines ◽

Serotype Replacement ◽

Strategy Versus

Abstract Background. The recent and available evidence on the distribution of pneumococcal serotypes, which affects the effectiveness of pneumococcal conjugate vaccines (PCV), suggest that additional health economic studies will be important for better understanding of potential economic benefits of pneumococcal vaccination. Methods A cohort simulation model was used for new births in Colombia between 2019-2022 and adults over 65 years, from social perspective (direct and indirect costs). The time horizon was a life expectancy and discount rate for costs and benefits of 5%. The outcomes were presented in terms of avoided pneumococcal diseases ─ Invasive Pneumococcal Disease (IPD), Community Acquired Pneumonia (CAP), Acute Otitis Media (AOM), and sequelae─, years of life gained (AVG) and herd effect in older adults.Results. Based on data from National Data of the serotype distribution between 2017-2019, PCV10 covers 5% of serotypes while PCV13 63%. The additional cases that PCV13 would prevent are in children: 1,205 cases of IPD, 60,274 of CAP, 26,619 of AOM, 3,980 deaths, 28 cases of neuromotor disability and 1,251 cochlear implants. In older adults, PCV13 would prevent 818 additional cases of IPD and 29,983 of CAP, generating 149,186 additional LYGs to those of PCV10 with a saving to the health system and patients of US $ 169,261 thousand. The model shows robustness in the sensibility analysis.Conclusion. PCV13 is a cost-saving strategy versus PCV10 to prevent pneumococcal diseases.

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Outcome of Severe Bacterial Pneumonia in the Era of Pneumococcal Vaccination

Frontiers in Pediatrics ◽

10.3389/fped.2020.576519 ◽

2020 ◽

Vol 8 ◽

Author(s):

Teresa del Rosal ◽

María Belén Caminoa ◽

Alba González-Guerrero ◽

Iker Falces-Romero ◽

María Pilar Romero-Gómez ◽

...

Keyword(s):

Hospital Admissions ◽

Pneumococcal Vaccination ◽

Relative Increase ◽

Community Acquired Pneumonia ◽

Pediatric Hospital ◽

Conjugate Vaccines ◽

Median Hospital Stay ◽

Single Center Study ◽

Median Hospital ◽

Over Time

Introduction: After the introduction of pneumococcal conjugate vaccines, community-acquired pneumonia (CAP) caused by Streptococcus pneumoniae has decreased whereas Staphylococcus aureus and Streptococcus pyogenes could be increasing. These bacteria have been associated with high rates of complications.Aims: (1) To describe the characteristics of pediatric bacterial CAP requiring hospitalization. (2) To compare outcomes according to causative microorganisms. (3) To analyze changes in bacterial CAP rate and etiology over time.Patients and Methods: Retrospective single-center study of inpatients aged 1 month-16 years with culture-confirmed bacterial CAP in 2010-2018 in Madrid, Spain.Results: We included 64 cases (42 S. pneumoniae, 13 S. pyogenes and 9 S. aureus). Culture-confirmed CAP represented 1.48-2.33/1,000 all-cause pediatric hospital admissions, and its rate did not vary over time. However, there was a significant decrease in pneumococcal CAP in the last 3 years of the study (78% of CAP in 2010–2015 vs. 48% in 2016-18, p = 0.017). Median hospital stay was 10.5 days (interquartile range 5-19.5), 38 patients (59%) developed complications and 28 (44%) were admitted to the intensive care unit. Outcomes were similar among children with S. pneumoniae and S. aureus CAP, whereas S. pyogenes was associated with a higher risk for complications (OR 8 [95%CI 1.1-57.2]) and ICU admission (OR 7.1 [95%CI 1.7-29.1]) compared with pneumococcal CAP.Conclusion: In a setting with high PCV coverage, culture-confirmed bacterial CAP did not decrease over time and there was a relative increase of S. pyogenes and S. aureus. Children with CAP caused by S. pyogenes were more likely to develop complications.

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Trends in adult otitis media incidence - a 20-year national observational study

10.22541/au.163253488.83082025/v1 ◽

2021 ◽

Author(s):

Marie Gisselsson-Solen

Keyword(s):

Otitis Media ◽

Watchful Waiting ◽

Hospital Admissions ◽

Acute Otitis Media ◽

Pneumococcal Vaccination ◽

National Database ◽

Common Disease ◽

Outpatient Visits ◽

Hospitalised Patients ◽

Number Of Patients

Objective: Otitis media (OM) is a common disease in childhood, but much less prevalent in adults, where it, however, tends to have a less benign course. The incidence of OM in children has decreased in recent years, which might be partly explained by the introduction of watchful waiting strategies, and by the introduction of conjugate pneumococcal vaccination (PCV) in children. Adult OM has been sparsely studied, and it is not known whether a herd immunity effect has been achieved after the introduction of PCV. Watchful waiting is usually not considered in adult OM patients. The purpose of this study was to use a national database to investigate the incidence of adult OM in Sweden during the last 20 years. Design: The yearly number of patients aged 20 and over, admitted to hospital with OM was obtained through a national database from 2000 to 2019. The corresponding numbers for outpatients were obtained between 2005 and 2019. Main outcome measures: incidence of acute otitis media in adults in in- and outpatient care. Results: Incidence rates decreased steadily during the study period. Comparing data on hospitalised patients from 2016-2019 to 2005-2008 (PCV was introduced in 2009), the incidence rate ratio was 0.49 (95% CI 0.45-0.53); p<0.0001. The corresponding figures for outpatients were 0.62 (95% CI 0.61-0.63); p<0.0001. The decrease in hospital admissions was most pronounced among younger patients, whereas the opposite was true for outpatient visits. Conclusions: There has been a continuous decrease in incidence of adult patients admitted to hospital with OM in Sweden during the last twenty years. Outpatient visits for OM have declined since 2009.

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